Community Health Services

FAREMI Adenike (RN, MSc)

&
ADEMOLA Adebayo (B.NSc)
Department of Nursing Science
Faculty of Basic Medical Sciences
OAU, Ile-Ife
 Content Outline
• Introduction
• Aims of Community Health Services (CHSs)
• Services offered as CHSs- different forms
• What agencies are involved in CHSs
• Public and private health sector agencies
• Voluntary health agencies/NGOs
• International Health agencies: multilateral and
bilateral
• National health Insurance Scheme
 Learning Objectives
At the completion of this course, students should
be able:
• To define community health services and give
examples of such services
• To explain the aims of CHSs
• To state governmental and non-governmental
bodies/agencies involved in CHSs
• To give examples of governmental (public) and
NGOs involved
 Learning Objectives…/2
• To state differences between multilateral and
bilateral agencies, and NGOs
• To discuss the relationships between
multilateral and bilateral agencies, and NGOs
• To present detailed account about the WHO,
UNICEF, USAID, etc
• To explain how health insurance and health
management organizations (HMOs) function
 Think about this!
• Recently, a private health facility has
just opened in a remote rural
community. Many under-5 children
were presented for immunization,
but a few of them were no more
eligible to be vaccinated because
they were older than 23 months.
Issues: Why were those children not
immunized earlier? What if the
facility was not opened? What could
have been done as an alternative?
 Scenario 2
• A free political surgical jamboree was moved
from the state capital to rural stations few
months ago. There, a good number of people
who have been diagnosed and booked for
minor surgeries many years earlier trooped
out and waited many hours to benefits.
Issues: Why didn’t they do surgeries ordered
earlier? Why didn’t they go to the state
capital at initial stage? What could be the
result of not doing it earlier? Why did they
now come out to be operated on? What is the
way out of this predicament?
 Introduction
• A community health service (CHS) is a service
which provides people care in the community.
• These may include provision of medical/dental,
nursing and allied health professional care to
people in need, usually in their homes or
community facilities e. g. city hall, village
square, health centre, etc.
• People with an identifiable physical condition or
mental illness or disability, expectant or nursing
mothers in the community are the focus of a
functional community health services.
 Introduction
• Health services offered are for various age groups and
include preventive services (immunization
outreaches), intervention (deworming tablets for school
children) or health promotion
programmes provided as a matter of public policy, targete
d
to age groups or provided in response to individual deman
d

• Such as breast screening, immunization, child

development surveillance, family planning, eye screening
and dental health services.
 Introduction
•The services available depend on the needs of individuals, families
and the community living in an area.

•In Nigeria, most community health program funding supports

flexibility in the delivery of services, and enables various agencies
public and private bodies to develop models of care that meet the
needs of their local communities. However, specific initiatives
deliver particular services to vulnerable population groups.

•Community health services focus on health promotion, and

disease prevention and management, which are designed to
improve the health and wellbeing of local residents, as well as take
pressure off the acute care health system.
 Aims of Community Health Services
Community health services aim to improve the health and
wellbeing of local residents by:

• Encouraging people to actively participate in their own

health care

• Working together with other primary health care providers

such as general practitioners to provide coordinated care

• Liaising with other health agencies and service providers to

fill service gaps
 Aims of CHS…/2
• Encouraging individuals and community groups to actively
participate in the service/program activities, including
service planning, fundraising and volunteer work

• Promoting prevention of lifestyle-related diseases and

conditions

• Developing health care programs and activities to improve

social and physical environments in the community.
 Services Offered
The services offered vary between
communities, depending on the
needs of the local area. They
include:
• Counselling and support services
• Health promotion activities
• Medical and nursing services
• Dental health
• Allied health, including optometry,
dietetics, physiotherapy,
occupational therapy
Other services and supports may include:

• Aged care services

• Alcohol and drug programs
• Maternal and child health
services - Immunization,
family planning
• Mental health programs
• Disability services
• Outreach services – mobile
health services
Organizations/Agencies Involved in CHSs

• Public sector health agencies

• Private sector health agencies
 Public Sector Health Agencies
• All levels of government healthcare service delivery
(primary, secondary and tertiary) are responsible for
CHS at one capacity or the other.
• Government owned health institutions e.g.
• primary health centres,
• mobile health services,
• rural health facilities managed by teaching hospitals e
g
– LTH Rural Comprehensive Health Centre, Ilie;
– OAUTHC Comprehensive Health Centres, Eleyele and
Imesi-Ile
 Private Sector Health Agencies
• These are non-profit organizations
concerned with various aspects of
health e.g., education, promotion,
treatment, services.
• They are legally constituted
organizations that operate
independently from any government
to carry out their community health
functions.
• Also, may be referred as voluntary
health organizations or non-
governmental organizations (NGOs)
 Voluntary Health Organizations
• Most of these organizations are small or big;
• many are church-affiliated. In the very poorest
countries, hospitals and clinics run by
missionary societies are especially important.
E g. Uganda case.
• Voluntary health agencies can be local or
international based on their scope or range of
operation.
CHS in Community Centre
 Examples of Local/Voluntary Health
Agencies
• Living Hope Care Foundation, Ilesa: helping
people living with HIV/AIDS (PLWHA), poverty
reduction, assisting women and orphans, and
people with TB infections.

