The extent to which close-to-community providers of health care are successful depends on three things: national, district and local policies, the interactionsbetween close-to-community providers and the rest of the health system, and the community context. Our initial work has identified a number of challenges to efficient working: human resource management, negotiating multiple workloads, quality assurance, and monitoring and evaluation. As our work progresses we will test whether these are the most appropriate areas to focus on.

First we will conduct a literature review and a situation analysis. This will allow us to develop a common analytical framework that can be used to analyse close-to-community services in our focus countries. Based on this we will look at the relationship between close-to-community providers, communities and the broader health system. From this we will create an inventory of potential constraints to efficiency, effectiveness and equity.

Once we have an idea of the constraints that are being experienced in Bangladesh, Ethiopia, Indonesia, Kenya, Malawi and Mozambique we will test interventions that improve the situation for close-to-community providers. Two ‘improvement cycles’ will allow two different focus areas, for example monitoring and evaluation of human resource management, to be worked on during the lifetime of the project.

During this process we aim to build capacity among partners, close-to-community providers and up and coming researchers both to do research and in the implementation of services. We will work with policy makers to assist them in using this research in policy and planning.

At the end of each improvement cycle we will conduct a post-intervention performance assessment. This will help us understand the contribution of the interventions to any improvements in practice and to find out what works, in which context and why.



  • To identify how community context, health policy and interactions with the rest of the health system influence the equity, effectiveness and efficiency of close-to-community services
  • To develop and assess interventions that have the potential to make improvements to close-to-community services. Each country will focus on priority areas that are based on national health priorities and capacity
  • To inform evidence-based and context appropriate policy making for close-to-community services. Strategic partnerships will be developed between policy makers and practitioners
  • To build capacity to conduct and use health systems research to improve close-to-community services. This is an integral part of the way REACHOUT will work and will be conducted on three levels: in research to fill knowledge gaps, in the implementation of services and in evidence-informed policy making relevant to close-to-community provider roles and management


Key principles

We will:

  • Include voices of close-to-community providers, the community, policy makers and other stakeholders
  • Show the evidence for impact or lack of impact of the interventions
  • Ensure that lessons are able to influence future programming at national level
  • Agree a common methodology so that inter-country comparison is possible
  • Ensure synergistic working with similar EU-funded research studies
  • Maintain capacity building as an integral component at all levels


This project is funded by the European Union.
This project is funded by the European Union.