adapting hblss to fit your program_kruger_5.11.11

Afghanistan Mozambique Sudan

WORLD VISIONMNCH PROJECTS

HBLSS INTEGRATION

MNCH Programs with HBLSS Integration

Afghanistan: MNCH in rural Herat• Integrated CHW HBLSS training• Links with community• midwifery training • Operations research: • HBLSS linked with mPhone pregnancy and newborn modules Mozambique: MNCH – Zambizia Province• Integrated CHW HBLSS training• HBLSS linked mPhone pregnancy and newborn modules

S Sudan: MNCH• CHW HBLSS training• Integration with Community Case Management

Karukh district: HBLSS supportive Supervision

How: MNCH and HBLSS Integration

• MNCH platforms

• CHW training

•Mother Support Groups- trained with CHWs

•CHW home visits; Timed and Targeted include

complication readiness

•Village Shura are sensitized

•Village Health Committees are sensitized

•MOH/HBLSS data collection referral forms

•Monitoring and evaluation plans-

include HBLSS dataPregnant Women in Naw-abad.

Photo: UK Forces Media Ops

HBLSS Adaptations

• All CHW training takes place within “community participatory meetings”- in local language

• Community meetings prioritized with local Shura/Village Health Committees

• Training tools prepared for non-literate: action cards, mPhone

• Attention to CHW male and female roles– Shura support, CHW male/female teams

• Birthing teams develop Birth Preparation Plans with families

• Communities develop Village emergency transport and communication (mPhone)

• MOH referral/data forms revised to include HBLSS data: complications, transport time

• Health Center verify accuracy of assessment by Birthing Teams

Lessons Learned

Adaptations needed:• Cultural • Rural/remote areas• Security situations• Illiterate CHW population: audio in local

language and local pictures• Gender considerations- male/female roles• Community priorities-- according to the

highest complication prevalence

Lessons Learned- continued

Training:•Master HBLSS TOT training team for basic and refreshers•CHWs trained in basic MNCH integrated with HBLSS training •Training approach - HBLSS participatory meetings –group negotiation skills•CHWs need re-freshers, mentoring and supportive supervision

Buy-in:• Provincial and district level- prior approval• Shura and Village sensitization• Community and Family Birthing Team participation• Maternity Center engagement- EMoC

Challenges

Mozambique

Security & remote areasSupportive supervision by local midwives

Afghanistan

Long distances between villages & health centers

•HBLSS mPhone modules need additional training•MOH approval for HBLSS training/ referral forms•Capacity to use adult learning principles, participatory methods, negotiation•MOH willingness to provide EmoC training at HCs•CHW skills in community participatory meetings and negotiation

Training Cost (example)Afghanistan:Master trainers- 4 • TOTs- 18• CHW trainings: 30 villages in 4 districts• CHWs- 155 plus• Mother Support Groups • (1 per village-30)

Approximate Cost: $30,000

Recommendations

Community assessments for HBLSS designStart out small- a pilot and then scale-upAdapt and Integrate within MNCH programs•Community meetings drive priority Mother/Baby problems•Community meetings use participatory /negotiation methods- need skill developmentInvolve and train Health Center staff in Basic EmOCMobilize communities for referral/transport plansBuild in CHW mentorship and refreshers for HBLSS skills

Surprises! (or not)

• Conducive to mPhone technology /design

• Initiative taken by communities to include Mother Support Groups in HBLSS programs

•Exclusive breastfeeding increased (newborn care)

•Afghanistan- empowered women to make decisions & travel out of homes to HCs

•ANC attendance and delivery at HC increased•Male involvement increased (Shura, fathers/brothers)

•Positive receptivity by Provincial and District MOH and Community Midwives

Thank You!

Photographer Credits

Brendan Bannon. Archive for the 'SIDA / AIDS' Category. Retrieved May 9, 2011 from http://www.msf-speakup.com/?cat=11

Alexandra Fazzina. The Perils of Childbirth In Delivery. TIME.Retrived May 4, 2011 from http://www.time.com/time/photogallery/0,29307,1842761_1766627,00.html

Food and Agriculture Organization of the United Nations. Map of Mozambique. Retrieved May 4, 2011 from http://www.fao.org/docrep/004/y3061e/image036.jpg

Probert Encyclopedia. Map of Afghanistan 1930. Retrieved May 4, 2011 from http://www.probertencyclopaedia.com/photolib/maps/Map%20of%20Afghanistan%201930.jpg

Women’s ITE Ministry. People In Circle. Retrived May 9th, 2011 from http://itemwm.com/wp-content/uploads/women_3.jpg

Nick Czernkovich. Pregnant Woman Masisi. CBC. Retrived May 9, 2011 from http://www.cbc.ca/news/world/story/2010/06/18/f-africa-surgery.html

UK Forces Media Ops. Pregnant Woman in Naw-abad. Retrieved May 9 th, 2011 from http://4.bp.blogspot.com/_ac-M0_bqRHU/S56Ex-i42JI/AAAAAAAAAE8/cu3I6NpJoCE/s400/VME+15Mar10_000+163.jpg

Why HBLSS was chosen?• High maternal and newborn mortality rates• Lack of access to maternity services• Vulnerable, rural populations• Women not empowered to make decisions• Builds on MNCH platform• Easy to integrate messages• Participatory family/community approach

A line is put into the arm of a woman suffering complications during childbirth at the Faizabad Maternity Hospital. Photo: Alexandra Fazzina

HBLSS Training Cascade• Master Trainers ( MOH and WV Staff)TOTs-Trainers at target district level train CHWs CHWs trained in 12 HBLSS Approach:

a) Participatory Community Meetings b)“hands-on” competency-based

skills

CHWs train Family Birthing Teams in HBLSS through schedule of Community Meetings

HBLSS training -Zindajan District

Training Plan

• Five-day basic training• Use of pre- and post testing- skills• Teach through 12 Community Meetings- picture cards,

role play and group feedback/evaluation• NO didactic- only learning through group meetings• Community Meetings integrate MNCH key messages• Competency-based skill development• Build in- Mentoring and refresher points

CHW RoleHome visits- integrate “timed and

targeted” MNCH messages with HBLSS

Conduct Community HBLSS meetings with participation of Family Birthing Team (FBT) and Mothers Groups

Village Mother Support Groups assist CHWs with Community Meetings

Develop Birth preparation plans with FBT

Assist family with timely referrals to ANC, skilled delivery, complication, follow-up

Supervised by community midwife or senior CHW

• Emergency HBLSS referral forms (complications, action taken, transport type)

• Supportive supervision tool

CHW Tools•MNCH integrated messages- check list

•mPHone pregnancy and newborn modules: “prompts” for emergency complications and referral

CHW/HBLSS Outcomes

• Maternal and newborn complications correctly assessed

• Correct action is taken according to HBLSS Action Steps

• Referral and transport forms correctly filled out and accompany client to HC

• HC validation of CHW assessment and newborn registration

• HC responsiveness- basic EmoC• Post HC follow-up visits and action

taken

Were the “three delays” decreased?