Effect of a Task Sharing Intervention Using Community Volunteers to Deliver Maternal and Neonatal Care Services on Knowledge, Practices and Coverage in Elgeyo Marakwet, Kenya Omedo OM1, 3, K’Ouma TM1, Castillo T1 , Menya D2, Vandana T4, Snell J1 and Navario P4 1 HealthRight
International, New York, USA 2 Moi University, School of Public Health, Eldoret, Kenya 3 University of Edinburg, Global Health Academy, Scotland and 4 New York University College of Global Public Health, New York, USA Study Setting
Introduction
Intervention
Approximately 86.3% of the population in Elgeyo Marakwet travel more than 1 KM to the nearest primary healthcare facility Delivery was in two sub-counties, Marakwet East and Marakwet West Targeted 20 community units consisting of 50 CHVs each Eight health facilities were identified as model sites to ensure the quality and quantity of healthcare deliveries
Maternal mortality ratio in Kenya is 360 per 100,000 live births (WHO 2014) Available tools to improve maternal, newborn and child health are: tetanus toxoid vaccinations, obstetric care, breastfeeding, antibiotics, skilled birth attendants (SBA), etc. Community strategy to package and deliver tools within existing programs is cost-effective and optimizes uptake Community health volunteers (CHVs) are proven effective in delivery of critical health interventions at household level Delivery of task sharing interventions is proven successful in other settings Limited evidence is available to guide task sharing to improve maternal health outcomes in low-resource settings
Study Purpose and Research Questions This study reports on task sharing between CHVs and community health extension workers (CHEWs) to improve the knowledge, practices and coverage of maternal and neonatal care (MNC) in a geographically and socio-economically isolated population in Kenya Primary question: Are CHVs able to maintain adequate quality of shifted services and their regular scope of work? Secondary questions: Does task shifting to CHVs affect availability and utilization of MNC services at the facility and community level? Does task shifting to CHVs affect quality of health services delivered by formal health providers? What constraints (e.g. policy, resources, capacity) present challenges to task shifting to CHVs, and what are potential health system and community solutions? Are maternal and newborn health (MNH) outcomes improved in communities with task shifting compared to communities without task shifting?
Facility
Antenatal and postnatal care (ANC/PNC) counseling on kangaroo mother care, exclusive breastfeeding (EBF)/nutrition, including danger signs during pregnancy and delivery, and for newborns Counseling to develop birth plans Family planning (FP) counseling and distribution of contraceptives HIV testing Counseling for HIV and AIDS Case management for HIV-positive mothers and their newborns
Study Design and Site Study Design: Pre- and post-evaluation design, with non-randomized and non-equivalent controls Indicators were identified using the USAID Rapid CATCH Selected MNH outcomes were measurements of change at population level Collected data through household surveys at baseline and midline
Characteristic
Improved knowledge of MNC dangers signs during pregnancy, delivery, and for the newborn
FP counseling Distribution of contraceptives: condoms, pill, long acting methods (LAM), and injectables HIV testing and referrals for care Counseling for HIV and AIDS Identification of low birth weight, cord cleaning with chlorhexidine, neonatal sepsis (diagnosis, treatment and/or referrals), provision of zinc, oral rehydration salt for diarrhea (treatment and/or referrals) were part of essential newborn care (ENC) and PNC
Study Participants: Mothers with children