title: Integrated community based child survival, reproductive health and water and sanitation program in Mkuranga district, Tanzania: a replicable model of good practices in community based health care.
abstract: BACKGROUND
  Over decades, evidence has accumulated to justify the concern that top-down approaches do not work and may result in lack of program ownership and sustainability. As a result, participatory approaches have increasingly become popular. An example of such an approach is hereby presented.
  
  
  METHODS
  Working with AMREF, Mkuranga district significantly gained experience and improved its community participatory approaches in health development. AMREF's model of Community Based Health Care (CBHC) approaches was used to implement integrated Water and Sanitation, Child Survival and Reproductive health programs.
  
  
  RESULTS
  The project established functioning village health and water committees. A 45% increase in utilization of services was reported. Adequate nutrition status among children rose from 67.9% to 81%. Attendance of antenatal clinics rose from 35% to 70.2%. A total of 117 shallow wells, 21 boreholes and 25 rain water harvesting systems were established.
  
  
  CONCLUSIONS
  Based on this experience, we conclude that in order to achieve the Millennium Development Goals (MDGs) and the National Poverty Reduction Strategy (Mkukuta) targets, building partnerships with communities who are the target beneficiaries is a prerequisite and CBHC approach is a fundamental towards attaining those goals.
  
  
  CONCLUSIONS
  The model demonstrates that community participation is key to community empowerment, as well as community ownership and sustainability of health interventions.
authors.affiliation: African Medical and Research Foundation, Tanzania Country Office, Dar es Salaam, Tanzania.
authors.forename: Koronel Mashalla
authors.initials: KM
authors.lastname: Kema
authors.forename: Joseph
authors.initials: J
authors.lastname: Komwihangiro
authors.forename: Saltiel
authors.initials: S
authors.lastname: Kimaro
mesh_terms: D002648:Child; D046688:Child Mortality; D002669:Child Welfare / Q000706:statistics & numerical data*; D003153:Community Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D003256:Community Participation; D003695:Delivery of Health Care / Q000458:organization & administration*; D006801:Humans; D009752:Nutritional Status; D010067:Ownership; D011203:Poverty; D060728:Reproductive Health; D034121:Reproductive Health Services / Q000458:organization & administration; D012499:Sanitation; D013636:Tanzania; D014881:Water Supply / Q000592:standards
keywords: Child survival; Tanzania; community based; integrated health care; reproductive health; water and sanitation