Community-Based Distribution of Low-Cost Family Planning and Maternal and Child Health Services in Rural Nigeria

Background: Community health workers (CHWs) are a component of the health system in many countries, providing effective community-based services to mothers and infants. However, implementation of CHW programmes at scale has been challenging in many settings.Aim: To explore the acceptability of CHWs conducting household visits to mothers and infants during pregnancy and after delivery, from the perspective of community members, professional nurses and CHWs themselves.Setting: Primary health care clinics in five rural districts in KwaZulu-Natal, South Africa.Methods: A qualitative exploratory study was conducted where participants were purposively selected to participate in 19 focus group discussions based on their experience with CHWs or child rearing.Results: Poor confidentiality and trust emerged as key barriers to CHW acceptability in delivering maternal and child health services in the home. Most community members felt that CHWs could not be trusted because of their lack of professionalism and inability to maintain confidentiality. Familiarity and the complex relationships between household members and CHWs caused difficulties in developing and maintaining a relationship of trust, particularly in high HIV prevalence settings. Professional staff at the clinic were crucial in supporting the CHW’s role; if they appeared to question the CHW’s competency or trustworthiness, this seriously undermined CHW credibility in the eyes of the community.Conclusion: Understanding the complex contextual challenges faced by CHWs and community members can strengthen community-based interventions. CHWs require training, support and supervision to develop competencies navigating complex relationships within the community and the health system to provide effective care in communities.

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Effect of Integrating Maternal and Child Health Services, Nutrition and Family Planning Services on Postpartum Family Planning Uptake at 6 Months Post-partum in Burkina Faso, Cote d’Ivoire and Niger: Protocol of a Longitudinal Quasi-experimental Study

10.21203/rs.3.rs-1094966/v1 ◽

2022 ◽

Author(s):

DENISE KPEBO ◽

Abou Coulibaly ◽

Maurice Yameogo ◽

Sujata Bijou ◽

Lazoumar Ramatoulaye ◽

...

Keyword(s):

Family Planning ◽

Child Health ◽

Health Services ◽

Maternal And Child Health ◽

Post Partum ◽

Child Health Services ◽

Family Planning Services ◽

Services Integration ◽

Quasi Experimental ◽

And Child Health

Abstract Background : Although several interventions integrating maternal, neonatal, child health and nutrition with family planning have been implemented and tested, there is still limited evidence on their effectiveness to guide program efforts and policy action,on health services integration. This study aims to assess the effectiveness of a service delivery model integrating maternal and child health services, nutrition and family planning services, compared with the general standard of care in Burkina Faso, Cote d'Ivoire, and Niger. Methods: This is a quasi experimental study with one intervention group and one control group of 3-4 health facilities in each country. Each facility was matched to a control facility of the same level of care and that had similar coverage on selected reproductive health indicators such as family planning and post-partum family planning. The study participants are pregnant women (with a 6 months pregnancy at maximum) coming for their first antenatal care visit. They will be followed up to 6 months after childbirth, and will be interviewed at each antenatal visit and also during visits for infant vaccines.The analyzes will be carried out by intention to treat, using generalized linear models (binomial log or log Poisson) to assess the effect of the intervention on the ratio of contraceptive use prevalence between the two groups of the study at a significance level of 5%, while taking into account the cluster effect and adjusting for potential confounding factors (socio-demographic characteristics of women, unevenly distributed at inclusion). Discussion :This longitudinal study, with the provision of family planning services integrated into the whole maternal care continuum, a sufficiently long observation time and repeated measurements, will make it possible to better appreciate the timeline and the factors influencing women's decision-making on the use of post-partum family planning services. The results will help in increasing the body of knowledge regarding the impact of maternal and child health services integration on the utilization of post-partum family planning, taking into account the specific context of sub-Saharan Africa French speaking countries where such information is very needed.

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Evaluation of a community-based intervention for health and economic empowerment of marginalized women in India

10.21203/rs.2.16129/v2 ◽

2020 ◽

Author(s):

Shantanu Sharma ◽

Devika Mehra ◽

Faiyaz Akhtar ◽

Sunil Mehra

Keyword(s):

Child Health ◽

Health Services ◽

Maternal And Child Health ◽

Qualitative Interviews ◽

Child Health Services ◽

Access To Health Services ◽

Community Based ◽

Access To Health ◽

Marginalized Women ◽

And Child Health

Abstract Background Empowered women have improved decision-making capacity and can demand equal access to health services. Community-based interventions (CBI) based on building women’s groups for awareness generation on maternal and child health (MCH) are the best and cost-effective approaches in improving their access to health services. The present endeavour evaluates a community-based intervention aimed at improving marginalized women’s awareness and utilization of maternal, and child health services, and access to livelihood and savings using the peer-led approach from two districts of India. Methods We used peer educators as mediators of knowledge transfer among women and for creating a supportive environment at the household and community levels. The intervention was implemented in two marginalized districts of Uttar Pradesh, namely Banda and Kaushambi. Two development blocks in each of the two districts were selected randomly, and twenty-four villages in each of the four blocks were selected based on the high percentage of a marginalized population. The evaluation of the intervention involved a non-experimental, pre- and post-research design, using a mixed-method approach. Data were collected at three points in time, including a rapid assessment (quantitative and qualitative interviews) at baseline, qualitative interviews at the end line and tracking data of the intervention population (n=37,324) through an online management information system. Results Most of the women in Banda (90%) and Kaushambi (85%) attended at least 60% of the education sessions. Around 39% of women in Banda and 35% of women in Kaushambi registered for the livelihood scheme, and 94% and 80% of them had worked in these two places, respectively under the scheme. Women during group discussions informed that their awareness about MCH increased post-intervention. The money earned after getting work under the livelihood scheme or from daily savings was deposited in the bank account by the women. These savings helped the women investing money at times of need, such as starting their work, in emergencies for the medical treatment of their family members, education of their children, etc. Conclusion Peer-led model of intervention can be explored to improve the combined health and economic outcomes of marginalized women.

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