Maternal|Child Health

Urban Community Health Workers in Afghanistan

Building strong relationships and trust between community health workers and the communities they serve prior to public health emergencies can help ensure continuity of health seeking behaviors during times of crisis. When health services dropped during COVID-19 lockdowns, women community health workers increased services 25%.

Health-seeking significantly decreased during COVID-19 lockdown due to fear of contracting the virus, and
many of the health posts in CHWs homes were shut down at this time. In contrast, CARE-supported urban CHWs,
particularly in Kabul and Balkh, were able to continue service provision in their homes due to the strong trust
they had built with the communities they served and their recognized leadership among community members
and as part of the health system. The relationship between CHWs and local communities was complemented by
CARE’s efforts to quickly provide CHWs with personal protective equipment and build capacity on WHO
protocols for COVID-19 screening, detection, and referral of cases as well as risk communication and
community engagement. During COVID-19 lockdown, the CHWs also continued provision of SRH, GBV services,
and referrals to midwives at community-based health centers run by CARE. In addition to maintaining service
delivery, the CHWs also began offering counseling and support to local women using mobile phones. Read More...

End line assessment of GSK supported Community Health workers (CHW) initiative in Sunamganj district, Bangladesh

In spite of improvement in maternal and child health, the Sylhet division continues to have the poorest indicators in Bangladesh. Higher mortality for both mother and child and poor utilization of healthcare services still exist in the Sylhet division. Sunamganj is one of the remotest areas in Bangladesh and belongs to the Sylhet division having the poorest maternal and child health status. Since December 2012, CARE Bangladesh together with GSK and other key stakeholders has been implementing a Community Health Workers (CHWs) Initiative, which aims to address the lack of skilled human resources in remote and underserved unions of Sunamganj district. The overall goal of the CHW initiative is to improve maternal and child health outcomes in underserved/remote and poor communities of Bangladesh by increasing their access to quality health care services. Through a unique model of Public-Private Partnership (PPP), the project developed 319 Private CSBAs who are providing maternal and child health services including primary treatment of Non-Communicable Diseases (NCDs) like diabetes and hypertension in the entire Sunamganj district. To do a robust measurement in terms of assessing maternal, neonatal and child health (MNCH) related knowledge and practices as well as documentation of learning of these innovative initiatives, icddr,b conducted a baseline study in 2012 and end-line assessment in 2018. Read More...

Endline Report: An interim analysis of baseline and endline data for key indicators

TAMANI is a complex intervention for improving maternal and newborn health in Tabora, Tanzania. The overarching objective of this intervention is to address the challenges linked to (1) the decision to seek care, (2) the barriers to accessing care, and (3) the provision of the highest possible quality of care, collectively known as the “three delays”. Addressing these delays requires a complex set of changes in behaviors, attitudes, access to and use of resources, skills, and knowledge of clients and service providers. The intervention targeted the supply side by improving the quality of care at health facilities, and the demand side through programs to increase utilization of care through community engagement and addressing gender barriers to accessing care by women and their families. Read More...

End of the Project Evaluation | Strengthening Approaches for Improved Maternal, Neonatal and Reproductive Health in Myanmar: Lashio Township, Northern Shan State, Myanmar

GSK and CARE Myanmar have been working together in the country since 2012 to provide better health services. The project was expanded from 45 villages to 60 villages in northern Shan State, based on successes and lessons learned in 2012-2015. The project goal is to contribute to the reduction of maternal and neonatal mortality through increased access to, and quality of, sexual and reproductive health, and maternal and child health services. Read More...

TAMANI (Tabora Maternal and Newborn Health Initiative) Impact Evaluation

According to the 2015-2016 DHS survey, Tabora region has the highest percentage population (45.8%) in the lowest wealth quintile in the country, which reflects high levels of structural inequality that have a direct bearing on reproductive, maternal, newborn, child, and adolescent health outcomes.(2) Polygamy is most prevalent in the Western zone with approximately one-third of marriages polygamous, contributing to high fertility rates. Tabora has a low contraceptive prevalence rate of 21.9%, and the Western Zone has the highest levels of teenage childbearing in Tanzania (38%). The latest DHS survey (2015-2016) indicated that 44.3% of women in Tabora deliver at home.

Given this context, the international aid organization CARE began reproductive health programming in Tabora in 2012 with the aim of improving maternal and reproductive health. This paper presents an impact evaluation of CARE’s second stage of reproductive, maternal and newborn health programming in Tabora, the Tabora Maternal and Newborn Health Initiative (TAMANI), which builds on the experience of CARE in the region and spans from 2017-2021. Read More...

PROMOTION DE LA SANTE DE LA MERE ET DE L’ENFANT (PSME)

