Conseils de Santé Communautaire (CSC) : Manuel d’Exécution pour l’Engagement Communautaire et l’Élimination de la Malaria en Haïti

Objectives

The manual establishes Community Health Councils as a voluntary, community-led platform for Haiti’s malaria-elimination strategy, aligned with the Ministry of Public Health and Population’s aim of universal access to quality health services. Its overarching purpose is to strengthen organised local participation in eliminating malaria transmission, including through the sterilisation of transmission foci, while supporting wider health promotion and positive social change.[1][2]

• Strengthen community capacity to identify, plan and act on local health priorities, initially concentrating on malaria prevention, control and elimination.[2][3]
• Support national malaria-control priorities: case management; diagnostic and treatment supply systems; epidemiological surveillance; vector control; health-system strengthening; and community information, education and communication.[4][5]
• Increase knowledge of malaria transmission, diagnosis, treatment, prevention and elimination, including unresolved local questions that can inform educational materials.[6]
• Map malaria cases, mosquito breeding sites, environmental risks and health-system barriers in each council area to inform locally adapted action.[7][8]
• Promote community interventions including household engagement, school programmes, awareness events, support for diagnosis and treatment, mosquito prevention, environmental sanitation and collaboration with health providers, traditional healers, local authorities and civil society.[9]
• Build inclusive, non-sectarian and apolitical councils that represent diverse geographical, social and professional groups and mobilise voluntary neighbourhood action.[10][11]
• Develop community solidarity and behavioural change through culturally appropriate communication, including Haitian music, arts, theatre, visual materials and local events.[12][13]

Each council is expected to prepare a Community Action Plan that reflects local needs, malaria risk and citizens’ concerns. The plan consists of routine malaria interventions, a rapid-response plan for cases or outbreaks, and a materials and resources plan; it should be reviewed and adapted every six months.[9][14]Active councils may broaden their work to additional community health issues after approximately 12 to 16 months or during the second year, but only through discussion and agreement with the Ministry and implementing partners.[3][15]

Implementation

Implementation uses a structured, Ministry-supported community-engagement model developed with support from The Carter Center, the University of Amsterdam, formative research and an initial Grand’Anse pilot. Community Health Councils are voluntary organisations operated by local residents, with Ministry staff and implementing partners providing technical guidance, training, supervision, selected materials and support for implementation challenges.[2][3][16]

• Establish each council through Ministry departmental offices and local health authorities, convening local government, community organisations, natural leaders and other relevant sectors.[17]
• Select nine to thirteen members through an open process, ensuring representation of groups such as women, young people, farmers, teachers, religious leaders, health personnel, businesses and local organisations.[10]
• Elect a four-person board for two-year terms, comprising a coordinator or president, secretary and two delegates or advisers; assign responsibilities for meetings, records, representation, mobilisation, conflict resolution and liaison with the Ministry.[10][18]
• Conduct initial situation analysis during the first month, including shared vision-setting, agreement on a name, slogan and code of conduct, malaria-question exercises, risk mapping and review of feasible interventions.[16][19][20][8]
• Plan routine interventions for three to six priority neighbourhoods, targeting areas with current or previous malaria cases and high mosquito density, alongside selected population groups and a six-month activity calendar.[14][21][22][23]
• Hold monthly council meetings and implement at least four community interventions each month in addition to the meeting, adapting the scale and mix of activities to local capacity.[5][23]
• Organise neighbourhood volunteer groups, normally with three resident volunteer leaders in each target area, and integrate malaria work into existing community health groups where feasible.[11][24]
• Activate rapid response following notification of a possible or confirmed malaria case, coordinating with Ministry staff, community representatives, civil-society groups and neighbourhood volunteers.[25][26][27]

Rapid response is intended to limit transmission through an intensive initial two-week phase to identify additional cases, a further three-month phase of action, and one year of routine follow-up in the affected neighbourhood. Where agreed with the Ministry, councils may support health personnel to provide rapid diagnosis and treatment to people with malaria-like symptoms.[25][28][29]Councils should begin with manageable activities, learn from experience, expand successful approaches and mobilise existing in-kind support from community groups, government and civil society rather than relying solely on Ministry and partner resources.[30]

Governance and oversight operate through Ministry departmental coordinators, communal-level supervisors, focal points and implementing partners. Departmental staff oversee technical and administrative delivery, while communal staff provide day-to-day field supervision; a monitoring and evaluation officer and data-entry operator support reporting quality and routine programme data management.[15][31]Councils maintain regular contact with the Ministry, health facilities, private clinics and community health agencies, including discussion of gaps in reporting suspected, confirmed and treated malaria cases.[4][30]

