Effectiveness of Community-based Primary Health Care: A Participatory Discussion of Program Implications PAUL FREEMAN and HENRY PERRY Part 4

1. Neonatal Health
108 reports included neonatal health
outcomes

2. Sepsis: major cause of neonatal mortality and can be
effectively addressed by community-based programs
Effective community-based interventions
• Balanced energy supplementation (during pregnancy)
• Micronutrient supplementation (during pregnancy)
• Maternal immunization against neonatal tetanus
• Labor and delivery management
• Clean post-natal practices
• Thermal care
• Chlorhexidene application to the umbilical cord
• Exclusive breastfeeding
• Oral antibiotics for newborn infection

3. Home-based neonatal care
• Management of birth asphyxia
• Promotion of immediate and exclusive
breastfeeding
• Promotion of cleanliness
• Application of topical antiseptic to the umbilical
cord
• Prevention of hypothermia
• Diagnosis and treatment or referral of neonatal
sepsis by Community Health Workers

4. Home-based neonatal care
• Management of birth asphyxia
• Promotion of immediate and exclusive
breastfeeding
• Promotion of cleanliness
• Application of topical antiseptic to the umbilical
cord
• Prevention of hypothermia
• Diagnosis and treatment of neonatal sepsis by
Community Health Workers

5. Strategies
• Home visitation by CHWs for education in relation to
prevention, recognition of danger signs, and early
treatment/referral of neonates with serious illnesses
• Community-based management and early referral by
CHWs for neonatal sepsis
• Participatory women’s groups (Participatory Learning and
Action Groups and Care Groups especially) to raise
awareness about healthy practices during pregnancy and
for the newborn, and to raise awareness of danger signs for
which facility-based care should be sought
• Outreach from health facilities especially for antenatal care
and maternal immunization against neonatal tetanus

6. Interventions among 108 articles in
dataset
N % (of 108)
Neonatal/perinatal
health 77 71
Breastfeeding 46 43
Child weight/ height
(LBW) 34 31
Primary health care 26 24
Immunizations 24 22
Diarrhea treatment 24 22
IMCI 23 21

7. Common associated activities
N % (of 103)
Training CHWs 85 82
Formation of
support groups 41 39
Participatory rural
appraisal 10 9
Income generation 7 6
Microcredit 2 2
Conditional cash
transfer 1 1

8. Common processes
N % (of 103)
Community
empowerment 65 63
Promoting partnerships
community and health
system 58 56
Local resource use 58 56
Women’s
empowerment 56 54
Promotion of leadership 49 47
Adaptive learning 29 28
Promotion of equity 27 26

9. • Did the study show that community participation
had an effect on outcome?
– 64% (N=68 out of 107) reported YES, and ALL of those
reported a positive result
• Did the study show that linkages between the health
system and community had an effect on outcome?
– 56% (N=60 out of 107) reported YES and 95%(N=57 out of
60) of those reported a positive result