Community system elements | |
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Leadership/Governance | |
1. Vision | Leadership articulates a clear vision for achieving health and development outcomes for the community |
2. Service and resource availability | Leadership identifies all curative and promotional health and social services available to the community and their social accessibility to community members |
3. Equity | Leadership ensures vulnerable and disenfranchised groups have equitable access to essential health and social services |
4. Collective action | Leadership ensures collective processes and actions that can promote the community’s health and development |
• Mobilizes community assets to engage in key policy, legal, and governance activities (such as campaigns, solidarity movements, and other advocacy actions) | |
• Ensures participatory decision-making by actively engaging community members in identifying problems and concerns, implementing their plans to solve these problems, and taking responsibility for their actions | |
• Facilitates consensus-building and collaboration that fosters trust, respect, negotiation, openness, conflict resolution, creativity, and responsibility among members | |
• Identifies areas in which community groups and members need to make changes in the way they work together and provides guidance and support in making these changes | |
• Respects and values the viewpoints of community members and cultivates community input and action | |
• Ensures transparency and accountability through meetings and other means of communication with stakeholders and community members | |
• Manages power relationships within and beyond the community to promote community development and well-being | |
• Fosters ownership over team decisions by suggesting new ideas, expressing opinions, and pointing out ways to overcome obstacles | |
5. Knowledge management | Leadership acknowledges, documents, and disseminates individual and community achievements and challenges encountered in improving the community’s health |
6. Mentoring | Leadership fosters the development and emergence of new leaders and other assets |
7. Sustainability | Leadership ensures any successes in improving the community’s health can be sustained beyond short-term projects: |
• Sustains a program’s focus of activity and gains funding and resource commitments | |
• Encourages the development of mutually reinforcing partnerships with formal health and development structures and actors beyond the community | |
• Supports strengthening productive linkages with groups within the community | |
• Encourages and cultivates self-help activities | |
Social belonging/cohesion | |
1. Trust/belonging | • Community members exhibit trust among group members and feel part of the community |
• Community members have positive perceptions of their communities, value their diversity, celebrate together, and have a sense of control and ownership in relation to planning and implementing local programs and activities to improve their health and well-being | |
2. Historical perspective | Community members understand the community’s history |
3. Compassion | Community members show a sense of compassion for others in the community |
4. Identify | Community members have a shared identity and are willing to take action based on that identity |
5. Commitment | Community members have a commitment to achieving outcomes and positive change and a shared responsibility for improving the community |
Resource mobilization | |
1. Identification | The community routinely identifies external and internal resources (funding, people, organizations, facilities, material, time) to help achieve its health goals |
2. Procurement | The community routinely accesses external and internal resources (funding, people, organizations, facilities, material, time) to help achieve its health goals for the community |
3. Use | The community uses resources (funding, people, organizations, facilities, material, time) in new, creative, and effective ways to achieve its health goals |
4. Allocation | The community makes informed decisions about fair distribution of resources and resolves conflicts regarding distribution, including distribution of common resources |
Health system elements | |
1. Governance | • Formulates and aligns all health sector strategies and technical policies |
• Identifies roles of public, private, and voluntary health system actors and of civil society at central and decentralized levels of the health system | |
• Provides robust oversight and regulation of health markets and all health activities in the public and private sector | |
• Holds all health system actors in the public and private sectors accountable for activities and results | |
• Provides incentives that reward good performance and sanctions poor performance to all health system actors in the public and private sector | |
• Ensures collaboration and coordination across sectors in government and with actors outside government | |
• Ensures generation, analysis, and use of intelligence on health sector performance trends | |
2. Financing | • Raises adequate funds for the health sector |
• Allocates these funds in accordance with population needs and in ways that ensure people can use needed services | |
• Pools funds when possible to ensure people are protected from financial catastrophe or impoverishment associated with having to pay for services | |
• Purchases packages of high-quality, high-impact services | |
• Promotes transparency and accountability in financing systems | |
• Ensures generation, analysis, and use of intelligence on the performance of the health financing system | |
3. Health workforce | • Develops national workforce policies and investment plans |
• Defines the roles, responsibilities, and performance expectations (as stated in service agreements or contracts, for example) of all health workers | |
• Ensures appropriate recruitment and development of the workforce (skill mix/cadre development) | |
• Ensures appropriate deployment and distribution of health workers relative to fixed facilities and burden of disease | |
• Uses strategic information to monitor the availability, distribution, and performance of health workers | |
• Establishes regulatory mechanisms to maintain the quality of education/training and practice | |
• Engages with multiple stakeholders and sectors for human resources for health (HRH) planning and workforce development | |
• Develops retention schemes that take into consideration local and international labor markets | |
• Designs training programs and other capacity development activities that facilitate integration across service delivery and disease control programs | |
4. Service delivery | • Organizes and regulates the health care delivery system in a way that ensures delivery of effective, safe, quality personal and non-personal health interventions to those who need them, when and where needed, with minimum waste of resources |
• Develops an organized provider network to ensure close-to-client care | |
• Adapts, adopts standard practice guidelines for the delivery of essential services in line with the HRH plan | |
• Delivers package of integrated services based on population health needs | |
• Generates demand for services through an understanding of the user’s perspective, raising public knowledge, and reducing barriers to use (cultural, social, financial, gender, etc.) | |
• Ensures proper management of service delivery at all levels to maximize service coverage, quality, safety, and minimize waste, including supervision, performance incentives, and a functioning referral system | |
• Oversees infrastructure and logistics (i.e., buildings, utilities, waste management, transport, communication) | |
5. Medical products, vaccines, and technologies | • Ensures equitable access to essential medical products, vaccines, technologies, equipment, and supplies of assured quality, safety, efficacy, and cost-effectiveness by: |
○ Developing national policies, standards, guidelines, and regulations in accordance with local laws | |
○ Setting and negotiating prices, using information on prices and international trade agreements | |
○ Ensuring reliable manufacturing practices and quality assessment of products | |
○ Developing procurement, supply, storage, and distribution systems | |
• Promotes rational use of essential medicines (drugs, vaccines), commodities, technologies, equipment, and supplies | |
6. Information | • Ensures the collection (via population-based, facility-based, and special surveys), analysis, dissemination, and use of timely and high quality information on: |
○ Health status | |
○ Financial risk protection | |
○ Health service use | |
○ Client satisfaction with services | |
○ Health behavior | |
○ Health system performance | |
○ Events that threaten public health security | |
• Ensures long-term capacity to archive and manage information, as well as promote its availability in the public domain and application |