Increasing demand for maternal & newborn care practices and care seeking: Implementing evidence-based approaches

Increasing demand for maternal & newborn care practices and care seeking: Implementing evidence-based approaches Joseph de Graft-Johnson Newborn and Community Health Team Leader, MCHIP

Presentation Outline
Mention various demand creation approaches
Define Community Mobilization
Evidence for impact of CM on newborn outcomes
Country example of implementing community mobilization at scale

Demand Creation Approaches
Interpersonal Communication and Counseling
Health talks
Group Counseling
Mass Media
Social Mobilization
Community Mobilization

Definition of Community Mobilization
It is a capacity-building process through which community members, groups, or organizations plan, carry out, and evaluate activities on a participatory and sustained basis to improve their health and other conditions, either on their own initiative or stimulated by others
Source: Health Communication partnership

Common Methodology: Community Action Cycle (CAC) Explore MNH Situation and Set Priorities Organize The Community For Action Plan Together Act Together Evaluate Together

Where it all started: WARMI Project (1990-1993)
Community members and service providers capacity built to collect and collate data
Joint analysis and utilization of data for decision making
Develop action plans to improve key MNH/FP practices at both community and facility levels
Monitor progress and adjust strategies
Howard-Grabman 1993

WARMI: Key results
Reduced perinatal mortality 117/1000 to 43.8/1000 (65% reduction)
50% of babies breastfed on first day of life compared to 25%
However, the study had no control group – further research was needed
Howard-Grabman 1993

Robust Evidence 1: Makwanpur Project
RCT conducted in Nepal using adapted Warmi approach (2001-2003)
Both control and interventions sites received health system improvement
Only interventions sites implemented community mobilization activities through women’s groups
Results:
-- NMR -26/1000 vs 37/1000 live births (30% reduction)
-- MMR – 69/100000 vs 341/100000 (80% reduction)
Manandhar et al., 2004

Robust Evidence 2: Jharkhand and Orissa, India
RCT conducted in Jharkhand and Orissa, India using participatory learning and action cycle (2005-2008)
36 clusters: 18 intervention and 18 control sites
Intervention clusters:
-- Existing women’s groups identified (172) and new ones established (72) – one group/468 population
-- Groups facilitated by trained local woman and meeting monthly
Control clusters:
-- No engagement with women’s groups
Tripathy et al., 2010

Robust Evidence 2: Health System Input
Both control and interventions sites received health system inputs:
Formation of health committees
Met every 2 months
Used action cycle to discuss newborn health issues
Appreciative inquiry with frontline govt health staff

Robust Evidence 2: Results
NMR -- 32% reduction over 3 yrs (45% reduction over last 2 yrs)
Baseline: 55.6/1000 vs 53.4
Yr 2: 37.1/1000 vs 59.6/1000 live births
Yr 3: 36.3/1000 vs 64.3/1000 live births
Selected key health practices:
Handwashing: 41% vs 23%
Safe-delivery kit used: 32% vs 18%
Use boiled thread: 32% vs 11%
Care-seeking for sick newborn: 54% vs 44%
Exclusive breastfeeding: 80% vs 69%

Research to practice: Bangladesh experience
NGOs hired male and female ‘Community Mobilizers’
CM staff worked with existing groups and/or organized separate male and female groups in each target community
CMs involved health workers, but no joint-ownership of CM activities

Bangladesh results 1
61% of groups (721) generated community emergency funds
83% of groups (972) had emergency transportation systems
Groups established 12 new satellite clinics and 2 new EPI centers
Groups helped re-open 69 inactive or irregular clinics/centers

Bangladesh results 2

CM Resources for MNH

Conclusion
Community Mobilization contributes significantly to improved MNH household and care-seeking practices
CM is most often implemented by NGOs with limited geographic coverage
Advocacy is needed to ensure community mobilization is implemented at scale, incorporated into the national strategy, to improve MNH

Increasing demand for maternal & newborn care practices and care seeking: Implementing evidence-based approaches

by jehill3 on May 03, 2010

Accessibility

Categories

Tags

Upload Details

Usage Rights

1 Embed 2

Statistics

Increasing demand for maternal & newborn care practices and care seeking: Implementing evidence-based approaches — Presentation Transcript