Maternal, Newborn and Child Health
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Community Health Volunteer Program Functionality and Performance in Madagascar: A Synthesis of Qualitative and Quantitative Assessments
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Publications
For more than a decade, the U.S. Agency for International Development (USAID) Mission in Madagascar and other partners have invested in the development of a national CHV system to improve access to life-saving primary health care services for rural and remote populations. Presently, the USAID/Santénet2 Project (SN2) aims to increase access to and availability of community-based interventions in 800 communes concentrated in 16 regions of eastern and southern Madagascar. SN2 provides local capacity building, training, and supervision to mobilize over 12,000 CHVs to offer lifesaving health services, including family planning counseling and short-acting contraceptives and maternal, newborn, and child health, including community case management for uncomplicated malaria, pneumonia, and diarrheal disease. In general, two CHVs have been elected by their communities from each of the 5,758 targeted villages located more than five kilometers from the nearest health center. MAHEFA, Santénet2’s sister project, is scaling up support for integrated community-based activities through an additional 3,500 CHVs in underserved western and northern Madagascar.
USAID/Madagascar asked the USAID Health Care Improvement Project (HCI) and the Global Health Technical Assistance (GH Tech) Project, with technical assistance from the U.S. Centers for Disease Control and Prevention (CDC), to conduct qualitative and cross-sectional studies, respectively, of CHV program functionality and performance. The purpose of this report is to synthesize the findings from the two assessments. Complete findings are available in the respective assessment reports (Wiskow et al. 2013 and Agarwal et al. 2013).
Based on the synthesized findings from the two assessments on CHV program functionality, the following recommendations are presented:
· Linkages with the communities should be strengthened, including clarifying CHV roles· Ongoing trainings should be budgeted for and conducted in both service delivery and management of supplies· Linkages with the health system should be strengthened, particularly with respect to the referral system· Supportive supervision, especially visits to CHVs’ communities, should be planned and budgeted. Creative approaches to supervising CHVs who live far from the facilities should be explored and tested.· A national monitoring and evaluation system should be established to inform programmatic decision and performance monitoring. Knowledge and competency of CHVs should be assessed periodically as a means of identifying gaps in knowledge and opportunities for improving performance and quality of care. -
Improving Maternal, Newborn and Child Health in Uganda | Short Film
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FY13 Activities of the USAID Health Care Improvement Project
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Publications
The Health Care Improvement Project (HCI) is the global mechanism of the United States Agency for International Development (USAID) for technical leadership and assistance to improve health care delivery and health workforce capacity and performance in USAID-assisted countries. HCI is currently working with 20 countries to strengthen facility- and community-based health services, human resources management, and services for vulnerable children and families, improving health outcomes and contributing to the achievement of the Millennium Development Goals. This short report describes the FY13 activities for the project.
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Qualitative study to identify solutions to local barriers to care-seeking and treatment for diarrhea, malaria and pneumonia - Report on findings from Nigeria
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Community Resource
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Optimizing health worker roles to improve access to key maternal and newborn health interventions through task shifting: WHO recommendations
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Community Resource
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Qualitative study to identify solutions to local barriers to care-seeking and treatment for diarrhoea, malaria and pneumonia - Report on findings from Niger
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Community Resource
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Qualitative study to identify solutions to local barriers to care-seeking and treatment for diarrhoea malaria and pneumonia in select high burden countries: Report on findings from Kenya
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Community Resource
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A systematic review of strategies to increase demand, uptake and quality of community-based diagnosis and case management of malaria
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Community Resource
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Community case management of diarrhea, malaria and pneumonia: Tracking science to policy and practice in sub-Saharan Africa
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Community Resource
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Tanzania | Manyara PMTCT/RCH Integration Improvement Collaborative
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Collaborative Profile
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Kenya | ANC and PMTCT Demonstration Collaborative in Kwale District
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Collaborative Profile
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Perceived barriers and motivating factors influencing student midwives' acceptance of rural postings in Ghana
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Community Resource
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Applying Quality Improvement to Integrate Family Planning in Maternal Health and HIV Services
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Publications
Since 2010, the USAID Health Care Improvement Project (HCI) has been applying quality improvement (QI) approaches to integrate family planning (FP) counseling and services in maternal health programs and in HIV services. Specifically, HCI has applied the collaborative improvement approach in selected districts in Mali, Afghanistan, and Uganda to engage QI teams of service providers at maternal health services (Mali and Afghanistan) and at HIV services (Uganda) to analyze the existing processes of service delivery to identify barriers to FP integration and the potential points where FP counseling can be introduced.This short report describes the global leadership that HCI has provided to document and disseminate quality improvement approaches for FP integration.
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Taking Every Opportunity to Save Lives: The Role of Modern Quality Improvement in Enhancing Maternal, Newborn, and Child Health Programs. A Synthesis of USAID Health Care Improvement Project Field Experience.
