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

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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

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Demand Creation Approaches

Interpersonal Communication and Counseling

Health talks Group Counseling Mass Media Social Mobilization Community

Mobilization

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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

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Common Methodology: Community Action Cycle (CAC)

Explore MNH Explore MNH Situation Situation

and Set Prioritiesand Set Priorities

OrganizeOrganizeThe CommunityThe Community

For ActionFor Action

PlanPlanTogetherTogether

Act Act TogetherTogether

Evaluate Evaluate TogetherTogether

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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

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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

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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

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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

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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

Tripathy et al., 2010

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Robust Evidence 2: Results

NMR -- 32% reduction over 3 yrs (45% reduction over last 2 yrs)

Baseline: 55.6/1000 vs 53.4Yr 2: 37.1/1000 vs 59.6/1000 live birthsYr 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%

Tripathy et al., 2010

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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

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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

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Bangladesh results 2

0

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60

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80

90

NBperson

Nothingon Cord

Dried &Wrapped

BF first hr Delayedbath

Baseline

March-09

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CM Resources for MNH

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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