Mazia Chw Honduras
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CORE Group Fall Meeting 2010. Working in newborn health with community agents in Honduras – the success of a NGO network. - Goldy Mazia, MCHIP

CORE Group Fall Meeting 2010. Working in newborn health with community agents in Honduras – the success of a NGO network. - Goldy Mazia, MCHIP

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Mazia Chw Honduras Mazia Chw Honduras Presentation Transcript

  • Working in newborn health with community agents in Honduras – the success of a NGO network Goldy Mazia, MD, MPH CORE Group Fall Meeting Washington, DC September 15, 2010
  • Background of BASICS work in Honduras (2006-2009)
      • With partners (USAID, PAHO, BASICS, CORE, ACCESS, SNL, HCI & UNICEF- now LAC Newborn Health Alliance) developed the LAC Interagency Strategic Consensus and a regional plan of action to promote newborn health (approved at the 2008 PAHO Directing Council meeting- res CD48.R4)
      • Under a regional approach and with partners in 3 countries BASICS operationalized one important element of the LAC regional strategy- prevention and treatment of neonatal sepsis (main cause of death)
        • Honduras: Community level ; El Salvador and the Dominican Republic: Facility level
        • Methodology: selected elements of quality improvement and collaborative strategies of URC/HCI - QI teams in hospitals/NGOs with in-country and HQ technical support; distance learning sessions ( Elluminate -CORE Group)
  • Maternal and newborn health in Honduras
    • High maternal and perinatal mortality rates (108/100,000 and 25-33/1,000)
    • 30% of women in rural areas give birth with TBAs
    • High proportion of home deliveries in underserved areas (La Paz 53%, Intibuca 54%) - NMR in La Paz 34/1,000
    DHS Honduras 2005-2006
  • Honduras Community Based Strategies
    • BASICS promoted coordination of activities among 9 NGOs to implement a standardized newborn health module that included
        • home visits in the first 72 hours
        • Prevention of infection as a part of preventive ENC
        • Identification of minor and danger signs of major infections
          • care-seeking/referral
          • Where feasible, treatment of minor infections and
          • First dose of antibiotics before referral
    • NGOs were encouraged to implement work with their own delivery platforms and their individual types of CHWs (“monitores” (AIN-C), rural pharmacies volunteers, TBAs) and/or community mobilization groups
  • Honduras Community Based Activities
    • Workshops for standardization of training and supervision tools related to newborn care among NGOs
    • Strengthening of ENC knowledge and skills of CHWs
    • Coordination of various NGO’s CHW working in same geographic areas
    • Cross-fertilization of strategies among NGOs
    • Participation in Elluminate sessions for technical updates and sharing of results and experiences (with countries in facility-based intervention)
    • NGOs in the initiative were invited by MOH to develop the community-based model for the National Strategy for Accelerating the Reduction of Maternal and Newborn Mortality (RAMNI) based on this experience
  • Community Intervention: Some Baseline Findings & Areas For Action
    • Mothers/families (100 mothers with babies < 3 mo.)
      • 16% used harmful substances on the cord (i.e. cooking oil, camphor, chicken fat)
      • 48% attended post-partum care visits; only 11% in the first week
    • Knowledge/skills observations of 48 AIN-C “monitores” :
      • Weakest counseling areas: elements of ENC and danger signs
    • Knowledge and practices of 36 “parteras”
      • Only 50% practiced all the recommended ENC elements at birth
    • Intervention identified: strengthen capacity of NGOs to improve knowledge and skills of CHWs, TBAs and volunteer mothers
  • Proportion of all Newborns in the Community evaluated within 3 days of birth (CCF) January 2008 – April 2009 20% of babies evaluated (66/338) had danger signs and were referred to a facility. Three of those babies died (4.5% case fatality ratio)
  • Expansion 2007 2008 Participating NGOs 5 9 Municipalities 16 40 Provinces 3 10 Population 142,532 648,987
  • Some lessons learned
    • NGOs with different delivery strategies with the help of a coordinating mechanism can adapt a newborn care module and work together for quick expansion
    • NGOs with diverse areas of expertise can exchange capacity building strategies and other resources
    • Political will for community interventions and for support of CHWs is important. In Honduras the MOH supports strategies and CHW activities such as:
      • Administration of 1 st dose of oral antibiotic to newborns with danger signs before referral (AIN-C manuals)
      • Attending normal deliveries by TBAs where there are no other options (MOH norms)
  • Red Cross Proyecto Aldea Global Thank you
  • The preceding slides were presented at the CORE Group 2010 Fall Meeting Washington, DC To see similar presentations, please visit: www.coregroup.org/resources/meetingreports