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Adapting HBLSS to Fit Your Program_Kruger_5.11.11
 

Adapting HBLSS to Fit Your Program_Kruger_5.11.11

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    Adapting HBLSS to Fit Your Program_Kruger_5.11.11 Adapting HBLSS to Fit Your Program_Kruger_5.11.11 Presentation Transcript

    • Afghanistan Mozambique Sudan WORLD VISION MNCH PROJECTS HBLSS INTEGRATION
    • MNCH Programs with HBLSS Integration
      • Afghanistan: MNCH in rural Herat
      • Integrated CHW HBLSS training
      • Links with community
      • midwifery training
      • Operations research:
      • HBLSS linked with
      • mPhone pregnancy and newborn modules
      • Mozambique: MNCH – Zambizia Province
      • Integrated CHW HBLSS training
      • HBLSS linked mPhone pregnancy and newborn modules
      • S Sudan: MNCH
      • CHW HBLSS training
      • Integration with Community Case Management
      Karukh district: HBLSS supportive Supervision
    • How: MNCH and HBLSS Integration
      • MNCH platforms
      • CHW training
      • Mother Support Groups- trained with CHWs
      • CHW home visits; Timed and Targeted include
      • complication readiness
      • Village Shura are sensitized
      • Village Health Committees are sensitized
      • MOH/HBLSS data collection referral forms
      • Monitoring and evaluation plans-
      • include HBLSS data
      Pregnant Women in Naw-abad. Photo: UK Forces Media Ops
    • HBLSS Adaptations
      • All CHW training takes place within “community participatory meetings”- in local language
      • Community meetings prioritized with local Shura/Village Health Committees
      • Training tools prepared for non-literate: action cards, mPhone
      • Attention to CHW male and female roles– Shura support, CHW male/female teams
      • Birthing teams develop Birth Preparation Plans with families
      • Communities develop Village emergency transport and communication (mPhone)
      • MOH referral/data forms revised to include HBLSS data: complications, transport time
      • Health Center verify accuracy of assessment by Birthing Teams
    • Lessons Learned
      • Adaptations needed:
      • Cultural
      • Rural/remote areas
      • Security situations
      • Illiterate CHW population: audio in local language and local pictures
      • Gender considerations- male/female roles
      • Community priorities-- according to the highest complication prevalence
    • Lessons Learned- continued
      • Buy-in:
      • Provincial and district level- prior approval
      • Shura and Village sensitization
      • Community and Family Birthing Team participation
      • Maternity Center engagement- EMoC
      • Training:
      • Master HBLSS TOT training team for basic and refreshers
      • CHWs trained in basic MNCH integrated with HBLSS training
      • Training approach - HBLSS participatory meetings –group negotiation skills
      • CHWs need re-freshers, mentoring and supportive supervision
    • Challenges Mozambique Security & remote areas Supportive supervision by local midwives Afghanistan Long distances between villages & health centers
      • HBLSS mPhone modules need additional training
      • MOH approval for HBLSS training/ referral forms
      • Capacity to use adult learning principles, participatory methods, negotiation
      • MOH willingness to provide EmoC training at HCs
      • CHW skills in community participatory meetings and negotiation
    • Training Cost (example)
      • Afghanistan:
      • Master trainers- 4
      • TOTs- 18
      • CHW trainings: 30 villages in 4 districts
      • CHWs- 155 plus
      • Mother Support Groups
      • (1 per village-30)
      Approximate Cost: $30,000
      • Recommendations
      • Community assessments for HBLSS design
      • Start out small- a pilot and then scale-up
      • Adapt and Integrate within MNCH programs
      • Community meetings drive priority Mother/Baby problems
      • Community meetings use participatory /negotiation methods- need skill development
      • Involve and train Health Center staff in Basic EmOC