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Publications
Several quality gaps have been documented across the continuum of maternal, newborn, and child health (MNCH) services. For antenatal care (ANC), despite the progress in increasing its coverage, quality gaps persist. Several studies show that ANC services often miss the opportunity to provide essential services such as counseling clients on danger signs of pregnancy, delivery plans, nutrition, and postpartum family planning. Similarly, services around childbirth are often provided with compromised quality. Common quality gaps include the inadequate or incorrect use of the partograph to prevent the complications of prolonged labor for the mother and the newborn, neglecting to apply active management of third stage of labor to prevent postpartum hemorrhage, poor quality of emergency obstetric care, and failure to promptly detect newborn asphyxia and apply immediate resuscitation.
Quality improvement (QI) offers a powerful a means to increase the effectiveness of MNCH programs in resource-limited countries. QI is based on the understanding that a system is designed to produce the results it produces; in order to obtain better results, the system must change. Hence, in applying QI, teams in health facilities or communities analyze the systems and processes of delivering services, test changes to obtain better results, and measure the effect of the tested changes on pre-determined indicators. Teamwork and shared learning between QI teams allow for rapid spread of best practices.
This paper discusses the role modern QI approaches can play in improving MNCH outcomes and describes specific applications of across the continuum of MNCH care, including ANC, essential obstetric and newborn care, infant and child care, and post-partum family planning. Drawing on examples from the work of the USAID Health Care Improvement Project (HCI) in Africa, Asia, and Latin America, the paper shows how quality gaps in the services addressing the antenatal, intra partum, postnatal, neonatal, and child periods can be closed through modern QI approaches.
QI can be applied at all levels of the health system, using existing resources, to put in place long-lasting changes in how care is provided. The first step in any QI project is to engage with national policymakers to understand their priorities and strategies. At the individual sites, process deficiencies and their associated outputs are quantified and the inner mechanisms responsible for those deficiencies, exposed. Specific barriers to implementation of effective processes are addressed with the in-depth knowledge and innovative capacity of individuals who work in those processes on a daily basis. Solutions are created by the owners of the problems who are best positioned to design and implement interventions to close the gaps in health service quality. Quality improvement uses continuous monitoring of processes to understand the effect changes have on health outcomes. When the data show that a change in the process produced an improvement, this learning is then shared with colleagues to spread the idea across facilities, districts, and regions. -
Assessment of Selected Best Practices for Maternal and Newborn Care in Albania, Armenia, Georgia, and Russia
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Publications
This report describes the results of a four-country assessment, funded by the US Agency for International Development (USAID), of high-impact maternal and newborn childbirth practices in the Europe and Eurasia (E&E) region. Conducted between October 2010 and August 2011 in 42 maternities in Albania, Armenia, Georgia, and Russia, the assessment examined the quality of high-impact childbirth and early post-partum maternal-newborn practices in sampled facilities, including the status of cross-cutting health system functions and provider and client attitudes, knowledge, and self-reported practices. The study provides a multi-perspective look at the quality of maternal- newborn care currently provided and as perceived by clients, with an eye toward assessing areas of strength and areas needing improvement.
The assessment found evidence for solid coverage of many best practices in the sampled maternities. Measured results are undoubtedly in part attributable to high stakeholder investment in the region, including by USAID, and most importantly are reflected in the decreasing maternal and neonatal mortality rates. However, despite the narrowing of the maternal and newborn mortality gap between E&E countries and their richer neighbors, the persistently higher rates of maternal and newborn mortality in the region demonstrate a need to hold and expand the gains, with a focus on areas of demonstrated service delivery weakness for high-burden conditions. Moreover, the legacy of highly specialized and medicalized care even for routine, uncomplicated deliveries remains strong in the region yet represents a care model that is unlikely to be cost-effective over the long-term.
Recommendations in the final section of this report focus on closing the gap between known best practices and observed practices for high mortality and morbidity maternal and neonatal conditions. Based on assessment findings, we provide specific recommendations to improve care in five areas: 1) labor, delivery, and immediate post-partum care; 2) early post-partum care; 3) complications care; 4) client-centered best practices; and 5) health system recommendations to improve care delivery. -
Collaborative on regionalization of perinatal care in Russia
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Collaborative Profile
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Collaborative on Primary Neonatal Resuscitation in six Russian regions
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Collaborative Profile
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Spread collaborative: optimizing labor management through use of the partograph in Ivanovo, Tula, Kostroma, Yaroslavl and Tambov regions of Russia
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Collaborative Profile
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Demonstration collaborative: optimizing labor management through use of the partograph in Kostroma, Yaroslavl and Tambov regions of Russia
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Collaborative Profile
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Spread collaborative: Expansion of breastfeeding in Kostroma, Tambov, Ivanovo, Tula and Tver regions of the Russian Federation
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Collaborative Profile