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

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Mazia Chw Honduras

  1. 1. 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
  2. 2. Background of BASICS work in Honduras (2006-2009) <ul><ul><li>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) </li></ul></ul><ul><ul><li>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) </li></ul></ul><ul><ul><ul><li>Honduras: Community level ; El Salvador and the Dominican Republic: Facility level </li></ul></ul></ul><ul><ul><ul><li>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) </li></ul></ul></ul>
  3. 3. Maternal and newborn health in Honduras <ul><li>High maternal and perinatal mortality rates (108/100,000 and 25-33/1,000) </li></ul><ul><li>30% of women in rural areas give birth with TBAs </li></ul><ul><li>High proportion of home deliveries in underserved areas (La Paz 53%, Intibuca 54%) - NMR in La Paz 34/1,000 </li></ul>DHS Honduras 2005-2006
  4. 4. Honduras Community Based Strategies <ul><li>BASICS promoted coordination of activities among 9 NGOs to implement a standardized newborn health module that included </li></ul><ul><ul><ul><li>home visits in the first 72 hours </li></ul></ul></ul><ul><ul><ul><li>Prevention of infection as a part of preventive ENC </li></ul></ul></ul><ul><ul><ul><li>Identification of minor and danger signs of major infections </li></ul></ul></ul><ul><ul><ul><ul><li>care-seeking/referral </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Where feasible, treatment of minor infections and </li></ul></ul></ul></ul><ul><ul><ul><ul><li>First dose of antibiotics before referral </li></ul></ul></ul></ul><ul><li>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 </li></ul>
  5. 5. Honduras Community Based Activities <ul><li>Workshops for standardization of training and supervision tools related to newborn care among NGOs </li></ul><ul><li>Strengthening of ENC knowledge and skills of CHWs </li></ul><ul><li>Coordination of various NGO’s CHW working in same geographic areas </li></ul><ul><li>Cross-fertilization of strategies among NGOs </li></ul><ul><li>Participation in Elluminate sessions for technical updates and sharing of results and experiences (with countries in facility-based intervention) </li></ul><ul><li>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 </li></ul>
  6. 6. Community Intervention: Some Baseline Findings & Areas For Action <ul><li>Mothers/families (100 mothers with babies < 3 mo.) </li></ul><ul><ul><li>16% used harmful substances on the cord (i.e. cooking oil, camphor, chicken fat) </li></ul></ul><ul><ul><li>48% attended post-partum care visits; only 11% in the first week </li></ul></ul><ul><li>Knowledge/skills observations of 48 AIN-C “monitores” : </li></ul><ul><ul><li>Weakest counseling areas: elements of ENC and danger signs </li></ul></ul><ul><li>Knowledge and practices of 36 “parteras” </li></ul><ul><ul><li>Only 50% practiced all the recommended ENC elements at birth </li></ul></ul><ul><li>Intervention identified: strengthen capacity of NGOs to improve knowledge and skills of CHWs, TBAs and volunteer mothers </li></ul>
  7. 7. 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)
  8. 8. Expansion 2007 2008 Participating NGOs 5 9 Municipalities 16 40 Provinces 3 10 Population 142,532 648,987
  9. 9. Some lessons learned <ul><li>NGOs with different delivery strategies with the help of a coordinating mechanism can adapt a newborn care module and work together for quick expansion </li></ul><ul><li>NGOs with diverse areas of expertise can exchange capacity building strategies and other resources </li></ul><ul><li>Political will for community interventions and for support of CHWs is important. In Honduras the MOH supports strategies and CHW activities such as: </li></ul><ul><ul><li>Administration of 1 st dose of oral antibiotic to newborns with danger signs before referral (AIN-C manuals) </li></ul></ul><ul><ul><li>Attending normal deliveries by TBAs where there are no other options (MOH norms) </li></ul></ul>
  10. 10. Red Cross Proyecto Aldea Global Thank you
  11. 11. 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

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