Engaging Communities_Ane Adondiwo_5.8.14

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  • Comprehensive/integrated package for improving MCH, male involvement,CoCs influence,
  • Literacy rate of 42 percent compared with a national average of 62 percent. Maternal and Newborn Care 60% LOE, 2. Nutrition – 30, 3. Malaria 10% LOE. Poor road network especially during the raining season and inadequate family/community support for emergency referral.
  • Aimed improving staff capacity to provide quality care/partnership with communities to support care processes
  • Using CoC to address social norms.
  • The CETS and LP approach basically aimed ataddressing the second delay
  • Changed heading
  • Mobil phone penetrations quite high and so owners of motor-cycle owner are shared with with all families to call any time labor sets in or they want to refer a newborn to a health facility.
  • Engaging Communities_Ane Adondiwo_5.8.14

    1. 1. 1 Integration of Community Emergency Transport System with repositioning Traditional Birth Attendants as Link Providers improves skilled assisted childbirth in northern Ghana By Ane Adondiwo, EPPICS Project Manager Double Tree Hotel May 8, 2014
    2. 2. 2 Presentation Outline • Introduction • The Problem • Interventions • Performance Indicators • Lessons Learned • Conclusion • Next Steps 2
    3. 3. 3 Introduction Encouraging Positive Practices for Improving Child Survival (EPPICS) project targets 51,000 direct beneficiaries Goal: To contribute to reduction in maternal and child morbidity and mortality LOE: Maternal and newborn care (60%), nutrition (30%), and malaria (10%) 3
    4. 4. 4 Why East Mamprusi? MNCH/N Indicators EM, NR and National- 2010/11 East Mampr usi Northern Region Ghana Antenatal visits (1st trimester) 30 49 55 Antenatal visits(4+) 46 58 78 Supervised deliveries 48 38 46 IPT2+ 51 33 44 ITN use 36 45 Institutional MMR 275 95 - Under 5 Mortality Rate 138 137 80 4
    5. 5. 5 EPPICS Strategies • Quality Improvement Methods/Emergency Obstetric Care • Council of Champions • Healthy Mothers/Newborn Care Committees • Pregnancy Surveillance • Community Monitoring and Evaluation System • Repositioning Traditional Birth Attendants(TBAs) as Link Provider • Community Emergency Transport System(CETS) 5
    6. 6. 6 Facility-based Strategies 6 Quality Improvement Training Training on Emergency Obstetric Care
    7. 7. 7 Community-based Strategies 7 Council of Champions Healthy Mothers/Newborn Committees Photos by CRS Field Officers
    8. 8. 8 Community-based Strategies 8 Pregnancy Surveillance Photos by CRS Field Officers Community Giant Scoreboard
    9. 9. 9 The Problem of Access to Health Services 1. Inability to recognize the problem and promptly seek care 2. Inability to reach the point of care 3. Delay in receiving appropriate and quality care 60% of population in East Mamprusi have no access to health facilities (live outside 5KM radius)
    10. 10. 10 How did EPPICS tackle the 2nd Delay? Intervention # 1 Repositioning Traditional Birth Attendants(TBAs) as Link Providers 10
    11. 11. 11 Repositioning TBAs as Link Providers - The Process 11 1. Identify Active TBAs 2. Negotiate with TBAs to get them enrolled into EPPICS 3. Provide training/orientati on to TBAs including logistics/supplies 4. Monitor and supervise the work of Link Providers at the community level 5.GHS and CRS engage Link Providers in Quarterly Reflection meetings Improve access to skilled professionals at health facilities
    12. 12. 12 How did EPPICS tackle the 2nd Delay? Intervention # 2 Community Emergency Transport System 12
    13. 13. 13 1. Assessment and baseline data collection 2. Mobilization and sensitization of community members 3. Formation of Community Emergency Transport Committees (CETCs) The Community Emergency Transport Process
    14. 14. 14 4. Training of CETCs members &Identification and training of motorbikes and transport owners 5. Collection and provision phone #s of ambulances and motor- cycles/tricycles The Community Emergency Transport Process
    15. 15. 15 Facilitating Community Emergency Transport System - The Process 15 Map out all communities outside 5 Km 2. Mobilize and engage communities on various options for emergency transport 3. Facilitate the formation of CETS committees and provide orientation on roles/responsibilities 4. Monitor and supervise the activities of CETS members 5. Engage CETS members in feedback sessions Improve access to skilled professionals at health facilities
    16. 16. 16 Key outcome of the combined interventions 16
    17. 17. 17 Outcome of Interventions 17 48 86 0 10 20 30 40 50 60 70 80 90 100 Baseline-2011 Mar.2014 Percent Skilled Assisted Deliveries at Baseline and Mar.2014
    18. 18. 18 Other key improvements in the maternal and newborn health indicators 18
    19. 19. 19 Process Improvements - Referrals 19 Langbisi Gambaga Nalerigu Sakogu Gbintiri Current status 56 30 59 40 37 Baseline 9 24 8 14 8 0 10 20 30 40 50 60 70 80 Percent Referral of mothers and newborns linked to CETS and Link Providers Oct.2011-Mar.2014
    20. 20. 20
    21. 21. 21
    22. 22. 22
    23. 23. 23 Lessons Learned • Effective integration, community mobilization and empowerment are necessary for sustainability • Recognition, adoption and scale up by government and other NGOs will increase investment and access to health services • The two strategies have the potential of accelerating a reduction in maternal and newborn deaths • Health workers relationship with community members improved 23
    24. 24. 24 Challenges • Human resource -limited number of trained personnel -Staff attrition due to lack of social amenities • Role of other non-governmental organizations • Dwindling allocation of government funding • No expansion in physical infrastructure
    25. 25. 25 Next Steps • CRS with funding from Helmsley Charitable Trust has started scaling up CETS in six districts through a project dubbed “Rural Emergency Health Service and Transport” (REST) • Finalize guidelines and reference manuals for scaling up CETS • Work with the Ghana Health Service and other project partners/stakeholder to scale up CETS and Link Provider strategies 25
    26. 26. 26 Conclusions Based on the positive lessons learned:  CETS and Link Providers achieved the objective of helping to address the challenge of inability to reach the point of care on timely basis and;  CETS and Link Provider designs could pass as interventions that should be adopted as part of Millennium Accelerated Framework for maternal health in most districts with limited access to health facilities 26
    27. 27. 27 THANK YOU
    28. 28. 28 Acknowledgment: • USAID • Project Implementation Partners: Ghana Health Service and University for Development Studies • Chiefs and people of East Mamprusi District. Ghana • The Catholic Diocese of Navrongo Bolgatanga, Ghana • EPPICS Field Officers For more information contact: Mohammed Ali, Health Program Manager, email: mohammed.ali@crs.org or Ane Adondiwo, EPPICS Project Manager email:ane.adondiwo@crs.org

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