Work package 3 - Detailed situation analysis of maternal and newborn health services and care at study sites

 

Overall objective

To assess in detail maternal and newborn health at the respective study sites, including quality and coverage of maternal and newborn health services and local epidemiology for maternal and newborn health to be able to provide scientific supported advice on strengthening facility and community-based care to improve maternal and newborn health.

 

Specific objectives
  • To assess at each study site the package of services, quality of care and utilization rate of existing postpartum services and the feasibility of introducing new interventions/services to improve the existing postpartum services and improve maternal and newborn health;
     
  • To assess at each study site the package of services, quality of care and utilization rate of services provided in the child-health clinics and the feasibility of integrating women orientated services within child-health clinics;
     
  • To assess in each study site the existing community participation in health care describing the kind of services delivered by the community, the quality of these services and their coverage and to assess the feasibility of including community health workers/programmes in the delivery of maternal and newborn care; and
     
  • To analyze the finding and formulate recommendations that will be used by work package 4.

 

Description

This work package is part of the first research phase and consists of a detailed situation analysis of maternal and newborn health at the respective study sites, including quality and coverage of maternal and newborn health services and local epidemiology for maternal and newborn health. Results of this analysis will inform decisions on the feasibility and appropriateness of: (1) integrating women-oriented services within child-health clinics, (2) strengthening existing postpartum services for women, and (3) introducing/strengthening community-based services for maternal and newborn health, and will guide the project researchers in the design of the context specific intervention packages (work package 4). This situation analysis will also constitute part of the baseline information needed for the effectiveness evaluation conducted after implementation (work package 6).

Tools will be developed for conducting a detailed situation analysis of maternal and newborn health care and services in the selected health zone/district. An initial mapping of sites and service provision will occur to determine the quality, coverage and scope of existing facility and community-based services. Based on the situational analysis, each study setting will prioritize either the strengthening of existing postpartum services and/or the provision of maternal services within child health clinics and/or the use of community-based services. For example, if priority commodities such as oxytocin or misoprostol are not available within health facilities then strengthening these existing services will take precedence over the design of new interventions.

To ensure the long-term sustainability of the proposed research interventions to strengthen postpartum care, it is important that these interventions are feasible, appropriate and agreed upon with local policy makers, clinicians and other relevant stakeholders. The research funding to support the intervention will only be used to support the planning and design of expanded and improved post-partum services; the training of available health personnel and volunteers, and the evaluation of postpartum care. We also envisage funding local personnel to support efforts at replicating successful interventions in neighbouring sites.

The situation analysis of maternal and newborn health services and care will inform the development and strengthening of postpartum services, taking into account:

  • Quality and coverage of maternal and newborn health services and local epidemiology of maternal and newborn health;
     
  • The additional burden placed on available human resources caused by expanding the packages of services;
      
  • The capacity of the available human resources to deliver new services/tasks (e.g. enough staff available, is the staff able to perform new tasks without additional training, what kind of training will be needed);
      
  • Financial implications of increasing the package of services (e.g. cost of additional drugs, equipment, laboratory tests, costs of additional human resources);
      
  • Existing community-based health services, including their quality, mechanism of supervision and mechanism of integration/cooperation with the facility based health services;
      
  • Strategies to motivate community health workers;
      
  • Strategies to ensure good quality care is delivered by community health workers/volunteer health workers;
     
  • Strategies to supervise community health workers and link them with facility-based health care.

 

The expected outcomes of work package 3 are:
1) tools developed for conducting a detailed situation analysis of maternal and newborn health services in a health zone/district
2) the ability to strengthen/introduce facility and community-based postpartum services and care in a feasible, realistic, sustainable and appropriate way in a context specific setting.