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Afghanistan  Mozambique  Sudan WORLD VISION MNCH PROJECTS HBLSS INTEGRATION
MNCH Programs with HBLSS Integration  <ul><li>Afghanistan:  MNCH in rural Herat </li></ul><ul><li>Integrated CHW HBLSS tra...
How: MNCH and HBLSS Integration <ul><li>MNCH platforms </li></ul><ul><li>CHW training </li></ul><ul><li>Mother Support Gro...
HBLSS Adaptations <ul><li>All CHW training takes place within “community participatory meetings”-  in local language </li>...
Lessons Learned <ul><li>Adaptations  needed: </li></ul><ul><li>Cultural  </li></ul><ul><li>Rural/remote areas </li></ul><u...
Lessons Learned- continued <ul><li>Buy-in: </li></ul><ul><li>Provincial and district level- prior approval </li></ul><ul><...
Challenges Mozambique Security & remote areas Supportive supervision by local midwives Afghanistan Long distances between ...
Training Cost (example) <ul><li>Afghanistan: </li></ul><ul><li>Master trainers- 4  </li></ul><ul><li>TOTs- 18 </li></ul><u...
<ul><li>Recommendations </li></ul><ul><li>Community assessments for HBLSS design </li></ul><ul><li>Start out small-  a pil...
Surprises! (or not) <ul><li>Conducive to mPhone technology /design </li></ul><ul><li>Initiative taken by communities to in...
Thank You! <ul><li>Photographer Credits </li></ul><ul><li>Brendan Bannon. Archive for the 'SIDA / AIDS' Category. Retrieve...
Why HBLSS was chosen? <ul><li>High maternal and newborn mortality rates </li></ul><ul><li>Lack of access to maternity serv...
HBLSS Training Cascade <ul><li>Master Trainers ( MOH and WV Staff) </li></ul><ul><li>TOTs-Trainers at target district leve...
Training Plan <ul><li>Five-day  basic training </li></ul><ul><li>Use  of pre- and post testing- skills </li></ul><ul><li>T...
CHW Role <ul><li>Home visits- integrate “timed and targeted” MNCH messages with HBLSS </li></ul><ul><li>Conduct Community ...
<ul><li>Emergency HBLSS referral forms (complications, action taken,  transport type) </li></ul><ul><li>Supportive supervi...
CHW/HBLSS Outcomes <ul><li>Maternal and newborn complications correctly assessed </li></ul><ul><li>Correct action is taken...
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Adapting HBLSS to Fit Your Program_Kruger_5.11.11

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Transcript of "Adapting HBLSS to Fit Your Program_Kruger_5.11.11"

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