CSS is born out of the long and ongoing process of monitoring and evaluating existing community-based psychosocial interventions. This means that many of its features are the direct product of lessons learnt from preceding projects. One such feature is the emphasis on community mobilization rather than assistance. It is about empowering people to restore social cohesion/trust and build their capacity to take charge of their own health and well-being. This refers to people’s ability to ‘bounce back’ and to manage the difficulties they face.
Resilience is best achieved by inviting people to participate fully from the very start and that the benefits of interventions are not maintained unless the community feels fully responsible for the changes. We therefore promote the development of informed, capable and coordinated communities and community based organisations, groups and structures. This involves a broad range of community actors, enabling them to contribute as equal partners alongside other actors to the long-term sustainability of health and psychosocial well-being and other interventions at community level, including an enabling and responsive environment in which these contributions can be effective.
Improve health without doctors
There is evidence that a fertile social context (i.e. high social capital) decreases the association between the individual emotional response to adversity and posttraumatic stress. And in communities with high social capital negative events may be less demanding for individual psychosocial resources. CSS can have an effect on health without the involvement of formal health care; its focus is to improve well-being in the broadest sense. The entrance is the community; CSS is socially oriented and focuses on enhancing genuine community in all aspects from planning to on-the-ground actions.
Within CSS, communities are considered both complementary to and linked with health systems, both with its own distinct strengths and advantages. The important role that the community should play in achieving better outcomes in the field of (mental) health and psychosocial well-being, is to address the broader determinants that affected health; that includes for instance income, social of cultural status, education, employment and working conditions, gender, social support, policy, legal and governance issues, advocacy, etc.
In the CSS approach we work on understanding local needs and problems and identifying and understanding available local resources and capacities to address these needs. We aim to create a condition in which poor health of individuals does not become an extra burden on the community. The final outcome is that people are able to better manage their own well-being, participate in the management of (health) service delivery and provide an interface between individuals and government institutions at different levels.
The starting point for all our CSS activities is the CSS Framework as defined by the Global Fund and that has been adapted for the purpose This framework consists of several components: 1) mapping communities; 2) building networks of support at different levels; 3) development of an action plan based on identified resources and needs; 4) capacity building of local stakeholders; and 5) specific community activities & service delivery.
In Afghanistan the on-going war brings many social uncertainties. Especially at risk are women and girls, suffering from violence in formal of forced marriages where unfair cultural practices like exchange of girls to avoid dowry costs, strengthen family relations or resolve conflict are common practice. In 2011 HealthNetTPO started a CSS programme with the specific aim to reduce domestic violence and reinforce women’s agency. The backbone of the programme consists of women in 10 participating provinces. In each province fifteen female focal points divided over several districts are trained and mobilized to set up local (sub) groups in order to generate plans and actions towards an increase in their autonomy. Each woman creates her own network of some twenty members, resulting in some three thousand direct beneficiaries.
Some outcomes mentioned by the focal points are decreased family violence, reduced tension, improved economic conditions, increased collective action, increased happiness in life, increased awareness about women’s role in Islam, increased knowledge of the Quran, greater awareness of women’s rights and the development of a culture of joint venture or common business.
 In press: The mechanisms that associate community social capital with post-disaster mental health: a multilevel model; Wind & Komproe
 The Global Fund (2010). Community Systems Strengthening Framework. http://www.theglobalfund.org/documents/civilsociety/CSS_Framework.pdf, pag. -31
In any instable situation or post-conflict setting HealthNet TPO has learned that communities function below the optimal level. Decades of threats, repression and violence lead to loss of trust, anxiety and fear for interaction. To understand this ‘resistance’ of the population and to be able to formulate a useful response, one needs to relate to the community. This picture shows a HealthNet TPO staff member talking to key people of a local village.