Table 1 Basic elements of the Census-Based, Impact-Oriented (CBIO) Approach
Overarching goals | 1. Health improvement at the population level |
Specific goals | 1. Improvement of health in a specific, geographically defined population 2. Intermittent measurement of population health, with orientation of program priorities toward health improvement 3. Establishment of partnerships between communities and health-oriented program(s), essential for achieving maximal success in health improvement |
Guiding principles | 1. Diagnosis of epidemiological priorities, essential in order for the health practitioner to “prescribe” an effective “treatment” (the diagnosis and the prescribed treatment may change over time as health conditions change over time and as effective treatments change over time) 2. Use of locally acquired surveillance data (best obtained through visitation of all households or a sample of households), the most desirable approach to defining epidemiological priorities and to measuring changes in the level of health in the population over time 3. Choosing the right interventions and strategies for implementing these interventions (especially those that involve behavior change), aided by formative research techniques (these techniques are also useful in identifying community-perceived health priorities) 4. Identifying and responding to community health priorities, essential for building a partnership and trust 5. Routine contact with every household, required to build trust, achieve high coverage of services, and obtain optimal surveillance data (including vital events) |
Initial steps (in a pilot area) | 1. Development of a relationship of trust between the health practitioner and the community 2. Definition of the community (geographic boundaries, number and location of inhabitants) 3. Exploratory and then pilot planning and program implementation 4. Definition of community priorities |
Definitive steps (in the complete program area) | 1. Determination of the most frequent, serious, readily preventable or treatable causes of sickness, disability, and death, their underlying causes (through formative research), and those persons at greatest risk 2. Determination of the health priorities as defined by the community members themselves 3. Establishment of program priorities based on epidemiologically defined and community-defined priorities 4. Development of a work plan based on the program priorities and the resources available 5. Implementation of the program 6. Monitoring of progress on a regular basis and evaluation of the program periodically, followed by a community re-diagnosis (after 3–5 years) |