Factors affecting effective community participation in maternal and newborn health programme planning, implementation and quality of care interventions.

BACKGROUND: Community participation in in health programme planning, implementation and quality improvement was recently recommended in guidelines to improve use of skilled care during pregnancy, childbirth and the postnatal period for women and newborns. How to implement community participation effectively remains unclear. In this article we explore different factors. METHODS: We conducted a secondary analysis, using the Supporting the Use of Research Evidence framework, of effectiveness studies identified through systematic literature reviews of two community participation interventions; quality improvement of maternity care services; and maternal and newborn health programme planning and implementation. RESULTS: Community participation ranged from outreach educational activities to communities being full partners in decision-making. In general, implementation considerations were underreported. Key facilitators of community participation included supportive policy and funding environments where communities see women's health as a collective responsibility; linkages with a functioning health system e.g. via stakeholder committees; intercultural sensitivity; and a focus on interventions to strengthen community capacity to support health. Levels of participation and participatory approaches often changed over the life of programmes as community and health services capacity to interact developed. CONCLUSION: Implementation requires careful consideration of the context: previous experience with participation, who will be involved, gender norms, and the timeframe for implementation. Relevant stakeholders must be actively involved, particularly those often excluded from decision making. Current limited evidence suggests that the vision of community participation as a process and the presence of a focus to strengthen community capacity to participate and to improve health may be a key factor for long term success.

Communities, birth attendants and health facilities: a continuum of emergency maternal and newborn care (the Global Network's EmONC trial).

BACKGROUND: Maternal and newborn mortality rates remain unacceptably high, especially where the majority of births occur in home settings or in facilities with inadequate resources. The introduction of emergency obstetric and newborn care services has been proposed by several organizations in order to improve pregnancy outcomes. However, the effectiveness of emergency obstetric and neonatal care services has never been proven. Also unproven is the effectiveness of community mobilization and community birth attendant training to improve pregnancy outcomes. METHODS/DESIGN: We have developed a cluster-randomized controlled trial to evaluate the impact of a comprehensive intervention of community mobilization, birth attendant training and improvement of quality of care in health facilities on perinatal mortality in low and middle-income countries where the majority of births take place in homes or first level care facilities. This trial will take place in 106 clusters (300-500 deliveries per year each) across 7 sites of the Global Network for Women's and Children's Health Research in Argentina, Guatemala, India, Kenya, Pakistan and Zambia. The trial intervention has three key elements, community mobilization, home-based life saving skills for communities and birth attendants, and training of providers at obstetric facilities to improve quality of care. The primary outcome of the trial is perinatal mortality. Secondary outcomes include rates of stillbirth, 7-day neonatal mortality, maternal death or severe morbidity (including obstetric fistula, eclampsia and obstetrical sepsis) and 28-day neonatal mortality. DISCUSSION: In this trial, we are evaluating a combination of interventions including community mobilization and facility training in an attempt to improve pregnancy outcomes. If successful, the results of this trial will provide important information for policy makers and clinicians as they attempt to improve delivery services for pregnant women and newborns in low-income countries. TRIAL REGISTRATION: ClinicalTrials.gov NCT01073488.

Impact of community organization of woman on perinatal outcomes in rural Bolivia

An intervention to improve maternal and child health was conducted in a remote Bolivian province with limited access to modern medical facilities. The intervention focused on initiating and strengthening women's organizations, developing women's skills in problem identification and prioritization, and training community members in safe birthing techniques. Its impact was evaluated by comparing perinatal mortality rates and obstetric behavior among 409 women before and after the intervention. Perinatal mortality decreased from 117 deaths per 1000 births before the intervention to 43.8 deaths per 1000 births after. There was a significant increase in the number of women participating in women's organizations following the intervention, as well as in the number of organizations. The proportion of women receiving prenatal care and initiating breast-feeding on the first day after birth was also significantly larger. The number of infants attended to immediately after delivery likewise increased, but the change was not statistically significant. This study demonstrates that community organization can improve maternal and child health in remote areas