Monitoring combines monthly activity reports and activity forms, transmitted to the Ministry or communal health level, with meeting minutes, membership and volunteer records, six-month plan reviews and routine malaria updates. Health-facility data on testing, positive cases and treatment are shared with councils for monthly discussion, while selected councils receive community-feedback visits every three months and all councils can use findings to adapt action plans.[5][18][32]Performance recognition may consider intervention number and quality, community acceptance, impact including malaria cases, and timely reporting and communication.[27]

No quantified overall budget or costed financing plan is specified. Council members and volunteers receive no salaries or per diems, although the Ministry and partners may support establishment, supervision, materials, limited travel, incentives or performance awards subject to available resources.[5][17][27]

Monitoring & Evaluation

The framework combines community-level malaria surveillance, routine reporting, supervision, feedback and adaptive planning. Community Health Councils or Committees (CSCs) support epidemiological surveillance by locating cases, identifying transmission areas and mosquito-breeding sites, and using malaria data to target interventions and assess control activities.[4][7][21]

• Require CSCs to submit monthly activity reports to the Ministry of Public Health and Population (MSPP), with reports and activity forms collected by supervisors and, in some cases, transmitted by mobile telephone.[5][18][16][32]
• Provide monthly MSPP malaria-case reports and epidemiological updates to CSCs, including numbers tested, positive cases and treated cases, to inform monthly meetings and local action.[30][32]
• Record organisational and activity evidence through meeting minutes, membership and volunteer records, activity forms, six-month calendars, rapid-response plans, maps and materials-resource plans.[18][8][33][26][34]
• Use risk mapping to plot malaria cases from the preceding ten years, identify stagnant water and suspected breeding sites, and discuss local risk factors and health-system barriers.[7][8]
• Monitor malaria risk through case information, mosquito-density assessments and identification of high-risk neighbourhoods, prioritising areas with current or previous malaria cases.[14][21][22]
• Maintain surveillance and support after rapid responses, beginning with collection of information on recently diagnosed cases, affected people and the MSPP outbreak response.[25][26]
• Review and adapt Community Action Plans every six months using progress, achievements, implementation challenges and monitoring and evaluation information.[14][32]
• Conduct supervision through MSPP focal points, departmental and communal staff, and implementing partners; departmental monitoring and evaluation officers apply protocols from a separate monitoring and evaluation manual and support reporting data quality.[16][15][31]
• Gather community feedback through selected CSC visits every three months, including discussions and interviews with volunteers, community groups and households, and use findings to improve CSC functioning.[32]
• Recognise performance on the basis of intervention number and quality, community acceptance, intervention impact including malaria cases, and timely reporting and engagement with MSPP and partners.[27]

The supplied material identifies reporting forms, checklists, supervision, regular reviews and malaria-service data, but does not set out a comprehensive quantitative indicator framework, evaluation design, surveillance targets or independent accountability mechanism.[35][5][15][29]

Costing & Financing

Financing is primarily described as technical, material and operational support from the MSPP, implementing partners and The Carter Center, supplemented by local resource mobilisation. The source does not provide a total programme budget, quantified activity costs, funding-gap estimate, financing target or economic assumptions.[1][34][15]

• Provide technical and financial support for the manual through The Carter Center, alongside technical and material assistance from MSPP partners for the CSC approach.[1][36]
• Maintain CSC participation on a voluntary basis, without salaries or per diem payments for members and volunteers.[5][27]
• Support CSC establishment, operations and supervision with educational and planning materials, badges, T-shirts, cleaning supplies and, where possible, small incentives.[17][16]
• Offer travel assistance for official MSPP meetings or award events only where financial resources are available; routine daily CSC operational support is not envisaged.[17][27]
• Plan materials and resources through Activity 11, distinguishing planning supplies, intervention materials and specialised disease-control supplies, and continuously review and update requirements.[34][37]
• Report stock-outs of malaria tests or medicines promptly to MSPP focal points and include them in requests for support where appropriate.[37][30]
• Mobilise in-kind contributions from community groups, local government and civil society, including cleaning equipment and personnel, meeting venues, food, educational goods, boards and flipcharts.[30]
• Depend on external financing for selected interventions in high-transmission areas, including mass bed-net distribution, testing, medicines, house spraying and treatment of stagnant water.[4]
• Consider airtime, transport expenses and refreshments for meetings only subject to available financial resources.[37]
• Provide performance awards to the three best CSCs in each department every six to twelve months, subject to available funding, using gold, silver and bronze categories.[27]
• Organise wider CSC conferences every six to twelve months only when financial resources permit.[32][15]

Resource planning tracks requests, approvals and receipt dates for educational materials, planning supplies, implementation materials, specialised equipment and community contributions, but no prices or budget allocations are specified.[29]