HBLSS: Improving on Innovation

HBLSS Elevator Speech
Family-focused community mobilization program
Series of facilitated community meetings to discuss and form action plans around individual topics to promote self care & effective referral
Women problems: Too much bleeding, birth delay sickness with pain and fever, swelling and fits, too many children
Baby problems: Trouble breathing at birth, baby too small, baby is sick
Preventing problems: self-care, family planning (LAM), PMTCT
Referral

Step 1: Review the previous meeting
Step 2: Ask what participants know and do when they see particular problems
Step 3: Share what trained health workers know and do when they see those problems
Step 4: Come to agree on what to do: negotiation
Step 5: Practice the (agreed) actions
Step 6: Discuss how to know if the actions are helpful
Step 7: Decide how to prevent the problem
Interactive Community Meetings Core Methodology

Problem Side Action Side Key Tool: Take Action Cards

HBLSS Strengths
Low-tech and sustainable
Skills-based, participatory
Designed for non- or low-literate participants
Uses a step-wise process that works towards safe, acceptable practices while recognizing & respecting traditional practices
Can be used for any community issue (e.g., water & sanitation, TB, malaria)
Transformative

Evidence to date
Community members are able to retain information following the training
Enhancing problem recognition
Community members who are exposed to HBLSS are more likely to take action to:
Provide first aid to respond to a complication
Refer women to a facility
Community is supportive and actively engaged in MNH issues

Skills Demonstration of Community Facilitators Pre-training Post-training 1-yr. post-training

Ability to Respond to Identified Complications Unexposed Exposed

Other Positive Results
Creates a sustainable community resource
Improves problem recognition
Initiates earlier referral of complications
Increases team work and better working relations between community-based providers/TBAs & clinic/hospital staff
Puts systems in place to track maternal & infant morbidity and mortality
Generates support of community leaders and members
Promotes change in peoples’ attitudes related to reproductive health and the value of individual life
Leads to inclusion of men in the birth process

India Ethiopia (Liben) Ethiopia (Harag) Afghanistan Tibet Ghana Haiti Liberia Bangladesh Kenya Zambia Guatemala India Pakistan Ethiopia (Somali) Tanzania Niger, Peru, and Cameroon In planning stage Expansion of HBLSS Programs

Perceived weaknesses
Rigid, cumbersome, expensive & un-scalable
Limited pool of master trainers
Promotes obstetrical first aid & home birth over skilled attendance at birth
Inconsistent feel of materials; expense & accessibility of materials
Methodology not readily apparent
Concerns r/t evidence based practices

Combating Perceptions & Reality
Rigidity
Promote the adaptability of HBLSS as a strength – recently adapted in Zimbabwe to address land restoration. Elegance is in the method, content can be changed!
Communities can choose priorities
Modular formatting aids ability to mix and match

Combating Perceptions & Reality
Two key endeavors:
Collaborative 2 nd edition Revision
ACNM/CORE joint HBLSS initiative

2 nd Edition Key Objectives & Methods
Seek expanded input from those with HBLSS implementation experience
Follow collaborative model of revision
Asked for broad stroke recommendations from wide field of users
A core group discussed & made changes
Edited version went back to wide field for review & comments
Comments discussed & incorporated by core group

Clarify methodology at the outset, make it more accessible
New ‘process explanation’ and introduction
Produce consistent look and feel of materials
Hired professional editor
Chose standard format to use with all meetings

Update technical information
Reviewed evidence base & updated references
Add new proven interventions
Misoprostal
Make materials more accessible
Previously laminated large picture cards will be printed in bound book
All materials will be available free of charge in pdf format on website; possibly sold via Hesperian in the future

Rigid , cumbersome, expensive & un-scalable

ACNM/CORE Joint Initiative: Basic Premise A model to create a household-to-hospital continuum of care capable of reducing maternal & neonatal morbidity and mortality is not widely available in a field friendly program package HBLSS IS POISED TO BE THAT PACKAGE

ACNM/CORE Joint Initiative: 5 yr Overview
Year 1: Repackaging of HBLSS materials
Years 2-4: 4 implementation sub-grants awarded; implementation and outcomes research carried out
Year 5: Wrap-up and Dissemination

ACNM/CORE Joint Initiative: Yr1: Repackage & Rebrand HBLSS
Steering committee will leverage collective experience and expertise of
ACNM
CORE Community Health Network
SMRH working group
Social and behavior change working group
M&E working group

ACNM/CORE Joint Initiative: Yr1: Repackage & Rebrand HBLSS
Renewed focus on
Streamlined design of materials, training cascade, & M&E tools
Practical program guidance
Adaptability, Scalability
Evaluate need for name change
Co-brand all materials with ACNM/CORE logos
1 staff from ACNM & CORE will be dedicated ½ time to this project

ACNM/CORE Joint Initiative: Yr 2: Implementation and Outcomes Research
Goal:
Yield credibly field tested product that can perform in diverse settings & foster ownership among wide array of stakeholders
Plan:
Put out call for applications to all CORE members to compete for 4, 3 year implementation sub-grants

ACNM/CORE Joint Initiative: Yr 2: Implementation and Outcomes Research
Grantees will conduct research on process & outcomes of repackaged model using incorporated M&E tools
M&E experts will assist to ensure effectiveness of research protocols & data collection tools/methods
ACNM/CORE staff will visit implementation sites

ACNM/CORE Joint Initiative: Dissemination
Partners will analyze data, synthesize lessons, and refine model and tools as needed.
Dissemination will target a range of global health channels and networks & use a variety of media.

Rigid, cumbersome, expensive & un-scalable

Work to ensure that all births are accompanied by skilled attendants must continue, but the needs of women and their infants who deliver in the absence of a skilled attendant must not be ignored as a result. This proposed package can be put into action immediately, contributing to reducing maternal & neonatal mortality, empowering communities, and fostering a stronger continuum of care

HBLSS: Improving on Innovation

by jehill3

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