Impact of community organization of woman on perinatal outcomes in rural Bolivia / mpacto de la organización de las mujeres en la comunidad sobre los resultados perinatales en zonas rurales de Bolivia

An intervention to improve maternal and child health was conducted in a remote Bolivian province with limited access to modern medical facilities. The intervention focused on initiating and strengthening women's organizations, developing women's skills in problem identification and prioritization, and training community members in safe birthing techniques. Its impact was evaluated by comparing perinatal mortality rates and obstetric behavior among 409 women before and after the intervention. Perinatal mortality decreased from 117 deaths per 1000 births before the intervention to 43.8 deaths per 1000 births after. There was a significant increase in the number of women participating in women's organizations following the intervention, as well as in the number of organizations. The proportion of women receiving prenatal care and initiating breast-feeding on the first day after birth was also significantly larger. The number of infants attended to immediately after delivery likewise increased, but the change was not statistically significant. This study demonstrates that community organization can improve maternal and child health in remote areas

Se llevó a cabo una intervención destinada a mejorar la salud materna e infantil en una provincia aislada de Bolivia con acceso limitado a instalaciones de salud modernas. La intervención se centró en la creación y el fortalecimiento de organizaciones para mujeres, en el desarrollo de habilidades entre las mujeres, en la identificación de problemas y la determinación de prioridades y en el adiestramiento de habitantes de la comunidad en la aplicación de técnicas seguras para la atención del parto. Para evaluar su impacto se compararon las tasas de mortalidad perinatal y las prácticas obstétricas de 409 mujeres antes y después de la intervención. La mortalidad perinatal bajó de 117 defunciones por 1 000 nacimientos antes de la intervención a 43,8 defunciones por 1 000 nacimientos después de ella. Se produjo un aumento significativo del número de mujeres que participaron en organizaciones femeninas después de la intervención, así como del número de dichas organizaciones. Asimismo, hubo un aumento significativo de la proporción de mujeres que recibieron atención prenatal y que iniciaron la lactancia materna desde el primer día después del parto. El número de neonatos atendidos inmediatamente después del alumbramiento también aumentó, pero el cambio no fue estadísticamente significativo. Este estudio demuestra que la organización comunitaria puede mejorar la salud materna e infantil en lugares aislados.

El autodiagnóstico: Metodología para facilitar la identificación y priorización de problemas de salud materna y neonatal en grupos de mujeres de areas rurales en Bolivia

I. Resumen II. Antecedesntes III. Contexto/Justificacion del Autodiagnostico IV. Metodología V. Resultados VI. Conclusión VII. Recomendaciones

Proyecto Warmi: Metodología Participativa para Mejorar la Salud Materna y Neonatal manual para Implementadores / Warmi Project; Methodology for improve the mathernal and neonatal resources health. Guide for humans resourses

Este manual es el estudio de un proyecto demostrativo de salud materna y neonatal de tres años de duración, realizado en la aprovincia Inquisivi, Bolivia. el proyecto fue implementado por Save the Children/Bolivia (SC/B) a través de un subcontrato con John Snow, Inc, y fue financiado por la agencia Internacional de Estados Unidos para el Desarrollo (USAID) y el proyecto MotherCare.

Proyecto Warmi: metodología participativa para mejorar la salud materna y neonatal manual para Implementadores / sss

Este manual es el estudio de un proyecto demostrativo de salud materna y neonatal de tres años de duración, realizado en la provincia Inquisivi, Bolivia. el proyecto fue implementado por Save the Children/Bolivia (SC/B) a través de un subcontrato con John Snow, Inc, y fue financiado por la agencia Internacional de Estados Unidos para el Desarrollo (USAID) y el proyecto MotherCare

Proyecto Warmi: metodología participativa para mejorar la salud materna y neonatal manual para Implementadores / sss

Este manual es el estudio de un proyecto demostrativo de salud materna y neonatal de tres años de duración, realizado en la provincia Inquisivi, Bolivia. el proyecto fue implementado por Save the Children/Bolivia (SC/B) a través de un subcontrato con John Snow, Inc, y fue financiado por la agencia Internacional de Estados Unidos para el Desarrollo (USAID) y el proyecto MotherCare