• MicCom Cancer Foundation, Ada: helping

people in the breast cancer screening, cervical
cancer screening (Pap smear).
 Local/Voluntary Health Agencies../2
• Nigeria Health Care Project:
supporting primary health care
facilities in rural areas.

• Action Health Incorporated (AHI):

promotion of of adolescent health
and development

• ActionAid international Nigeria:

reproductive sexual health and rights
(HIV/AIDS),
International Health Organizations
• International health organizations are usually
divided into three groups: multilateral
organizations, bilateral organizations, and non-
governmental organizations (NGOs).
• The term multilateral means that funding comes
from multiple governments (as well as from non-
governmental sources) and is distributed to many
different countries.
• The major multilateral organizations are all part of
the United Nations.
World Health Organization (WHO)
• WHO began when her Constitution came into force on 7
April 1948 – a date still celebrated every year as World
Health Day.
• It is an organization of more than 7000 people working in
150 country offices, in six regional offices and at her
headquarters in Geneva, Switzerland.
• Her primary role is to direct and coordinate international
health within the United Nations system.
• Her main areas of work are health systems; health
through the life-course; non-communicable and
communicable diseases; preparedness, surveillance and
response; and corporate services.
WHO
 WHO…/2
• WHO supports countries as they coordinate the efforts of
governments and partners – including bi- and multilaterals,
funds and foundations, civil society organizations and the
private sector.
• The principal work of WHO is directing and coordinating
international health activities and supplying technical
assistance to countries.
• It develops norms and standards, disseminates health
information, promotes research, provides training in
international health, collects and analyzes epidemiologic
data, and develops systems for monitoring and evaluating
health programs.
 The World Bank
• The World Bank is the other major
"intergovernmental agency related to the UN"
heavily involved in international health.
• It is an institution (agency) of the World Bank Group
• The World Bank loans money to poor countries on
advantageous terms not available in commercial
markets.
• The amount of money loaned to developing
countries for human resources development, i.e.
health and education, has increased steadily over
the past years.
 The World Bank (Group)
• With 189 member countries, staff from more than 170
countries, and offices in over 130 locations, the World
Bank Group is a unique global partnership: five institutions
working for sustainable solutions that reduce poverty and
build shared prosperity in developing countries.
• The World Bank Group is one of the world’s largest
sources of funding and knowledge for developing
countries.
• Its five institutions share a commitment to reducing
poverty, increasing shared prosperity, and promoting
sustainable development.
 United Nation Children's Fund (UNICEF)

