The delayed initiation of community-based activities 3 years following facility-based training of providers meant that assessments at the facility level preceded community-level implementation.
Originally formalized at the International Conference on PHC held in Alma Ata, PHC (Box 1) has seen limited application at the government level (12), despite examples of successful community-level implementation (13).
(Provincial Health Officer, Female) Some key informants at the district level and health centres felt there were significant improvements at the community level due to the implementation of the MNCH programs.
These may refer for example to changes in the contact patterns due to self-awareness or changes at the community level due to the implementation of intervention strategies to control the epidemic [ 49, 69- 73].
However, there is a political will on the part of the Government of Malawi to improve PHC implementation at community level and to ensure larger community participation.
It follows that in areas where aggregated data from electronic patient records are available, the diabetes risk scores may be used as a population prediction tool for example, to produce small area statistics (perhaps as pictorial maps) of diabetes risk across a population, thereby allowing targeted design and implementation of community level public health interventions.
While an association between training and the identification of DHF is not causal, it is likely that the surveillance training, the inclusion of hemorrhagic fever into a routine data collection, and the increased availability of rapid diagnostic tools contributed to the early identification and timely implementation of community level control measures during this outbreak.
2. Factors influencing effective implementation at the community level.
We will therefore limit it to comments on some important aspects of efficiency related to implementation at the community level.
Experience with KMC implementation at the community level is much more restricted than hospital-level initiatives [ 115].
Programme implementation at the community level was through non-governmental organizations (NGOs) or community-based organizations (CBOs), and included a rights-based approach [ 21].
