Reaching out to those who cannot reach you - the true meaning of outreach

Shifo launches report on solution to help key actors close equity gaps in preventive healthcare delivery

Some 400 million people in low and middle income countries lack access to basic preventive health services, including but not limited to family planning, antenatal care, skilled birth attendance, child immunisation and supplemental care. Remote populations and marginalised groups – such as unregistered children, ethnic minorities, women, girls, the urban poor, or rural dwellers – are more likely to fall outside the reach of preventive healthcare and often bear the greatest burden of disease and ill health.

Outreaches were designed to be an extension of the services provided at fixed health centres. By providing care closer to intended recipients, the aim was to counter the shortfalls within care delivery and decrease the inequality in access, availability and quality, but there is a disconnect between the aim and the reality.

The reality is that while outreaches have played a role in increasing immunisation coverage, the provision of preventive health services to marginalised populations is uneven and below target. The reality is that financial and human resource constraints have had the combined effect of outreaches not being utilised to their full potential. And with no methods and data to measure the effectiveness of outreach services, there is no way to know for certain the true extent to which outreaches contribute to improving maternal and child health.

How can outreaches help reduce inequalities within immunisation and preventive care delivery when they are often held irregularly, or not at all? How can they be effective when the persons to whom they are directed are often unaware that there will be an outreach in their district? For many families, outreaches are the only access they have to healthcare. What does it mean for them when there is no outreach?

Care provided during outreach is data- rather than patient-centred, and though health workers allocate a substantial portion of their time to paperwork, the data is of varying and unknown quality

It is important to devise strategies that can be sustained in the absence of donor funding. Likewise, solutions should aim to enhance existing structures and in so doing, refine rather than add to, the workload of health workers. It is with this in mind that Shifo introduced MyChild Outreach to measure the performance of outreach service provision in at-risk areas, and to identify equity gaps that can be closed by key actors.

A new Shifo report Leaving no child behind - closing equity gaps and strengthening outreach performance with MyChild Outreach shows how the system produces outreach-specific data, providing health planners and decision-makers with a clear and accurate picture of the delivery of child preventive services. MyChild Outreach is designed to facilitate the delivery of more effective preventive healthcare and strengthen the capacity of key stakeholders from community to national level such as health workers, health centres, district/provincial health offices, health ministries, national and international NGOs to better meet the demands of marginalised communities during outreach sessions.

The system provides accurate data on total child population in districts, follows vaccination schedules and sends SMS reminders to parents, with automatically generated defaulter lists sent to health workers. It delivers nearly 40 indicators disaggregated by gender, including specific indicators on immunisation and supplemental care performance in outreach sites.

The applicability of the solution in addressing gaps in preventive care delivery for all children has been confirmed and endorsed by governments and partners during recent field studies in Lao PDR, Vietnam, Cambodia, Uganda, The Gambia, Senegal and Afghanistan.