• The United Nation Children's Fund (UNICEF) spends the

majority of its program (non-administrative) budget on
health care.
• UNICEF makes the world's most vulnerable children its top
priority, so it devotes most of its resources to the poorest
countries and to children younger than 5.
• The US government is the largest single donor to UNICEF,
• Other contributors include private sources from Canada,
Switzerland, the Netherlands, and the Scandinavian
countries.
• UNICEF runs many of the child health programs in
cooperation with WHO.
UNICEF
 United Nations Population Fund (UNFPA)
• UNFPA is the United Nations sexual and reproductive health
agency.
• Her mission is to deliver a world where every pregnancy is
wanted, every childbirth is safe and every young person's
potential is fulfilled.
• The organization was created in 1969, the same year
the United Nations General Assembly declared “parents have
the exclusive right to determine freely and responsibly the
number and spacing of their children.”
• UNFPA calls for the realization of reproductive rights for all and
supports access to a wide range of sexual and reproductive
health services – including voluntary family planning, maternal
health care and comprehensive sexuality education.
 UNFPA Supports:
1. Reproductive health care for women and youth in more
than 150 countries – which are home to more than 80 per
cent of the world’s population
2. The health of pregnant women, especially the 1 million who
face life-threatening complications each month
3. Reliable access to modern contraceptives sufficient to
benefit 20 million women a year
4. Training of thousands of health workers to help ensure at
least 90 per cent of all childbirths are supervised by skilled
attendants
5. Prevention of gender-based violence, which affects 1 in
3 women
 UNFPA Supports:
1. Abandonment of female genital mutilation, which
harms 3 million girls annually
2. Prevention of teen pregnancies, complications of which
are the leading cause of death for girls 15-19 years old
3. Efforts to end child marriage, which could affect an
estimated 70 million girls over the next 5 years
4. Delivery of safe birth supplies, dignity kits and other
life-saving materials to survivors of conflict and natural
disaster
5. Censuses, data collection and analyses, which are
essential for development planning
 Bilateral Agencies
• Bilateral agencies are governmental agencies in a single country
which provide aid to developing countries.
• A bilateral organization is a government agency or non-profit
organization based in a single country while the agency provides aid,
including medical aid or disaster relief, for people in other countries.
• The organization or government agency does not usually provide
this kind of aid to citizens of the home country and is usually
concerned solely with providing aid to citizens of developing
countries throughout the world
• Most of the industrialized nations have a similar governmental
agency.
• Political and historical reasons often determine which countries
receive donations from bilateral agencies and how much they
receive.
 United States Agency for International
Development (USAID)
• The largest of the bilateral agencies is the United States
Agency for International Development (USAID).
• USAID leads international development and humanitarian
efforts to save lives, reduce poverty, strengthen democratic
governance and help people progress beyond assistance.
• U.S. foreign assistance has always had the twofold purpose of
furthering America's interests while improving lives in the
developing world.
• USAID carries out U.S. foreign policy by promoting broad-scale
human progress at the same time it expands stable, free
societies, creates markets and trade partners for the United
States, and fosters good will abroad.
 USAID…/2
USAID works in over 100 countries to:
• Promote Global Health
• Support Global Stability
• Provide Humanitarian Assistance
• Catalyze Innovation and
Partnership
• Empower Women and Girls
• USAID channels most of this aid
through "cooperating agencies" -
private international health
agencies which contract with
USAID.
 National Health Insurance Scheme (NHIS)
• The National Health Insurance Scheme (NHIS) is a body
corporate established under Act 35 of 1999 Constitution by the
Federal Government of Nigeria to improve the health of all
Nigerians at an affordable cost through various prepayment
systems.
• It aims at providing easy access to healthcare for all Nigerians at
an affordable cost through various prepayment systems.

• NHIS is totally committed to securing universal coverage and

access to adequate and affordable healthcare in order to
improve the health status of Nigerians, especially for those
participating in the various programmes/products of the Scheme
 NHIS…/2
• NHIS is to provide social health insurance in Nigeria
where health care services of contributors are paid
from the common pool of funds contributed by the
participants of the Scheme.
• It is a pre-payment plan where participants pay a
fixed regular amount.
• The amount/funds are pooled, allowing the Health
Maintenance Organisations (HMOs) to pay for those
needing medical attention.
• It is primarily a risk sharing arrangement which can
improve resource mobilisation and equity.
 NHIS…/3
• It is indeed regarded as the most widely used
form of health care financing worldwide.
• NHIS also regulate private health Insurance
operated by HMOs.
• Health Insurance is social security system that
guarantees the provision of needed health
services to persons on the payment of token
contributions at regular intervals.
 Conclusion
• Community health services contribute immensely
to the wellbeing of citizen and of the nation at
large. CHSs is a multidimensional services where
everyone has specific roles to play.
• All, especially professionals must rise to the
challenge of promoting the community health as
the country and donor agencies count on our
expertise and always seek our collaboration.
 Summary
• We have discussed what community health services
mean and entail. Why they are important and different
forms they take.
• Roles and involvement of governmental and non-
governmental agencies are very crucial to have effective
health services that will impact the lives of the
community people.
• Health insurance plays a unique role in the health
system funding in a nation, hence Nigeria National
Health Insurance Scheme must be revitalized to perform
her role to more Nigerian citizens.
 Further Reading
• https://www.betterhealth.vic.gov.au/health/healthyli
ving/community-health-centres
• https://www.nhis.gov.ng/About%20us/
• http://www.imva.org/pages/orgfrm.htm
• https://www.unfpa.org/about-us
• http://www.who.int/about-us
• https://www.worldbank.org/en/who-we-are
Questions
 Evaluation
• Justify your understanding of community
health services.
• What different forms do they take?
• State 5 international donor agencies, their
categories and unique roles
• NHIS- an albatross or a blessing? Discuss.
 Assignment
1. As a community health nurse, identify a
particular community health need in your area
and how you would go about solving it by way of
CHS establishing collaboration with appropriate
public and voluntary health agencies.
2. NHIS is performing below expectation in Nigeria.
Dig out factors that could be responsible for that
and discuss solutions to those excavated
challenges.