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Table 2 CHA Work Package

From: The Tanzania Connect Project: a cluster-randomized trial of the child survival impact of adding paid community health workers to an existing facility-focused health system

Service

Description

Health Promotion and Education

Behavior Change Communication

• Delivered through household visits and mobilization of men’s and women’s groups

• Main topics are: family planning; antenatal care; delivery care; post-natal care; child health; HIV and STI prevention; water, sanitation and hygiene and environmental health.

Focused Counseling and Service Delivery in Households

Family Planning

• Refer client to the nearest facility for family planning initiation

• Make household visits to refill methods and provide counseling and support

• Counsel and provide condoms and demonstrate their proper use

Antenatal Care

Three households visits during pregnancy:

• Visit 1 at 12-16 weeks: counseling, promote early initiation of ANC within first 4 months, emergency referral in the case of complications; provision of condoms for HIV/STI prevention, monitor ITN use

• Visits 2 and 3 at 20 and 28 weeks: promote 4+ ANC visits, provide emergency referral for complications, continue monitoring ITN use, IPTp and PMTCT, develop birth preparedness plans, and counsel on danger signs, essential newborn care, post-partum family planning and HIV prevention/PMTCT

Delivery Care

Emergency referral for obstetric and newborn complications:

• Call for advice and transport

• Mobilize community to create local solutions to the referral problem

Postnatal Care

Four visits in the postnatal period:

• Visits 1 and 2 within 24 hours of delivery and 3 days after birth:

â—‹ Intensified counseling on essential newborn care

â—‹ Promotion of postpartum family planning

â—‹ Refer for maternal and newborn complications

○ Measure the newborn’s foot size to detect low birth weight

â—‹ Educate household on maternal and newborn postpartum danger signs

• Visits 3 and 4 at 7 and 28 days to promote immunization and exclusive breastfeeding and refer for complications

Under-five Health

• Management of simple cases of diarrhea, pneumonia, malaria (pending RDT rollout), and helminthic infections; referral for severe cases of child illness

• Mobilize villages and coordinate immunization and Vitamin A outreach events with health facility staff

• Focused counseling on child nutrition, growth monitoring, and prevention and recognition of childhood illness

• Depending on mothers’ voluntary disclosure, encourage HIV diagnosis of the newborn and infants at 18 months.

HIV/STIs and TB

• Provide HIV/STI prevention education and distribute condoms

• Encourage VCT

• Link PLWHA to support groups.

• Identify potential cases of TB and refer

First Aid

• Perform first aid and refer

Vulnerability and Risk Protection

Disability

• Identify individuals with disabilities

• Refer to appropriate services

Social Protections

• Educate households on the Community Health Fund and encourage them to enroll

• Identify poor households that qualify for exemptions

Community Mobilization and Health Systems Strengthening

Mobilization and Outreach

• Convene village groups to identify and discuss priority community health issues

• Mobilize community-based responses for emergency referrals and other priority issues

Health Information

• Collect service statistics (CHA) and assist with vital registration at village level

• Manage and report community-based service information into broader HMIS

Governance and Leadership

• Attend Village Health Committee, Health Facility Management Team and Health Facility Governing Committee meetings to articulate community health needs and priorities

• Support committees in coordinating events and activities as needed

  1. The below table provides an overview of the main tasks CHA are trained and authorized to provide.