Working in newborn health with community agents in Honduras – the success of a NGO network

Goldy Mazia, MD, MPHCORE Group Fall Meeting

Washington, DC September 15, 2010

Background of BASICS work in Honduras (2006-

2009)

With partners (USAID, PAHO, BASICS, CORE, ACCESS, SNL, HCI & UNICEF- now LAC Newborn Health Alliance) developed the LAC Interagency Strategic Consensus and a regional plan of action to promote newborn health (approved at the 2008 PAHO Directing Council meeting- res CD48.R4)

Under a regional approach and with partners in 3 countries BASICS operationalized one important element of the LAC regional strategy- prevention and treatment of neonatal sepsis (main cause of death)

Honduras: Community level; El Salvador and the Dominican Republic: Facility level

Methodology: selected elements of quality improvement and collaborative strategies of URC/HCI - QI teams in hospitals/NGOs with in-country and HQ technical support; distance learning sessions (Elluminate -CORE Group)

Maternal and newborn health in Honduras

• High maternal and perinatal mortality rates (108/100,000 and 25-33/1,000)• 30% of women in rural areas give birth with TBAs• High proportion of home deliveries in underserved areas (La Paz 53%, Intibuca 54%) - NMR in La Paz 34/1,000

DHS Honduras 2005-2006

Honduras Community Based Strategies

BASICS promoted coordination of activities among 9 NGOs to implement a standardized newborn health module that included

home visits in the first 72 hours Prevention of infection as a part of preventive ENC Identification of minor and danger signs of major

infections care-seeking/referral Where feasible, treatment of minor infections and First dose of antibiotics before referral

NGOs were encouraged to implement work with their own delivery platforms and their individual types of CHWs (“monitores” (AIN-C), rural pharmacies volunteers, TBAs) and/or community mobilization groups

Honduras Community Based Activities

Workshops for standardization of training and supervision tools related to newborn care among NGOs

Strengthening of ENC knowledge and skills of CHWs

Coordination of various NGO’s CHW working in same geographic areas

Cross-fertilization of strategies among NGOs

Participation in Elluminate sessions for technical updates and sharing of results and experiences (with countries in facility-based intervention)

NGOs in the initiative were invited by MOH to develop the community-based model for the National Strategy for Accelerating the Reduction of Maternal and Newborn Mortality (RAMNI) based on this experience

Community Intervention: Some Baseline Findings & Areas For

Action

Mothers/families (100 mothers with babies < 3 mo.) 16% used harmful substances on the cord (i.e. cooking

oil, camphor, chicken fat) 48% attended post-partum care visits; only 11% in the

first weekKnowledge/skills observations of 48 AIN-C “monitores” :

Weakest counseling areas: elements of ENC and danger signs

Knowledge and practices of 36 “parteras” Only 50% practiced all the recommended ENC elements

at birth

Intervention identified: strengthen capacity of NGOs to improve knowledge and skills of CHWs, TBAs and volunteer mothers

Proportion of all Newborns in the Community evaluated within 3 days of birth (CCF)January 2008 – April 2009

Percentage of newborns assessed within 3 days of birth

4559 65 70 80 90 92 95

020406080

100

Jan'08

Mar May Jul Sept Nov Jan'09

Mar

Month

Perc

enta

ge

20% of babies evaluated (66/338) had danger signs and were referred to a facility. Three of those babies died (4.5% case fatality ratio)

Expansion

20072007 20082008

Participating Participating NGOsNGOs

55 99

MunicipalitiesMunicipalities 1616 4040

ProvincesProvinces 33 1010

PopulationPopulation 142,532 648,987

Some lessons learned

NGOs with different delivery strategies with the help of a coordinating mechanism can adapt a newborn care module and work together for quick expansion

NGOs with diverse areas of expertise can exchange capacity building strategies and other resources

Political will for community interventions and for support of CHWs is important. In Honduras the MOH supports strategies and CHW activities such as: Administration of 1st dose of oral antibiotic to newborns

with danger signs before referral (AIN-C manuals) Attending normal deliveries by TBAs where there are no

other options (MOH norms)

Red Cross

Proyecto Aldea Global

Thank you

The preceding slides were presented at theCORE Group 2010 Fall Meeting

Washington, DC

To see similar presentations, please visit:www.coregroup.org/resources/meetingreports