Saving Newborn lives Initiative-aka Hala Project - Nipccd

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Form 2: Evidence Review for Community-Based Newborn Care Name of Intervention: Hala Project (Pilot phase), Pakistan Date of Review: August 2007 1. Location and scale Number of villages by block, district and state names 315 villages Hala and Matiari sub districts of Pakistan 2. Agencies Lead agency(ies) Other key agencies (partners) Department of Pediatrics & London School of Tropical Child Health Aga Khan Medicine and Hygiene University, Karachi, Pakistan Govt. of Sindh 2. Intervention Description Population covered Comments Time period 138,600 2003-2005 Implementing agencies Sponsor/donor Comments List Type (Govt./NGO/private) 1.World Health Organization 1. Department of Health 1. Government of Sind, Pakistan (WHO 2.Aga Khan University 2. Save the Children (funded by Bill and Melinda gates Foundation) Goal and Objectives Key strategies Key components/activities Primary target group Secondary target group Goal: To study effect of a package of 1.Training LHWs in home-based newborn care, 1. Household visits and health education by LHWs to mothers Pregnant Women of reproductive age, community-based interventions to community mobilization and health education during pregnancy and post-delivery (within 24 hours of birth mothers adolescent girls, community reduce perinatal and neonatal and days three,seven,14 and 28) elders and local political leaders mortality, delivered through 2.Training of TBAs (dais)-on basic newborn care, 2. Delivery care by TBAs community-based Lady Health including basic resuscitation and immediate newborn 3. The community-based interventions included identification Workers (LHWs) and Traditional Birth care of community volunteers, formation of Community Health Attendants (TBAs) Committees (CHC), organizing emergency transport fund, 3. Community education and mobilization-use of group education sessions by LHWs, and advocacy work community volunteers to establish village-level with community elders and local political leaders to promote community health committees for maternal and maternal and newborn care newborn care and organize group health education 4. Development of local Behavior Change Communication Information sources sessions (BCC) material including a two part video docudrama in local language (Sindhi) 5. Training of LHWs and TBAs in intervention area 6. Training in basic and intermediate newborn care to all public sector Rural Health Centre and hospital-based medical and nursing staff in intervention and control clusters Publication names Websites)/on-line Unpublished project documents Comments 1. Child and Adolescent Health and Development; Progress Report 2006, WHO “Implementing Community-Based Perinatal Care: Results from a Pilot study in Rural 2. Research Plans and Progress Journal of Perinatology ( 2002 ) 22, S12 – S19 SNL- Bangladesh Program Evaluation, Jan 2005, Save the Children Pakistan” 2
5. Monitoring and Evaluation Methodology/design (adopted for program Monitoring and Evaluation data collection – summarize it from monitoring, baseline, special studies, midterm or final evaluation reports that you are referring) Eight clusters were randomly selected for the pilot study (which would guide the final effectiveness trial) A complete household and facility survey was conducted in these eight clusters from May - June 2003 to assess socio-economic characteristics and baseline perinatal and neonatal mortality rates All births and deaths in the preceding 12 month period were identified by recall Four of the eight clusters were chosen to receive the intervention. Choice was based on trying to ensure that the intervention and control clusters had similar distributions with respect to population size, number of births and neonatal deaths in the preceding 12 months, but did not use a formal randomization procedure In addition to the baseline survey in mid 2003, two cross-sectional surveys of all households were conducted by a separate census team at the midpoint (June-July 2004) and at the end of the pilot phase (August –September 2005) to collect data on births, deaths and care seeking patterns in the preceding 12 months Key measures/indicators Key lessons learnt 1. % mothers who received tetanus toxoid during pregnancy 2. % mothers who received antenatal check-up during last pregnancy 3. % mothers who received maternal newborn health information during pregnancy 4. % mothers who received domiciliary visit by LHW during the last pregnancy 5. % mothers who procured clean delivery kit before delivery 6. % mothers who delivered in a government health facility 7. % deliveries with presence of LHW 8. % of newborns received post-natal visit by LHW after birth 9. % of newborns examined by LHWs within the first 48 hours after birth 10. % newborns with bathing delayed beyond six hours 11. % mothers who fed colostrums to their babies 12. % mothers who breastfed their infant within an hour of birth 13. % mothers who breastfed their infant exclusively for first four months 14. % mothers reported receiving support from the community health committee during pregnancy Community health workers can play a major role in delivering effective interventions for maternal and newborn care, and can do so in collaboration with both TBAs and skilled care providers Packages of evidence-based interventions can be delivered through community care and outreach strategies within the existing health system, and make a difference to newborn outcomes Dais and LHWs from the same community collaborated readily and community members (both males and females) were generally receptive to their messages and group sessions Community group counseling sessions may be a powerful, low-cost and effective means of reaching large numbers of women in rural settings and may also influence other community members Although the overall number of skilled attendants in the area did not change during the period 2003-5, the proportion of births attended by skilled attendants within the public sector facilities increased substantially in the intervention clusters indicating that community support strategies and demand creation affect care seeking behaviors and neonatal mortality The observed increase in skilled attendant utilization in these public health facilities underscores the importance of health system strengthening as a complement to community-based approaches Health staff retention was an issue. For example, of the 28 medical officers in the eight clusters trained in neonatal care and resuscitation, 19 (68%) were transferred out during the course of the pilot study, including the pediatrician in the district referral hospital. There were three different director generals of health in the area during the period 2002-2005, placing a large burden on project staff with respect to communication and consensus building with health system managers and staff 6. Program cost Total per year Estimated cost per component Estimated cost per beneficiary/unit Comments Information on cost not A full analysis of costs and cost-effectiveness available analysis is planned for the main trail currently being implemented in 16 clusters. Results should be available in late 2008 3
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