HBLSS:  Improving on Innovation
HBLSS Elevator Speech <ul><li>Family-focused community mobilization program </li></ul><ul><li>Series of facilitated commun...
<ul><li>Step 1:  Review the previous meeting </li></ul><ul><li>Step 2:  Ask what participants know and do when they    see...
Problem Side Action Side Key Tool: Take Action Cards
HBLSS Strengths <ul><li>Low-tech and sustainable </li></ul><ul><li>Skills-based, participatory </li></ul><ul><li>Designed ...
Evidence to date <ul><li>Community members are able to retain information following the training </li></ul><ul><ul><li>Enh...
Skills Demonstration of Community Facilitators Pre-training Post-training 1-yr. post-training
Ability to Respond to  Identified Complications Unexposed Exposed
Other Positive Results <ul><li>Creates a sustainable community resource </li></ul><ul><li>Improves problem recognition </l...
India Ethiopia (Liben) Ethiopia (Harag) Afghanistan Tibet Ghana Haiti Liberia Bangladesh Kenya Zambia Guatemala India Paki...
Perceived weaknesses <ul><li>Rigid, cumbersome, expensive & un-scalable </li></ul><ul><li>Limited pool of master trainers ...
Combating Perceptions & Reality <ul><li>Rigidity </li></ul><ul><ul><li>Promote the adaptability of HBLSS as a strength – r...
Combating Perceptions & Reality <ul><li>Two key endeavors:  </li></ul><ul><li>Collaborative 2 nd  edition Revision  </li><...
2 nd  Edition Key Objectives & Methods <ul><li>Seek expanded input from those with HBLSS implementation experience </li></...
2 nd  Edition Key Objectives & Methods <ul><li>Clarify methodology at the outset, make it more accessible </li></ul><ul><u...
2 nd  Edition Key Objectives & Methods <ul><li>Update technical information  </li></ul><ul><ul><li>Reviewed evidence base ...
Perceived weaknesses <ul><li>Rigid , cumbersome, expensive & un-scalable </li></ul><ul><li>Limited pool of master trainers...
ACNM/CORE Joint Initiative:  Basic Premise   A model to create a household-to-hospital continuum of care capable of reduci...
ACNM/CORE Joint Initiative:  5 yr Overview <ul><li>Year 1: Repackaging of HBLSS materials </li></ul><ul><li>Years 2-4: 4 i...
ACNM/CORE Joint Initiative:  Yr1: Repackage & Rebrand HBLSS <ul><li>Steering committee will leverage collective experience...
ACNM/CORE Joint Initiative:  Yr1: Repackage & Rebrand HBLSS <ul><li>Renewed focus on  </li></ul><ul><ul><ul><li>Streamline...
ACNM/CORE Joint Initiative:  Yr 2: Implementation and Outcomes Research <ul><li>Goal:  </li></ul><ul><li>Yield credibly fi...
ACNM/CORE Joint Initiative:  Yr 2: Implementation and Outcomes Research <ul><li>Grantees will conduct research on process ...
ACNM/CORE Joint Initiative:  Dissemination <ul><li>Partners will analyze data, synthesize lessons, and refine model and to...
Perceived weaknesses <ul><li>Rigid, cumbersome, expensive & un-scalable </li></ul><ul><li>Limited pool of master trainers ...
<ul><li>Work to ensure that all births are accompanied by skilled attendants must continue, but the needs of women and the...
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HBLSS: Improving on Innovation

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HBLSS: Improving on Innovation

American College of Nurse Midwives

Safe Motherhood and Reproductive Health Working Group Showcase

CORE Group Spring Meeting, April 29, 2010

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  • TAC is adapted in country and needs to happen!
  • 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
  • For all these positive results, in 10 years it’s only reached 15 countries, and to widely varying degrees of scale. Something needs to change.
  • 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
  • HBLSS: Improving on Innovation

