Community Directed Approaches for Health Improvement

The community-directed intervention (CDI) strategy is an approach in which communities themselves direct the planning and implementation of intervention delivery fostered with support from the Special Programme for Research and Training in Tropical Diseases of the World Health Organization and partners. This approach grew out of the onchocerciasis control effort in Africa and has been piloted in several African countries, such as Nigeria and Kenya. The approach would become a stimulus for developing primary health care (PHC) services in remote and previously unreached rural villages. Empirical works across countries indicated that CDI is an accepted and effective strategy in the mass treatment of schistosomiasis and soil transmitted helminths (STH) infections. That will further support technical skill and institutional knowledge on mass treatment across countries using a standard approach. Staff orientation and training were needed to get programs off the ground since few staff had basic training in the benefits and procedures of organizing community participation. However, technical training to perform these health tasks did not guarantee that services would reach communities where participation was not the underlying value of the system. The team aimed to trace the development and evolution of CDI from community-directed treatment with ivermectin (CDTI), a focused disease control effort for onchocerciasis/river blindness; adapt the approach to address other health and development needs; and examine the challenges CDI has faced, which are not unlike those experienced by PHCs.