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Table 1 Overview of Integrated Community-Based Health Systems Strengthening (ICBHSS) model components

From: Assessing the Integrated Community-Based Health Systems Strengthening initiative in northern Togo: a pragmatic effectiveness-implementation study protocol

  ICBHSS model component Details
1. Community engagement meetings and feedback
Evidence: [13,14,15]
- Pre-intervention consultation meetings with community leaders.
- Community participation in CHW selection.
- Biannual community review meetings with local leaders, community members, facility, and IH staff.
- IH staff presentation of programmatic results and updates.
- Community-provided feedback on ICBHSS implementation challenges, successes, and areas for improvement.
2. Removal of point-of-care costs in IH intervention public sector health facilities
Evidence: [16,17,18,19]
- Pertains to all children under five, pregnant/post-partum women, women of reproductive age for family planning services, and people living with HIV infections who seek care at study sites.
- Includes facility-based consultation fees, medications, supplies, and services provided at IH intervention sites and advanced care referrals at the district or regional hospital.
- Selected fees and coverage population chosen in consultation with MoH and based on national and global guidelines.
3. Proactive community-based IMCI using trained, equipped, supervised, and salaried CHWs with additional services including linkage to family planning and counseling, HIV testing, and referrals
Evidence: [11, 19,20,21,22,23,24,25,26,27]
- Candidate selection from community by local leadership, health facility, and IH staff.
- Preference for female residents who meet selection criteria (some literacy, pre-test/post-test results, demonstrated related competencies).
- Pre-service 23-day training in IMCI, maternal health, and HIV counseling and testing led by MoH and IH staff.
- In-service 5-day training in family planning and counseling led by MoH and IH staff.
- All training materials developed in consultation with MoH and based on national/global guidelines and evidence-based materials from Association Togolaise pour le Bien-Être Familial, Better Birth Project, Last Mile Health, Muso, and Partners In Health.
- Equipped with materials (training guides, backpacks, timers, thermometers, scales, MUACs, rapid tests, medical treatment for basic IMCI cases, notebooks, pens).
- CWH consultations, referrals, medicines, and materials are provided free of charge.
- Supportive supervision with coaching and mentoring by IH supervisor (nurse/medical assistant).
- Regular observation of CHW service delivery through routine programmatic data and community feedback.
- CHWs receive a regular equitable salary for full-time work through proactive case seeking and follow-up.
4. Clinical mentoring and enhanced supervision by a trained peer coach at public sector health facilities
Evidence: [28,29,30]
- Onsite pre-service 4-day training in maternal, reproductive, neonatal, and child health and HIV led by IH clinical mentor (nurse/medical assistant) and medical director.
- Training materials developed in collaboration with MoH and based on national/global guidelines and evidence-based materials from WHO, American Academy of Pediatrics, Ariadne Labs, Better Birth Project, Last Mile Health, Muso, and Partners In Health.
- Weekly facility-based supportive supervision by IH clinical mentors (nurses, midwives, medical assistants) with prior experience in public sector health facilities.
- Regular observation of facility staff service delivery through routine programmatic data and community feedback.
5. Basic infrastructure/equipment improvements and supply chain management training of pharmacy managers
Evidence: [15, 31,32,33]
- Formal infrastructure assessment and equipment needs with MoH using WHO’s SARA tool [41].
- Facilitate structural improvements to improve care delivery.
- Equip facility with essential medicines and equipment identified by assessment and national health protocols.
- Onsite training in supply-chain management practices, including proper storage of medicines, filling of stock cards, and orders based on average monthly input consumption.
- Regular supervision and support by IH clinical mentor.