      • Mobilize communities for referral/transport plans
      • Build in CHW mentorship and refreshers for HBLSS skills
    • Surprises! (or not)
      • Conducive to mPhone technology /design
      • Initiative taken by communities to include Mother Support Groups in HBLSS programs
      • Exclusive breastfeeding increased (newborn care)
      • Afghanistan- empowered women to make decisions & travel out of homes to HCs
      • ANC attendance and delivery at HC increased
      • Male involvement increased (Shura, fathers/brothers)
      • Positive receptivity by Provincial and District MOH and Community Midwives
    • Thank You!
      • Photographer Credits
      • Brendan Bannon. Archive for the 'SIDA / AIDS' Category. Retrieved May 9, 2011 from http://www.msf-speakup.com/?cat=11
      • Alexandra Fazzina. The Perils of Childbirth In Delivery. TIME.Retrived May 4, 2011 from http://www.time.com/time/photogallery/0,29307,1842761_1766627,00.html
      • Food and Agriculture Organization of the United Nations. Map of Mozambique. Retrieved May 4, 2011 from http://www.fao.org/docrep/004/y3061e/image036.jpg
      • Probert Encyclopedia. Map of Afghanistan 1930. Retrieved May 4, 2011 from http://www.probertencyclopaedia.com/photolib/maps/Map%20of%20Afghanistan%201930.jpg
      • Women’s ITE Ministry. People In Circle. Retrived May 9 th , 2011 from http://itemwm.com/wp-content/uploads/women_3.jpg
      • Nick Czernkovich. Pregnant Woman Masisi. CBC. Retrived May 9, 2011 from http://www.cbc.ca/news/world/story/2010/06/18/f-africa-surgery.html
      • UK Forces Media Ops. Pregnant Woman in Naw-abad. Retrieved May 9 th , 2011 from http://4.bp.blogspot.com/_ac-M0_bqRHU/S56Ex-i42JI/AAAAAAAAAE8/cu3I6NpJoCE/s400/VME+15Mar10_000+163.jpg
    • Why HBLSS was chosen?
      • High maternal and newborn mortality rates
      • Lack of access to maternity services
      • Vulnerable, rural populations
      • Women not empowered to make decisions
      • Builds on MNCH platform
      • Easy to integrate messages
      • Participatory family/community approach
      A line is put into the arm of a woman suffering complications during childbirth at the Faizabad Maternity Hospital. Photo: Alexandra Fazzina
    • HBLSS Training Cascade
      • Master Trainers ( MOH and WV Staff)
      • TOTs-Trainers at target district level train CHWs
      • CHWs trained in 12 HBLSS Approach:
      • a) Participatory Community Meetings b)“hands-on” competency-based skills
      • CHWs train Family Birthing Teams in HBLSS through schedule of Community Meetings
      HBLSS training -Zindajan District
    • Training Plan
      • Five-day basic training
      • Use of pre- and post testing- skills
      • Teach through 12 Community Meetings- picture cards, role play and group feedback/evaluation
      • NO didactic- only learning through group meetings
      • Community Meetings integrate MNCH key messages
      • Competency-based skill development
      • Build in- Mentoring and refresher points
    • CHW Role
      • Home visits- integrate “timed and targeted” MNCH messages with HBLSS
      • Conduct Community HBLSS meetings with participation of Family Birthing Team (FBT) and Mothers Groups
      • Village Mother Support Groups assist CHWs with Community Meetings
      • Develop Birth preparation plans with FBT
      • Assist family with timely referrals to ANC, skilled delivery, complication, follow-up
      • Supervised by community midwife or senior CHW
      • Emergency HBLSS referral forms (complications, action taken, transport type)
      • Supportive supervision tool
      CHW Tools
      • MNCH integrated messages- check list
      • mPHone pregnancy and newborn modules: “prompts” for emergency complications and referral
    • CHW/HBLSS Outcomes
      • Maternal and newborn complications correctly assessed
      • Correct action is taken according to HBLSS Action Steps
      • Referral and transport forms correctly filled out and accompany client to HC
      • HC validation of CHW assessment and newborn registration
      • HC responsiveness- basic EmoC
      • Post HC follow-up visits and action taken
      Were the “three delays” decreased?