global health action - haiti

BackgroundPetit Goave, 65 KM from Port Au Prince

Population: 125,78925% (31,447) WRA11% (13,836) under 5

Project Goal: To contribute to the reduction of maternal and infant mortality in the Petit Goave Region of Haiti.

improve the availability and quality of key child survival and maternal and newborn health services; and

increase the demand for and utilization of those same key services

LOE: MNC: 55%Promotion of BF: 25%Immunization of pregnant women and WRA: 20%

Maternal and Child Health StrategiesBehavior Change Communication:

Use of media, radio spots, and public events to promote improved health seeking behaviors and practices

Quality Improvement: Reintroduction of MOH protocol and guidelines to improve quality of

services via in-service training for service providers including management of stock

Increasing Access to Services: Establish a referral system Strengthen and expand network of Community Health Workers

(CHWs) and Traditional Birth Attendants (TBAs) Train health providers in essential drug and laboratory services Strengthen mobile clinic services in the region

Birth Spacing/Family Planning StrategiesBehavior Change Communication:

Story-telling activities disseminated during festivals Mobile services, including FP, are available during festivals

Quality Improvement: Capacity building trainings with clinics and hospitals around FP

logistics management

Increasing Access to Services: Family Planning is part of CHW and TBA training FP counseling for women who wish to space births Pills and Condoms provided by CHW and TBA Referral made to nearby facility for other FP methods Mobile services provided which include FP services (promoted by

CHW/TBA)

BackgroundKonni Health District in Tahoua Region,Niger, 417 KM

East of Niamey Population: 400,000

22.8% (91,297) WRA20.7% (83,124) under 5

Project Goal: Healthy Start’s goal is to reduce morbidity and mortality rates of mothers and children less than five years of age in the district of Konni.

Increase practice of selected behaviors for MCH

Ensure sustainable MOH and community support for community health workers

Strengthen capacity of communities and local/district health teams

LOE: MCH: 30% Nutrition : 30% Malaria : 20% Control of Diarrheal Diseases : 20%

Maternal and Child Health StrategiesBehavior Change Communication:

Community groups and health workers disseminating messages

Improving quality of services: In service training for CHWs in safe delivery Strengthen the HIS from district to community level

Increasing Access to services: Link communities to services Immunization Campaign ITN Distribution and Net-Retreatment

Policy and Advocacy: National policy changes: Zinc, Vitamin A distribution, ANC kits, and

matrons training


Birth Spacing messages are part of the CHW training and disseminated during visits

Women and CARE groups conduct health education sessions which include birth spacing information

Increasing Access to services: CHWs refer women to pharmacies and health posts for contraceptive

methods

Tanzania

BackgroundKaratu District in Arusha Region in northern Tanzania

Population: 218,654Target group is WRA and children under 5

Project Goal: to improve the health of infants and children under the age of five and women of reproductive age in Karatu District, Tanzania

strengthening government mandated cadres (VHWs) and institutions (VHCs) mainstreaming traditional providers (TBAs, drug vendors)

developing new community groups for high-need populations (single mothers, transport drivers)

LOE: MCH: 35% Malaria : 20% Control of Diarrheal Diseases : 15% Pneumonia : 15% Birth Spacing: 15%

Maternal and Child Health StrategiesEstablish and strengthen community based workers,

health committees, and social support groups Reinvigorate Village Health Committees (VHCs) Train existing and new Village Health Workers (VHWs) and TBAs Promote Male involvement (Men Active in Sustaining Health Action) Establish and Support Survive and Thrive Groups (STGs)

Behavior Change Communication Individual level: AFYA 1-2-3 campaign Community level: Communication campaign to change behaviors

(posters, dramas, etc.); MAISHA and STGs


Facility and community based health workers convey messages on: delaying first pregnancy, child spacing, efficacy/safety of modern FP methods

Council Health Management Team recruits FP users to speak to STG and Women’s Groups

MAISHA peer educators promote child spacing to men

Increase Access Community health workers refer clients to health facilities for FP methods

(CBD not available)

Quality Improvement: In service training and regular supervision of all FP service providers to

update knowledge and skills

Liberia

BackgroundNorth-central Liberia; Northwest Nimba County in six

sub-districts Population: 149,322

23%(34,344 ) WRA17% (25,385) under 5

Project Goal: 60% reduction in the U5 mortality rate over baseline by EOP

to increase access to the Basic Package of Health Services to increase equityincrease demand for health services ensure quality ensure sustainability

LOE: MNC: 30% Malaria : 20% HIV: 15% Control of Diarrheal Diseases : 15% Pneumonia : 10% Immunization: 10%

Maternal and Child Health StrategiesIncrease Access to Basic Package of Health Services

4 Mobile Primary Health Care Teams: Community Health Volunteers (CHVs) Care Groups of female community volunteers Traditional Birth Attendants (TBAs)

Ensure Quality Community Health Volunteers (CHVs) trained in the CBIO

Methodology to monitor community health Intervention Teams (Intervention Supervisor):

Maternal/Newborn Care Team (Maternal/Newborn Care) IMCI Team (Pneumonia, Malaria, Diarrhea) WatSan Team (Diarrhea) HIV Team (HIV/PMTCT) EPI Team (Immunization) Community Support Team (cross-cutting)

Behavior Change Communication Child spacing messages disseminated by CHVs and TBAs during home

visits. Facility based health workers disseminate child spacing messages

during immunization, antenatal care, and mobile outreach services

Increase Access to Basic Package of Health Services which includes Post Abortion Care (PAC) TBAs trained in basic health life skills which includes post-abortion

care. Service providers trained in PAC and receive referrals from nurses and

TBAs

Birth Spacing/Family Planning Strategies

Indicators measuring birth spacing/family planning activities % non-pregnant mothers who desire no more children in next two years

(or are not sure) who are using a modern method of child spacing – GHA Haiti

Percentage of mothers of children age 0-23 months who are using a modern contraceptive method-WellShare Tanzania & Curamericas Liberia

No birth spacing/FP indicator collected by RI Niger

Challenges with integrating birth spacing/family planning activities Without additional funding, unable to scale up successful model of CHW

curriculum/training (GHA Haiti) Weak supply chain system (stockouts of commodities) (All interviewees) Difficult to add another health intervention when the health system is

already so weak (RI Niger) Cultural barriers (Curamericas Liberia) CBD of FP methods not approved by MOH (WellShare Tanzania) KPC survey is already long and time consuming so adding more FP

indicators might be burdensome for some and also costs money (WellShare Tanzania)

Recommendations to improve integration of birth spacing/family planning activities Share best practices or lessons learned on community based integration of

child spacing/child survival programs Technical assistance to work with the MOH to improve the supply chain

system (get commodities to rural areas) USAID approved protocol manual related to FP messages for all health

programs Exchange visits between programs that have successful CBFP programs Pilot project to do CBD in remote areas (Tanzania) Funding to expand birth spacing/family planning activities to youth Additional education material on birth spacing to share with WRA Create community depots throughout project areas for access to FP methods

while building demand Train existing CHWs in CBD of injectables, pills, FAM, etc Use community groups such as CARE groups as points of access for FP

methods and services Train local health partners in FP service provision for sustainability purposes

Recommendations to improve integration of birth spacing/family planning activities Share case studies that highlight the synergies between education, job

opportunities, and family planning Have child spacing/FP be mandatory in any RFA that is released that

include immunization, MCH, or HIV health interventions as these are opportunities for integration

Include an indicator in KPC which states preferred FP method for women so we can focus our energies on increasing access to that method and what the beneficiaries want

global health action - haiti

Health & Medicine