Table 1 Key components of facility and community-level interventions
From: The effect of a multi-component intervention on disrespect and abuse during childbirth in Kenya
Intervention Activity | Implementation activities |
|---|---|
Facility level | |
Training in promoting respectful care including values clarification and attitude transformation (VCAT) | Three day training on VCAT based on providers’ and clients’ rights and obligations. Revision of professional ethics and practices. Each of the study facilities developed action plans for institutionalization in maternity units. |
Quality Improvements teams (QITs) | Strengthen facility quality improvement teams (e.g. health facility management committees-HFMCs) for monitoring, addressing, and resolving D & A cases and address infrastructure, drugs and commodity supply concerns. Additionally HFMCs were trained on rights and obligations related to childbirth, develop D & A protocol for reporting and monitoring, and encouraged community membership. |
Caring for Carers | Counseling for providers at the group and/or individual levels to support providers with coping mechanisms to overcome experiences related to high workload, trauma or critical incidents. Initially this was conducted by FIDA counselors (one counseling session per site) while at the same time they would role model the sessions for trained counselor with the facility or within reach of the county if the facility does not have any. This site level counselor would then continue with counseling session in their respective sites. |
D & A Monitoring | Providing mechanisms to report D & A such as customer service desks, suggestion boxes and through consortium supervision visits by implementing team. Also the county health teams and facility quality improvements conducted monitoring as part of routine work. |
Mentorship | On-the-job role-modeling for provider behavior change by identified champions within the facility as part of routine continuous professional education. |
Maternity Open Days | Trust-building with local communities during which men and women from the community can visit the nearby facility and learn about procedures in the maternity wards and interact with nurse-midwives. |
Community level | |
Community workshops | Civic education of community rights to sexual and reproductive health including maternal health care by community health (extension) workers (CHWs and CHEWs) associated with a particular county area and facility conducted by the partners but by led by Federation of women Lawyer-Kenya. Trainers (CHWs, CHEWs, opinion leaders, civil and legal aids) conducted respectful care sensitization meetings for community members (women, men and youth) with support of their respective county health management teams. Deliberate effort was made to involve male in community workshops as participants and facilitators as well through targeted meetings for men ‘calling them to action’ to demand respectful care for their wives and partners. |
Mediation/alternative dispute resolution | Training society leaders (e.g. CHWs, respected persons) on mediation skills, to act as intermediaries between community members and the health facility to address D & A issues. Mediators were selected by communities and facilities (on set criteria) and trained by Federation of women Lawyer-Kenya |
Counseling Community Members | Counseling community members who have experienced D & A by Federation of women Lawyer-Kenya and other professional counselors within the facilities. These would be referral from CHWs or community legal aids. |