There were no community level workers and only very few nurses with ophthalmic training; there is a need for a better mix of professional, mid-level and community-level staff to increase access, demand and efficiency.
Evidence from the literature on supervision of healthcare providers at peripheral service delivery locations, including CHWs, suggests that supervisors seldom travel to supervise community-level staff because of other duties in patient care and administration, a lack of funds to cover transport costs for field visits or a general disinclination to carry out this responsibility.
At the community level, for school staff, parents, and other community members, the framework can serve as both a goal and a tool of quality improvement through localized self-assessment, planning, and management and as a means for mobilizing the community around education and child rights.
The main health workforce at community level is the domiciliary staff called Health Assistants (HAs).
Staff at community level complained about poor management: for example they were not allowed to take leave, and rules and regulations were not always clear.
Major challenges noted included insufficient transportation and funds for fuel to carry out supervision at the community level, in addition to facility staff being overwhelmed with their various job requirements.
The community level had 779 health care staff working in the 187 CHCs, including at least one midwife or one assistant doctor responsible for neonatal care at each CHC.
What I can say is that PHC is at community level but short of government staff and this is making people benefiting in bits and pieces from the activities".
The aim of NeoKIP is to evaluate facilitation; a knowledge translation intervention that we hypothesize will speed up identification of local health care-related problems at community level, increase primary health care staff knowledge and use of evidence-based knowledge and subsequently achieve improvement of neonatal outcomes.
Additional field notes were taken during the subsequent quantitative survey from August to December 2011 based on observations during visits to health posts, markets and shops as well as informal discussions with stakeholders at the community level and district health office staff.
The limited availability of health facilities and health staff at the community level is a crucial factor that restricts nomadic women's access to health care services.
