Adapting HBLSS to Fit Your Program_Stalls_5.11.11


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  • Positive feedback mechanism; increased chance of participation
  • Pay attention to TAC and to Steps in a meeting (do this at end of presentation)
  • TAC is adapted in country and needs to happen!
  • Adapting HBLSS to Fit Your Program_Stalls_5.11.11

    1. 1. HBLSS: An Overview of Methodology and Applications
    2. 2. Pathway to Survival Source: Adapted from MotherCare 1995. P r o b l e m Recognizing Problem Receiving First Aid Care Deciding to Seek Care Reaching Care Receiving Quality EmOC S u r v i v a l Family & Community Referral Site
    3. 3. Home-Based Life-Saving Skills <ul><li>A family-focused community mobilization program that aims to: </li></ul><ul><ul><li>Improve problem recognition and first aid response to maternal and newborn complications </li></ul></ul><ul><ul><li>Increase timely access to EmONC (where available) </li></ul></ul><ul><li>Draws heavily upon the WARMI methodology which has demonstrated significant reduction in perinatal mortality, but HBLSS also includes first aid care </li></ul>
    4. 4. HBLSS Essential Elements <ul><li>Low-tech and sustainable </li></ul><ul><li>Skills-based, participatory </li></ul><ul><li>Designed for non- or low-literate participants </li></ul><ul><li>Uses a step-wise process that works towards safe, acceptable practices that will be used when needed </li></ul><ul><li>Can be used for any community issue (e.g., water & sanitation, TB, malaria) </li></ul>
    5. 6. Unique Characteristics <ul><li>Multiple subtle cues set the stage for collaboration and respect for all types of knowing </li></ul><ul><li>Content repeated multiple times in multiple ways to enhance retention: hear, see, and do </li></ul><ul><li>Key facilitation skills build bridges between what community knows and what “advisors” know </li></ul><ul><li>Behaviors/actions are agreed upon as response to problem recognition </li></ul><ul><li>Facilitator is able to negotiate with community members to incorporate actions that the community wishes to continue </li></ul>
    6. 7. HBLSS Methodology <ul><li>Clinically simple content with exacting process </li></ul><ul><li>Series of facilitated community meetings to discuss individual topics </li></ul><ul><ul><li>Women problems: Too much bleeding, birth delay sickness with pain and fever, swelling and fits, too many children </li></ul></ul><ul><ul><li>Baby problems: Trouble breathing at birth, baby too small, baby is sick </li></ul></ul><ul><ul><li>Preventing problems: self-care, family planning (LAM), PMTCT </li></ul></ul><ul><ul><li>Referral </li></ul></ul><ul><li>Communities prioritize which topics they view as the most important and common problems </li></ul>
    7. 8. Applying HBLSS Methodology <ul><li>Process can be adapted to any area of health: pediatrics, primary care, adult care or any particular disease process such as HIV/AIDS, avian flu, diabetes </li></ul><ul><li>Recently adapted to curriculum of Africa Centre for Holistic Management, an organization in Zimbabwe dedicated to land restoration in semi-arid/arid climates. Africare and Land o’Lakes (Africa) interested in using methodology for similar community programs. </li></ul><ul><li>Use of methodology is crucial to adaptation of new approaches and behaviors </li></ul>
    8. 9. <ul><li>Whoever will be present at the time of birth </li></ul><ul><ul><li>Pregnant women </li></ul></ul><ul><ul><li>Family caregivers </li></ul></ul><ul><ul><li>Birth attendants </li></ul></ul><ul><ul><li>Community leaders </li></ul></ul><ul><ul><li>Referral facility staff </li></ul></ul>Who Participates?
    9. 10. <ul><li>Step 1: Review the previous meeting </li></ul><ul><li>Step 2: Ask what participants know and do when they see particular problems </li></ul><ul><li>Step 3: Share what trained health workers know and do when they see those problems </li></ul><ul><li>Step 4: Come to agree on what to do: negotiation </li></ul><ul><li>Step 5: Practice the (agreed) actions </li></ul><ul><li>Step 6: Discuss how to know if the actions are helpful </li></ul><ul><li>Step 7: Decide how to prevent the problem </li></ul>Interactive Community Meetings
    10. 11. Problem Side Action Side Take Action Card Bleeding Too Much After Baby is Born
    11. 13. Focus group comments <ul><li>“ In the past we sat and watched with an emergency, now we can seek help.” </li></ul><ul><li>“ We are happy that HHF is working here, women are not dying, and we are proud to be so knowledgeable.” </li></ul><ul><li>“ When women used to bleed, we used to stick things inside, now we know to take the road to the hospital.” </li></ul><ul><li>“ I used the Take Action Card booklet with women who did not attend the training and they understand.” </li></ul><ul><li>“ Now we know what to do when a baby is not breathing. It has shone light on us.” </li></ul><ul><li>“ We hope to never tell Regine’s story again.” </li></ul>
    12. 14. Evidence to date <ul><li>Community members are able to retain information following the training </li></ul><ul><ul><li>Enhancing problem recognition </li></ul></ul><ul><li>Community members who are exposed to HBLSS are more likely to take action to: </li></ul><ul><ul><li>Provide first aid to respond to a complication </li></ul></ul><ul><ul><li>Refer women to a facility </li></ul></ul><ul><li>Community is supportive and actively engaged in MNH issues </li></ul>
    13. 15. Program presentations <ul><li>Integration into existing programs </li></ul><ul><li>Lessons learned </li></ul><ul><li>Adaptations </li></ul><ul><li>Challenges </li></ul><ul><li>Costs </li></ul><ul><li>Recommendations </li></ul><ul><li>Surprises </li></ul>