Package of Services for Postpartum and Newborn Care

 

The lack of clear clinical or policy guidance on an essential or optimal package of postpartum services is partly explained by the paucity of evidence on the effectiveness of the individual postpartum interventions. A further reason for the poorly-defined postpartum packages is that variations in local needs, capacity and health policies affect the feasibility and appropriateness of different packages of services. Attention is needed to ensure that new interventions are not designed independently of existing antenatal, intrapartum and postpartum services, and are cognizant of other primary health care priorities in the study areas. Presently, many low-income countries are hampered by the presence of multiple, selective and disjointed interventions, particularly at the community level. This has resulted in damaging competition between health priorities as well as high transaction costs and inefficiencies. Since the exact combination of such factors will vary across settings - together with varying needs, capacity and health-seeking patterns - different sites call for different packages of interventions. Many authors argue that there has been undue promotion of the one-size-fits all core strategy, whereas context-specific policies are needed.

The MOMI research project proposes a cluster of linked interventions, provided at both facility and community level, which aims to reduce maternal mortality in the postpartum and prevent newborn deaths. In the early postpartum, it makes sense to prioritize the key causes of death, especially postpartum haemorrhage and sepsis. In the middle and latter part of the first year after childbirth, key interventions might include: family planning counselling and contraception; STI prevention and treatment; HIV testing and counselling; distribution of HIV prevention commodities; linkages to antiretroviral treatment; cervical cancer screening; mental health services; prevention and treatment of anaemia and reproductive tract infections; and nutrition and hygiene education and commodities. Packages of interventions and services will be designed as part of the research and will always be in line with local national health policies.