Care in Communities: Guidelines for National Red Cross Red Crescent Societies A community health systems approach 2020 www.ifrc.org Saving lives, changing minds. Acknowledgements Special thanks to the following National Red Cross Red Crescent Societies, organizations and individuals for their expertise, ongoing support, commitment and contributions to the development of the Care in the Communities guidelines: British Red Cross, Bulgarian Red Cross, Canadian Red Cross, Danish Red Cross, Finnish Red Cross, Kenya Red Cross, Red Crescent Society of Kyrgyzstan, Red Cross of Montenegro, Norwegian Red Cross, South Sudan Red Cross, Sri Lanka Red Cross, Swiss Red Cross and the Red Crescent Society of Uzbekistan. We appreciate the work and support of colleagues from IFRC head- quarters, regional and country staff who took the time to participate in interviews and share their experience. Particular thanks to Norwegian Red Cross, Finnish Red Cross and Canadian Red Cross for their finan- cial support to finalize the guidelines. We would also like to thank the following individuals: Project Leader: Dr Bhanu Pratap, IFRC Geneva Ms Chika Nwaka, IFRC Geneva Editor: Vivienne Seabright Author: Dr Monica Singhi Pant © International Federation of Red Cross and Red Crescent Societies, Geneva, 2020 Copies of all or part of this guideline may be made for non-commercial use, providing the source is acknowledged. The IFRC would appreciate receiving details of its use. Requests for commercial reproduction should be directed to the IFRC at [email protected]. The opinions and recommendations expressed in this study do not necessarily represent the official policy of the IFRC or of individual National Red Cross or Red Crescent Societies. The designations used do not imply the expression of any opinion on the part of the International Federation or National Societies concerning the legal status of a territory or of its authorities. All photos used in this study are copyright of the IFRC unless otherwise indicated. Cover Photo: Rose & Sjölander / IFRC P.O. Box 303 CH-1211 Geneva 19 Switzerland Telephone: +41 22 730 4222 Telefax: +41 22 730 4200 E-mail: [email protected] Web site: www.ifrc.org International Federation of Red Cross and Red Crescent Societies CIC: Guidelines for National Red Cross Red Crescent Societies Table of contents Abbreviations and acronyms 5 Foreword 6 Executive summary 7 Part 1: Setting up a CIC programme 11 Background and rationale 11 Goals and objectives 12 Methodology 13 Understanding concepts and definitions 13 Role of IFRC 16 Role of National Societies and cooperation mechanisms with the health authorities 18 Selection criteria of CBHWs, including volunteers 19 Training and competencies 22 Incentives 23 Measuring the change: reporting, monitoring and evaluation 25 Supply chain mechanisms 26 Community engagement and accountability 26 Ensuring quality of care in communities 27 Risks and challenges 28 Ensuring sustainability and analysing conditions for a win-win situation 28 Recommendations to operationalize the guidelines 29 Part 2A: Essential evidence-based health services packages for delivery at the community / home levels 31 Sexual, reproductive, maternal, neonatal, child and adolescent health 33 Communicable diseases 37 Malaria 37 Tuberculosis 38 HIV/AIDS 39 Neglected tropical diseases 41 Noncommunicable diseases 41 Mental health and psychosocial support (MHPSS) 43 Healthy ageing 46 Palliative care 47 3 International Federation of Red Cross and Red Crescent Societies CIC: Guidelines for National Red Cross Red Crescent Societies Part 2B: Care in the Communities in emergencies and protracted settings 48 Background 48 Objective 49 Systems approach 49 Selection criteria 50 Training 50 Supportive supervision 51 Incentives 51 Referral 51 Supply chain 51 Reporting, monitoring and evaluation 52 Sustainability 52 Quality of care 52 Job descriptions and tasks 52 Essential evidence-based health services packages for delivery at the community / home levels 52 Sexual, reproductive, maternal, neonatal, child and adolescent health 52 Tuberculosis 56 HIV/AIDS 57 Malaria 58 Neglected tropical diseases 58 Noncommunicable diseases 59 Mental health and psychosocial support 60 Healthy ageing 61 Palliative care 61 Part 3: Case studies 62 Guinea 62 mHEALTH: Safe Delivery App: Strengthening knowledge and confidence in basic emergency care among health workers and midwives 62 Kenya 63 Home care and management of malaria 63 Montenegro 64 Taking care of older persons through a home care programme 64 Burundi, Lesotho, Rwanda and Zimbabwe 65 Integrated community-based approach for orphans and vulnerable children programme 65 Liberia 66 Community-based health care and the ebola outbreak 66 South Sudan 67 Providing community-based interventions