    1. 1. HBLSS: Improving on Innovation
    2. 2. HBLSS Elevator Speech <ul><li>Family-focused community mobilization program </li></ul><ul><li>Series of facilitated community meetings to discuss and form action plans around individual topics to promote self care & effective referral </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>
    3. 3. <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 Core Methodology
    4. 4. Problem Side Action Side Key Tool: Take Action Cards
    5. 5. HBLSS Strengths <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 while recognizing & respecting traditional practices </li></ul><ul><li>Can be used for any community issue (e.g., water & sanitation, TB, malaria) </li></ul><ul><li>Transformative </li></ul>
    6. 6. 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>
    7. 7. Skills Demonstration of Community Facilitators Pre-training Post-training 1-yr. post-training
    8. 8. Ability to Respond to Identified Complications Unexposed Exposed
    9. 9. Other Positive Results <ul><li>Creates a sustainable community resource </li></ul><ul><li>Improves problem recognition </li></ul><ul><li>Initiates earlier referral of complications </li></ul><ul><li>Increases team work and better working relations between community-based providers/TBAs & clinic/hospital staff </li></ul><ul><li>Puts systems in place to track maternal & infant morbidity and mortality </li></ul><ul><li>Generates support of community leaders and members </li></ul><ul><li>Promotes change in peoples’ attitudes related to reproductive health and the value of individual life </li></ul><ul><li>Leads to inclusion of men in the birth process </li></ul>
    10. 10. 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
    11. 11. Perceived weaknesses <ul><li>Rigid, cumbersome, expensive & un-scalable </li></ul><ul><li>Limited pool of master trainers </li></ul><ul><li>Promotes obstetrical first aid & home birth over skilled attendance at birth </li></ul><ul><li>Inconsistent feel of materials; expense & accessibility of materials </li></ul><ul><li>Methodology not readily apparent </li></ul><ul><li>Concerns r/t evidence based practices </li></ul>
    12. 12. Combating Perceptions & Reality <ul><li>Rigidity </li></ul><ul><ul><li>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! </li></ul></ul><ul><ul><li>Communities can choose priorities </li></ul></ul><ul><ul><li>Modular formatting aids ability to mix and match </li></ul></ul>
    13. 13. Combating Perceptions & Reality <ul><li>Two key endeavors: </li></ul><ul><li>Collaborative 2 nd edition Revision </li></ul><ul><li>ACNM/CORE joint HBLSS initiative </li></ul>
    14. 14. 2 nd Edition Key Objectives & Methods <ul><li>Seek expanded input from those with HBLSS implementation experience </li></ul><ul><li>Follow collaborative model of revision </li></ul><ul><ul><li>Asked for broad stroke recommendations from wide field of users </li></ul></ul><ul><ul><li>A core group discussed & made changes </li></ul></ul><ul><ul><li>Edited version went back to wide field for review & comments </li></ul></ul><ul><ul><li>Comments discussed & incorporated by core group </li></ul></ul>
    15. 15. 2 nd Edition Key Objectives & Methods <ul><li>Clarify methodology at the outset, make it more accessible </li></ul><ul><ul><li>New ‘process explanation’ and introduction </li></ul></ul><ul><li>Produce consistent look and feel of materials </li></ul><ul><ul><li>Hired professional editor </li></ul></ul><ul><ul><li>Chose standard format to use with all meetings </li></ul></ul>
    16. 16. 2 nd Edition Key Objectives & Methods <ul><li>Update technical information </li></ul><ul><ul><li>Reviewed evidence base & updated references </li></ul></ul><ul><li>Add new proven interventions </li></ul><ul><ul><li>Misoprostal </li></ul></ul><ul><li>Make materials more accessible </li></ul><ul><ul><li>Previously laminated large picture cards will be printed in bound book </li></ul></ul><ul><ul><li>All materials will be available free of charge in pdf format on website; possibly sold via Hesperian in the future </li></ul></ul>
    17. 17. Perceived weaknesses <ul><li>Rigid , cumbersome, expensive & un-scalable </li></ul><ul><li>Limited pool of master trainers </li></ul><ul><li>Promotes obstetrical first aid & home birth over skilled attendance at birth </li></ul><ul><li>Inconsistent feel of materials; expense & accessibility of materials </li></ul><ul><li>Methodology not readily apparent </li></ul><ul><li>Concerns r/t evidence based practices </li></ul>
    18. 18. 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
    19. 19. ACNM/CORE Joint Initiative: 5 yr Overview <ul><li>Year 1: Repackaging of HBLSS materials </li></ul><ul><li>Years 2-4: 4 implementation sub-grants awarded; implementation and outcomes research carried out </li></ul><ul><li>Year 5: Wrap-up and Dissemination </li></ul>
    20. 20. ACNM/CORE Joint Initiative: Yr1: Repackage & Rebrand HBLSS <ul><li>Steering committee will leverage collective experience and expertise of </li></ul><ul><ul><li>ACNM </li></ul></ul><ul><ul><li>CORE Community Health Network </li></ul></ul><ul><ul><ul><li>SMRH working group </li></ul></ul></ul><ul><ul><ul><li>Social and behavior change working group </li></ul></ul></ul><ul><ul><ul><li>M&E working group </li></ul></ul></ul>
    21. 21. ACNM/CORE Joint Initiative: Yr1: Repackage & Rebrand HBLSS <ul><li>Renewed focus on </li></ul><ul><ul><ul><li>Streamlined design of materials, training cascade, & M&E tools </li></ul></ul></ul><ul><ul><ul><li>Practical program guidance </li></ul></ul></ul><ul><ul><ul><li>Adaptability, Scalability </li></ul></ul></ul><ul><li>Evaluate need for name change </li></ul><ul><li>Co-brand all materials with ACNM/CORE logos </li></ul><ul><li>1 staff from ACNM & CORE will be dedicated ½ time to this project </li></ul>
    22. 22. ACNM/CORE Joint Initiative: Yr 2: Implementation and Outcomes Research <ul><li>Goal: </li></ul><ul><li>Yield credibly field tested product that can perform in diverse settings & foster ownership among wide array of stakeholders </li></ul><ul><li>Plan: </li></ul><ul><li>Put out call for applications to all CORE members to compete for 4, 3 year implementation sub-grants </li></ul>
    23. 23. ACNM/CORE Joint Initiative: Yr 2: Implementation and Outcomes Research <ul><li>Grantees will conduct research on process & outcomes of repackaged model using incorporated M&E tools </li></ul><ul><li>M&E experts will assist to ensure effectiveness of research protocols & data collection tools/methods </li></ul><ul><li>ACNM/CORE staff will visit implementation sites </li></ul>
    24. 24. ACNM/CORE Joint Initiative: Dissemination <ul><li>Partners will analyze data, synthesize lessons, and refine model and tools as needed. </li></ul><ul><li>Dissemination will target a range of global health channels and networks & use a variety of media. </li></ul>
    25. 25. Perceived weaknesses <ul><li>Rigid, cumbersome, expensive & un-scalable </li></ul><ul><li>Limited pool of master trainers </li></ul><ul><li>Promotes obstetrical first aid & home birth over skilled attendance at birth </li></ul><ul><li>Inconsistent feel of materials; expense & accessibility of materials </li></ul><ul><li>Methodology not readily apparent </li></ul><ul><li>Concerns r/t evidence based practices </li></ul>
    26. 26. <ul><li>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 </li></ul>

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