The development of a new accountability measurement framework and tool for global health initiatives.

The Global Strategy for Women's Children's and Adolescents' Health emphasizes accountability as essential to ensure that decision-makers have the information required to meet the health needs of their populations and stresses the importance of tracking resources, results, and rights to see 'what works, what needs improvement and what requires increased attention'. However, results from accountability initiatives are mixed and there is a lack of broadly applicable, validated tools for planning, monitoring and evaluating accountability interventions. This article documents an effort to transform accountability markers-including political will, leadership and the monitor-review-act cycle-into a measurement tool that can be used prospectively or retrospectively to plan, monitor and evaluate accountability initiatives. It describes the development process behind the tool including the literature review, framework development and subsequent building of the measurement tool itself. It also examines feedback on the tool from a panel of global experts and the results of a pilot test conducted in Bauchi and Gombe states in Nigeria. The results demonstrate that the tool is an effective aid for accountability initiatives to reflect on their own progress and provides a useful structure for future planning, monitoring and evaluation. The tool can be applied and adapted to other accountability mechanisms working in global health.

Effect of Volunteer Household Counseling in Improving Knowledge of Birth Preparedness and Complication Readiness of Pregnant Women in Northwest Nigeria.

Maternal and Child Health Integrated Program (MCHIP), a program by Jhpiego global, implemented maternal and newborn health project between 2006 and 2010 in Kano and Zamfara States, Nigeria. This was evaluated with an objective to characterize the effects of volunteer household counselors (VHCs) upon improving knowledge of birth preparedness and complication readiness (BPCR) among pregnant women. VHCs were trained to educate women and their families at home about BPCR. Knowledge of BPCR was compared among 152 and 594 women who did and did not receive household counseling. Mothers' knowledge of BPCR among those who did and did not receive counseling was 32.2% and 11.2% respectively. Mothers who received counseling had better knowledge of BPCR compared to women who did not (Relative Risk [R.R.] 2.30, 95% [C.I.] 1.50, 3.51, P = 0.0001) in a multivariable logistic regression model adjusting for potential confounders. Mothers who received counseling had better odds of knowledge of danger signs during delivery (R.R. 1.48, 95% C.I. 1.05, 2.09, P = 0.02), and post-partum period (R.R. 1.69, 95% C.I. 1.22, 2.32, P = 0.001), but not during pregnancy (R.R. 1.26, 95% C.I. 0.97, 1.64, P = 0.08), compared with women who received no counseling. VHCs can substantially increase knowledge of BPCR and danger signs among women in Nigeria.

Effect of volunteer household counseling in improving knowledge of birth preparedness and complication readiness of pregnant women in northwest Nigeria

Maternal and Child Health Integrated Program (MCHIP), a program by Jhpiego global, implemented maternal and newborn health project between 2006 and 2010 in Kano and Zamfara States, Nigeria. This was evaluated with an objective to characterize the effects of volunteer household counselors (VHCs) upon improving knowledge of birth preparedness and complication readiness (BPCR) among pregnant women. VHCs were trained to educate women and their families at home about BPCR. Knowledge of BPCR was compared among 152 and 594 women who did and did not receive household counseling. Mothers' knowledge of BPCR among those who did and did not receive counseling was 32.2% and 11.2% respectively. Mothers who received counseling had better knowledge of BPCR compared to women who did not (Relative Risk [R.R.] 2.30, 95% [C.I.] 1.50, 3.51, P = 0.0001) in a multivariable logistic regression model adjusting for potential confounders. Mothers who received counseling had better odds of knowledge of danger signs during delivery (R.R. 1.48, 95% C.I. 1.05, 2.09, P = 0.02), and post-partum period (R.R. 1.69, 95% C.I. 1.22, 2.32, P = 0.001), but not during pregnancy (R.R. 1.26, 95% C.I. 0.97, 1.64, P = 0.08), compared with women who received no counseling. VHCs can substantially increase knowledge of BPCR and danger signs among women in Nigeria

Counting every stillbirth and neonatal death through mortality audit to improve quality of care for every pregnant woman and her baby.

BACKGROUND: While there is widespread acknowledgment of the need for improved quality and quantity of information on births and deaths, there has been less movement towards systematically capturing and reviewing the causes and avoidable factors linked to deaths, in order to affect change. This is particularly true for stillbirths and neonatal deaths which can fall between different health care providers and departments. Maternal and perinatal mortality audit applies to two of the five objectives in the Every Newborn Action Plan but data on successful approaches to overcome bottlenecks to scaling up audit are lacking. METHODS: We reviewed the current evidence for facility-based perinatal mortality audit with a focus on low- and middle-income countries and assessed the status of mortality audit policy and implementation. Based on challenges identified in the literature, key challenges to completing the audit cycle and affecting change were identified across the WHO health system building blocks, along with solutions, in order to inform the process of scaling up this strategy with attention to quality. RESULTS: Maternal death surveillance and review is moving rapidly with many countries enacting and implementing policies and with accountability beyond the single facility conducting the audits. While 51 priority countries report having a policy on maternal death notification in 2014, only 17 countries have a policy for reporting and reviewing stillbirths and neonatal deaths. The existing evidence demonstrates the potential for audit to improve birth outcomes, only if the audit cycle is completed. The primary challenges within the health system building blocks are in the area of leadership and health information. Examples of successful implementation exist from high income countries and select low- and middle-income countries provide valuable learning, especially on the need for leadership for effective audit systems and on the development and the use of clear guidelines and protocols in order to ensure that the audit cycle is completed. CONCLUSIONS: Health workers have the power to change health care routines in daily practice, but this must be accompanied by concrete inputs at every level of the health system. The system requires data systems including consistent cause of death classification and use of best practice guidelines to monitor performance, as well as leaders to champion the process, especially to ensure a no-blame environment, and to access change agents at other levels to address larger, systemic challenges.