to increase access to health 67 Myanmar 67 Community-based health development programme 2012—2017: lessons in sustainability 67 Sustainability, ownership and capacity development of MRCS 68 References 69 Annex 1: List of contributors 76 Annex 2: Examples of existing Red Cross Red Crescent CIC programmes 78 4 International Federation of Red Cross and Red Crescent Societies CIC: Guidelines for National Red Cross Red Crescent Societies Abbreviations and acronyms ACT Artemisinin-based combination therapy AIDS Acquired immuno-deficiency syndrome AMW Auxiliary midwife ART Anti-retroviral treatment CB-DOTS Community-based, direct observed treatment, short course (TB) CEA Community engagement and accountability CHV Community health volunteer CBHW Community-based health worker CIC Care in Communities DOTS Direct observed treatment, short course HIC High income country HIV Human immunodeficiency virus HMIS Health Management Information System HR Human resources iCCM Integrated Community Case Management IFRC International Federation of Red Cross and Red Crescent Societies LMIC Low- and middle-income countries M&E Monitoring and evaluation MoH Ministry of Health MoU Memorandum of Understanding MNCH Maternal, neonatal and child health MNS Mental, neurological and substance use disorders MUAC Mid-Upper Arm circumference NCD Noncommunicable disease NTD Neglected tropical disease ODK Open data kit ORS Oral rehydration solution ORT Oral rehydration treatment OVC Orphans and vulnerable children PFA Psychological first aid PHC Primary health care PMER Planning, Monitoring, Evaluation and Reporting PMTCT Prevention of mother to child transmission (HIV) RDT Rapid diagnostic test 5 International Federation of Red Cross and Red Crescent Societies CIC: Guidelines for National Red Cross Red Crescent Societies Foreword For more than one billion people around the world, access to appropriate and quality health services has been hampered by shortages in human resources and the limited availability of health facilities. Projections estimate a potential shortfall of 18 million health workers in low- and lower-middle-income countries if Universal Health Coverage (UHC) is to be achieved by 2030. Achievement of the Sustainable Development Goals (SDG) and UHC will require innovative solutions and a concerted effort from governments and international organizations to meet these demands. A well-trained, community- based health workforce can play a key role in ensuring that these challenges are met in an effective, efficient and timely manner. Studies have demonstrated the effectiveness of community-based health workers in tackling reproductive, maternal and child health issues, communicable and noncommunicable diseases, and in providing rehabilitative and palliative care services. The International Federation of Red Cross and Red Crescent Societies (IFRC), along with its 192 member National Societies, has long been at the forefront of providing health services to people in varied settings around the world. In 2017, through its large volunteer network, more than 118 million people were reached by the Health and WASH programmes. The Red Cross Red Crescent network is committed to making the “last mile” its collective “first mile” and has access to underserved and marginalized populations through its 13.7 million volunteers. The Red Cross Red Crescent network’s Care in Communities (CIC) programme focuses on community- based health workers, including trained Red Cross Red Crescent volunteers, delivering, at the community level and in varied settings, evidence-based and essential community health interventions throughout people’s life course. The CIC guidelines aim to provide National Societies with a framework that uses a systems approach that can be contextualized by programme managers and implemented hand-in- hand with governments and communities. We hope that these guidelines will support National Red Cross Red Crescent Societies in the important and valuable work they are doing in their communities. Dr Emanuele Capobianco Director Health and Care Department IFRC, Geneva 6 International Federation of Red Cross and Red Crescent Societies CIC: Guidelines for National Red Cross Red Crescent Societies Executive summary Over one billion people cannot use the health services they need because they are either unavailable or unaffordable. Health workforce deficiencies, inadequate distribution and quality and performance challenges represent some of the main obstacles to the scaling up of essential health interventions. Addressing these challenges is essential for progress towards Sustainable Development Goal 3 to “ensure healthy lives and promote well-being for all at all ages” and to guarantee Universal Health Coverage (UHC). Projections estimate