From: Innovative approaches for improving maternal and newborn health - A landscape analysis
Health system building block | Innovative Approaches/Strategies |
---|---|
Health service delivery | Quality improvement |
• Management and leadership skills development activities • Safe childbirth checklist, a standardized protocol for MNH care • Implementation of redesigned care model/protocol based on selected evidence-based recommendations and women’s views • Collaborative quality improvement of a network of sites working together • Comprehensive intervention packages based on quality improvement approaches (including certifications, delivery of services, incentives, promotion, etc.) • UNICEF Safe motherhood programme • Special care newborn units to provide high quality care • Infection control programme to reduce nosocomial infections • Package of MNH interventions at institutional level • Mental health care for pregnant women using existing primary care resources • Provision of equipment and training to facilities • Community education on maternal health • Application of quality of care model from family planning to EmOC | |
Skin-to-skin care / kangaroo mother care | |
• Community-based kangaroo mother care • Kangaroo mother care implementation tool to monitor progress • Implementation of kangaroo mother care in government hospitals • Use of facilitation to implement kangaroo mother care in hospitals | |
MNH nutrition | |
• New micronutrient supplementation programs (e.g. zinc, iron, calcium) • Positive deviance approach to improve antenatal nutrition | |
Breastfeeding | |
• Innovative promotion strategies (e.g. postnatal visits, counselling by community volunteers, mass media) and delivery systems (e.g. baby-friendly hospitals, peer facilitators) including mainstreaming breastfeeding into the scale-up of MNH | |
Prenatal care | |
• Maternity waiting homes, some combined with MCH services and income generation activities • Yoga for high risk pregnancies • Education for first time childbearing women • Group prenatal care | |
Medical products and health technologies | Maternal |
• Non-pneumatic anti-shock garment to stabilize and resuscitate hypovolemic shock • Automated blood pressure devices for low resource settings • Single use obstetric emergency kits • Misoprostol for community-based use, storage and application system for oxytocin delivery and balloon condom catheter to treat intractable uterine bleeding • Foilized polyethylene pouch to store neviparine • Low-cost, low-tech devices: portable OB ultrasound and Doppler, simplified partograph, vacuum delivery/EmOC devices, birth simulator, cell-phone-based malaria diagnostics, hemoglobinmeter, EmOC transporter (eRanger) • Clean delivery kits | |
Neonatal | |
• Low-cost devices: ventilator support, temperature measurement, pulse oximeter and phototherapy • Devices to prevent PMTCT (e.g. breastfeeding shields) • Application of chlorhexidine for umbilical cord care • Topical application of emollients to reduce nosocomial infections and mortality • Thermoprotection mechanisms: cot-nursing using heated water-filled mattress, infant warmers, wraps and foils | |
Health workforce | Training |
• E-learning via internet and phone text messages • Training of community health worker cadres in tasks previously not assigned: antenatal care, safe delivery, neonatal resuscitation, essential newborn care and PMTCT care, IMNCI • Low-technology obstetric and neonatal resuscitation simulation training (e.g. Helping Babies Breathe Programme) • Training programs/courses for trainers and providers in antenatal care, EmOC, essential newborn care and neonatal resuscitation: Making Pregnancy Safer, Promoting Effective Perinatal Care, WHO Essential Newborn Care, acute care of at-risk newborns, Perinatal Continuing Education Programme, Essential Surgical Skills Emergency MCH Programme • Partnering international professional organizations for training of providers • Training TBAs in antenatal care, safe delivery, neonatal resuscitation and essential newborn care, use of delivery mat and misoprostol • Training of nurses: quality improvement tools, oxytocin use | |
Task-shifting to non-physicians | |
• Non-physician clinicans to provide EmOC • Anaesthesia services provided by mid-level cadres • NICU newborn aides to help staffing problems • Pictorial job aids used by providers | |
Health financing | Enhancing demand for MNH services |
• Conditional cash transfers • Cash incentives for skilled delivery at facility • Vouchers for maternal health services and related costs (e.g. transport costs and cash payment for delivery at facility) • Community-based health or obstetric insurance • Abolition or reduction of user fees | |
Incentives for health workers to increase supply and quality of services | |
• Performance-based payment • Free reimbursement for training and costs | |
Community ownership and participation | Women’s groups and community-based intervention packages |
• Women’s groups convened by female facilitators to identify problems and formulate solutions • Female community health worker outreach • Community/home-based intervention packages including pregnancy, delivery and ENC components | |
Linkage between community and facility | |
• Integration of newborn care into existing community-based package and national health system • Creating a network of providers/CHWs | |
Community mobilisation | |
• Community-based quality improvement process involving learning and problem-solving cycle • Home-based care and linkages to facility based services including distribution and use of misoprostol, recognition of danger signs, improvements in transport • Community participatory learning activities • Positive deviance behavior change activities | |
Leadership and governance | Partnerships |
• Public-private partnerships, international/regional partnerships and inter-agency task teams to create capacity for MNH care | |
National MNH policies | |
• Health system reforms • Use of research, data and policies to develop community-based newborn care package/national newborn strategy and influence high-profile champions to act • Integration of skilled birth attendance into national plan/policy • Increase in political commitment • Rights-based programming and micro-planning strategy to increase access, coverage and quality of MNH care • Use of situation analysis to develop newborn action plan |