Innovation in 20 communitiesFormative research facilitated by NicaSaludSummative research by CIES
KPC and FGD with volunteers baseline
Organization:20 communities selected using pre-established criteriaTraining CS and MoH team in methodology Field work planning, development of guidelines and interview techniquesInvitation to community membersField workAnalysis and discussion of findings:Team compiled and analyzed the information4 session to present the results to governmental authorities in three municipalities (major office, MoH, MoEd, Police, other organizations) 35 participants8 sessions at community level with men, women for a total of 64 participantsIn all the sessions participants made recommendations about strategies could be implemented to overcome barriers
Chose community strategies to launch BCC strategySelection of community volunteers to become bcc counselors8 community sessions to validate materialsSelection of strategiesDevelopment of IEC materials
FGD and in-depth interview with men and women
25 men in three municipalitiesMen with pregnant women’Men whose wives where in last two weeks of pregnancy: behavior 1,2Anecdote about the wife didn’t want to go back and wash the baby’s clothes after one months of probing phaseThe husband convinced it was important to participate in the ANC came to the H/U but the doctor didn’t let him inThe H/U staff brainstorming how to declare “husband friendly units”. “welcome all me who love their wives”
Selection of men to probe the behaviors was based on the behavior that was going to be probed. For example if the behavior is to seek ANC the man was whose wife is pregnant and didn’t have ANC or was not attending follow up sessions. Men whose wife in the third trimester of pregnancy, post partum and with newborn alive.Development of materials to record the behaviors and mark the days the behavior was practicedHome visits to negotiate the behaviors: selection of 9 behaviors to be practiced 4 times each. ( minimum 3 times, max 5 times)ssess enablers, barriers to probe the behaviorUse of job aids to remind the behavior and track the days and number of time the behavior was done
Follow up visits to assess if the behavior was done every two weeks or monthly The counselor record the days the behavior was practiced and during the session counsel the man about the benefits, and negotiate with them to try again (in the case the man hasn’t been able to practice the behavior). If the men has achieved all the days the behavior was agreed to be practice, the counselor negotiates with him a new behaviorTo motivate more men, those who have achieved the tasked share with other men and familiy members the experience of practicing the behavior
Of the 9 behaviors 6 were probed 3 times1 five times2 only two timesTwenty five visits were done with 25 menAnecdoteabout the wife didn’t want to go back and wash the baby’s clothes after one months of probing phaseThe husband convinced it was important to participate in the ANC came to the H/U but the doctor didn’t let him inThe H/U staff brainstorming how to declare “husband friendly units”. “welcome all me who love their wives”
Gender responsive programming Changing men’s support to women during pregnancy, delivery, and post-partum. Use of a modified TIPS methodology Elena McEwan, MD Senior Technical Adviser Catholic Relief Services Core Spring meeting, May 2011
Step 2 We can take care of our newborn during the day and the night Step 2: a) Debrief and analyze information b) Develop community “counseling” strategies
Motivation for recommended practices Child will grow up to have more love for the father than is typical. Newborn will be healthy and the family will save money not treating sickness. Infant will grow easily and be happy. After work, I find time to share quality time with my family
Potential barriers to male supportive care practices Potential barriers: Don’t know how to do it Lack of communication with wife regarding pregnancy Lack of motivation due to feeling left out by the health staff during care They feel embarrassed to be seen by other women when taking care of the newborns
Developing community counseling strategies During childbirth and delivery: Find someone to take care of the house while he goes with wife to HU for delivery. Assist wife to go to maternity house 2 weeks before delivery. Go with wife to HU and stay in room during labor and delivery. Agree with wife to stay at the maternity waiting home seven days post partum. During pregnancy: Collect firewood and water. Support wife with household work Go with wife during at least 3 ANC visits and Ask questions during care. During post-partum period: Alternating take care of newborn during the day and the night. After work, feed other children (one snack and dinner).
Step 3 Step 3: Negotiate “trial” practices (3 men per each practice) Note: Negotiation done at group level
Step 4: Results, response, reactions Step 4: Follow up home visits to gather information on experience with trial practice: results, response, reactions
Step 4: Gather results During pregnancy: Collect firewood and water.
76% (practiced at least 4 times)
Support wife with household work.
100% (practiced at least 4 times)
Go with wife during ANC visits and ask questions.
66% (practiced at least during 3 ANC visits)
Step 4: Gather results (continued) During childbirth and delivery: Find someone to take care of the house while he goes with wife to HU for delivery.
Assist wife to go to maternity house 2 weeks before delivery.
Go with wife to HU and stay in room during labor and delivery.
Agree with wife to stay at the maternity waiting home seven days post partum.
Step 4: Gather results (continued) During post-partum period: Alternating with wife taking care of the newborn during the day and the night.
71% practiced at least 4 times
After work, feed other children (one snack and dinner).
98% practiced at least 4 times
Step 5 Step 5: Recommendations for the program Changes in recommended practices are feasible. It will be possible to overcome resistance encountered. It is critical to involve the Ministry of Health personnel in support of recommended practices that involve Health Units / Hospitals.