adapting hblss to fit your program_stalls_5.11.11

HBLSS:An Overview of Methodology and

Applications

Pathway to Survival

Problem

Recognizing

Problem

Receiving First

Aid Care

Deciding to Seek

Care

Reaching

Care

Receiving

Quality EmOC

Survival

Family & Community Referral

Site

Source: Adapted from MotherCare 1995.

Home-Based Life-Saving Skills

• A family-focused community mobilization program that aims to:– Improve problem recognition and first aid response to

maternal and newborn complications– Increase timely access to EmONC (where available)

• Draws heavily upon the WARMI methodology which has demonstrated significant reduction in perinatal mortality, but HBLSS also includes first aid care

HBLSS Essential Elements

• Low-tech and sustainable

• Skills-based, participatory

• Designed for non- or low-literate participants

• Uses a step-wise process that works towards safe, acceptable practices that will be used when needed

• Can be used for any community issue (e.g., water & sanitation, TB, malaria)

Unique Characteristics• Multiple subtle cues set the stage for collaboration

and respect for all types of knowing• Content repeated multiple times in multiple ways

to enhance retention: hear, see, and do• Key facilitation skills build bridges between what

community knows and what “advisors” know • Behaviors/actions are agreed upon as response

to problem recognition• Facilitator is able to negotiate with community

members to incorporate actions that the community wishes to continue

HBLSS Methodology• Clinically simple content with exacting process• Series of facilitated community meetings to

discuss individual topics– Women problems: Too much bleeding, birth delay

sickness with pain and fever, swelling and fits, too many children

– Baby problems: Trouble breathing at birth, baby too small, baby is sick

– Preventing problems: self-care, family planning (LAM), PMTCT

– Referral• Communities prioritize which topics they view as

the most important and common problems

Applying HBLSS Methodology

• Process can be adapted to any area of health: pediatrics, primary care, adult care or any particular disease process such as HIV/AIDS, avian flu, diabetes

• Recently adapted to curriculum of Africa Centre for Holistic Management, an organization in Zimbabwe dedicated to land restoration in semi-arid/arid climates. Africare and Land o’Lakes (Africa) interested in using

methodology for similar community programs. • Use of methodology is crucial to adaptation of new

approaches and behaviors

• Whoever will be present at the time of birth • Pregnant women

• Family caregivers

• Birth attendants

• Community leaders

• Referral facility staff

Who Participates?

Step 1: Review the previous meeting

Step 2: Ask what participants know and do when they see particular problems

Step 3: Share what trained health workers know and do when they see those problems

Step 4: Come to agree on what to do: negotiation

Step 5: Practice the (agreed) actions

Step 6: Discuss how to know if the actions are helpful

Step 7: Decide how to prevent the problem

Interactive Community Meetings

Problem Side Action Side

Take Action CardBleeding Too Much After Baby is Born

Focus group comments• “In the past we sat and watched with

an emergency, now we can seek help.”

• “We are happy that HHF is working here, women are not dying, and we are proud to be so knowledgeable.”

• “When women used to bleed, we used to stick things inside, now we know to take the road to the hospital.”

• “I used the Take Action Card booklet with women who did not attend the training and they understand.”

• “Now we know what to do when a baby is not breathing. It has shone light on us.”

• “We hope to never tell Regine’s story again.”

Evidence to date

• Community members are able to retain information following the training– Enhancing problem recognition

• Community members who are exposed to HBLSS are more likely to take action to:– Provide first aid to respond to a complication– Refer women to a facility

• Community is supportive and actively engaged in MNH issues

Program presentations

• Integration into existing programs

• Lessons learned

• Adaptations

• Challenges

• Costs

• Recommendations

• Surprises