La vaccination et les services de planification familiale sont deux composantes importantes des soins de santé primaire. La plupart des femmes en période post-partum prolongée souhaitent retarder ou éviter d’autres grossesses mais beaucoup d’entre elles n’utilisent pas de méthode moderne de contraception. Une analyse des données provenant de plusieurs pays a montré que les besoins de contraception non satisfaits chez cette population étaient très importants, allant de 45 % à plus de 80 % des femmes en post-partum (Borda and Winfrey, 2008). La planification familiale permet aux couples d’avoir le nombre d’enfants qu’ils désirent et de choisir le moment et l’espacement des grossesses, ce qui permet d’améliorer la santé de la mère et de l’enfant. Les grossesses trop rapprochées peuvent représenter un danger pour la santé de la mère et de l’enfant (OMS, 2007a). Les grossesses espacées de moins de 18 à 24 mois ont été associées à des risques plus élevés de naissance prématurée, de faible poids de naissance, de décès fœtal, néonatal ou du nourrisson, et d’effets négatifs sur la santé maternelle (Conde-Agudelo et al. 2012). La vaccination des enfants est l’un des services de santé les plus équitables et les plus utilisés dans le monde. Le calendrier de vaccination et de soins de santé primaire recommandé pendant la première année de vie de l’enfant donne lieu à de nombreux contacts pour des soins de santé. Veiller à ce que des services et conseils de planification familiale soient liés aux contacts pour la vaccination des enfants via des services de santé primaire bien gérés peut permettre de proposer aux mères des informations et des services de planification familiale pendant la période critique des 12 mois suivant l’accouchement. Une modélisation à partir de données provenant de cinq pays d’Afrique subsaharienne a montré que le fait d’entrer en contact avec les femmes en post-partum au moment de la vaccination infantile pouvait faire diminuer les besoins de planification familiale non satisfaits de 3,8 à 8,9 points de pourcentage (Gavin et al. 2011). Dans ce contexte, CARE Benin/Togo, sur financement de la Fondation GSK en collaboration avec le Ministère de la Santé et de l’Hygiène Publique du Togo, a mis en œuvre depuis Décembre 2018 une initiative de renforcement du système de santé et d'intégration des services de vaccination et de planification familiale dans 11 Formations Sanitaires du district de la Binah dans la Région de la Kara au Togo, dénommée « Promotion de la Santé de la Mère et de l’Enfant (PSME) [48 Pages]. Read More...

COVID-19 Vaccination Uptake: A study of Knowledge, Attitudes and Practices of Marginalized Communities in Iraq

CARE Iraq conducted a study to better understand community acceptance of COVID-19 vaccination and existing barriers to vaccine uptake. The objectives of the study were to create an understanding of people’s knowledge, attitudes and perceptions about COVID-19 and the vaccines, establish what reasons undermine the COVID-19 vaccination campaign and inform about the status of vaccine uptake among marginalized communities. The results of the study can inform policy makers and health actors to design awareness campaigns and address barriers to vaccine uptake to increase the vaccination rate.

CARE found that:
• Vaccine hesitancy is high.
• Women have less access to, knowledge of, and willingness to accept the COVID-19 vaccine then men.
• Barriers to access are still high, and higher for women than for men.
• Fear of side effects is the biggest obstacle.
• There is little trust in the vaccination process.
• Many people do not believe vaccines are important.
• People are not confident they have enough accurate information.

Key recommendations
• Social media can be a primary channel for vaccine messaging.
• It’s critical to counteract misinformation.
• Multiple sources of information are critical.
• Focus messaging for women and religious leaders.
• Develop different messages in different areas.
• Build on people’s willingness to be convinced with good information. Read More...

Tabora Maternal & Newborn Health Initiative (TAMANI): Year 4 results

The Tabora Maternal and Newborn Health Initiative (TAMANI) is a five-year project led by CARE in partnership with the Government of Tanzania’s Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC) and the Prime Minister’s Office for Regional and Local Government (PO-RALG). Implementing partners include the Society of Obstetricians and Gynecologists of Canada (SOGC), the Association of Gynecologists and Obstetricians of Tanzania (AGOTA), the Canadian Society for International Health (CSIH), McGill University’s Institute for Health & Social Policy, and Ifakara Health Institute (IHI). The project is financially supported by the Government of Canada and is closely aligned to Government of Tanzania (GoT) health polices, strategies and guidelines.
The Annual Report covers the period of April 1, 2020, to March 31, 2021.The report provides an analysis on operations to date against the Year Four Annual Work Plan. This report also highlights how the project
pivoted to respond to the COVID-19 global pandemic and includes reporting on COVID response programming as approved by GAC in March 2020. Read More...

COVID-19 Response in Tabora Tanzania (Bloomberg)

CARE Tanzania builds on its successful partnership with the Government of Tanzania’s Regional Health Management Team (RHMT) in Tabora Region. Leveraging funding from the Government of Canada as part of the Tabora
Maternal Newborn Health Initiative (TAMANI), CARE’s Bloomberg-funded COVID-19 activities builds on efforts to improve access of and quality of health services across health facilities and communities to challenge harmful gender norms.
In partnership with the Government of Tanzania, activities cover all 8 districts in Tabora Region. CARE provides technical support and training to Community Health Workers, who are supported by the government in their duties.With the onset of COVID-19, CARE Tanzania quickly implemented a digital survey to understand the impacts of COVID-19. The majority of female respondents reported increases in gender-based violence and harassment, with COVID-19 restricting women’s access to resources and decision-making. Read More...

The Final Evaluation of the Opportunities for Mother and Infants Development Project

The Opportunities for Mother and Infant Development (OMID) is a three year project (from 2018 to 2021), funded by The Glaxo Smith Kline (GSK). The current phase of the project has been implemented in the two districts (16th and 17th) in Kabul city. The main purpose of the project is to improve the health and reduce the mortality among mothers, newborns and children in the most vulnerable communities through community-based interventions facilitated and delivered by Community Health Workers (CHWs) and Community Midwives (CMWs).

Overall, the project has been effective in achieving the intended outcomes. Access and utilization of Maternal and Neonatal Child Health (MNCH) services have improved as demonstrated by achievement of the project’s key performance indicators across the continuum of care.

This included increases in the %:
- of women reporting ANC utilization
- of women who undertook the first ANC visit before by the 3rd trimester of their pregnancy
- of those who knew the date that the baby was expected to arrive
- of those women who had a plan where she would deliver the baby
- of those women who believed health facility is safer to deliver there

And decreases in the %:
- of those who didn’t go for ANC and believed it is not important
- of those who didn’t go for ANC and indicated the high cost of care as reason

The community systems strengthening undertaken by the project through establishment of community based health facilities and CHWs was effective in increasing health awareness and adoption of positive MNCH behaviors and practices. Read More...

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