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.
This project is funded by the European Union.