Table 1 Overview of Integrated Community-Based Health Systems Strengthening (ICBHSS) model components
ICBHSS model component | Details | |
|---|---|---|
1. | Community engagement meetings and feedback | - 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 | - 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 | - 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 | - 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 | - 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. |