Community-based postnatal care services for women and newborns in Kenya: an opportunity to improve quality and access?

Burnett-Zieman, Brady; Abuya, Timothy; Mwanga, Daniel; Wanyugu, John; Warren, Charlotte E.; Sripad, Pooja

doi:10.7189/jogh.11.07006

Cited by 12 publications

(11 citation statements)

References 27 publications

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“…A study from Malawi found that only 29% of health surveillance assistants had the family planning methods they were supposed to have in order meet their clients’ needs [ 59 ]. In Kenya, only 6% of CHWs had all of the job aids and tools specified in the national guidelines for their maternal health activities [ 60 ].…”

Section: Resultsmentioning

confidence: 99%

Community health workers at the dawn of a new era: 9. CHWs’ relationships with the health system and communities

LeBan

Kok

Perry

2021

Health Res Policy Sys

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Background This is the ninth paper in our series, “Community Health Workers at the Dawn of a New Era”. Community health workers (CHWs) are in an intermediary position between the health system and the community. While this position provides CHWs with a good platform to improve community health, a major challenge in large-scale CHW programmes is the need for CHWs to establish and maintain beneficial relationships with both sets of actors, who may have different expectations and needs. This paper focuses on the quality of CHW relationships with actors at the local level of the national health system and with communities. Methods The authors conducted a selective review of journal articles and the grey literature, including case study findings in the 2020 book Health for the People: National CHW Programs from Afghanistan to Zimbabwe. They also drew upon their experience working with CHW programmes. Results The space where CHWs form relationships with the health system and the community has various inherent strengths and tensions that can enable or constrain the quality of these relationships. Important elements are role clarity for all actors, working referral systems, and functioning supply chains. CHWs need good interpersonal communication skills, good community engagement skills, and the opportunity to participate in community-based organizations. Communities need to have a realistic understanding of the CHW programme, to be involved in a transparent process for selecting CHWs, and to have the opportunity to participate in the CHW programme. Support and interaction between CHWs and other health workers are essential, as is positive engagement with community members, groups, and leaders. Conclusion To be successful, large-scale CHW programmes need well-designed, effective support from the health system, productive interactions between CHWs and health system staff, and support and engagement of the community. This requires health sector leadership from national to local levels, support from local government, and partnerships with community organizations. Large-scale CHW programmes should be designed to enable local flexibility in adjusting to the local community context.

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Section: Resultsmentioning

confidence: 99%

Community health workers at the dawn of a new era: 9. CHWs’ relationships with the health system and communities

LeBan

Kok

Perry

2021

Health Res Policy Sys

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“…For a full content of effective PNC to be delivered these healthcare providers need to have the necessary equipment, dugs, consumables as well as up-to-date knowledge and skills in all aspects of PNC. As it can be expected that many women are home-bound especially in the early postnatal period, there is a need to provide care at home or very close to home and models for this may require further development [ 76 ]. Recently there have been suggestions that community-based healthcare workers and/or volunteers may be better placed to provide PNC.…”

Section: Discussionmentioning

confidence: 99%

Essential components of postnatal care – a systematic literature review and development of signal functions to guide monitoring and evaluation

McCauley

Lowe

Furtado

et al. 2022

BMC Pregnancy Childbirth

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Background Postnatal Care (PNC) is one of the healthcare-packages in the continuum of care for mothers and children that needs to be in place to reduce global maternal and perinatal mortality and morbidity. We sought to identify the essential components of PNC and develop signal functions to reflect these which can be used for the monitoring and evaluation of availability and quality of PNC. Methods Systematic review of the literature using MESH headings for databases (Cinahl, Cochrane, Global Health, Medline, PubMed, and Web of Science). Papers and reports on content of PNC published from 2000–2020 were included. Narrative synthesis of data and development of signal function through 7 consensus-building workshops with 184 stakeholders. Results Forty-Eight papers and reports are included in the systematic review from which 22 essential components of PNC were extracted and used to develop 14 signal functions. Signal functions are used in obstetrics to denote a list of interventions that address major causes of maternal and perinatal morbidity or mortality. For each signal function we identified the equipment, medication and consumables required for implementation. The prevention and management of infectious diseases (malaria, HIV, tuberculosis) are considered essential components of routine PNC depending on population disease burden or whether the population is considered at risk. Screening and management of pre-eclampsia, maternal anaemia and mental health are recommended universally. Promotion of and support of exclusive breastfeeding and uptake of a modern contraceptive method are also considered essential components of PNC. For the new-born baby, cord care, monitoring of growth and development, screening for congenital disease and commencing vaccinations are considered essential signal functions. Screening for gender-based violence (GBV) including intimate partner- violence (IPV) is recommended when counselling can be provided and/or a referral pathway is in place. Debriefing following birth (complicated or un-complicated) was agreed through consensus-building as an important component of PNC. Conclusions Signal functions were developed which can be used for monitoring and evaluation of content and quality of PNC. Country adaptation and validation is recommended and further work is needed to examine if the proposed signal functions can serve as a useful monitoring and evaluation tool. Trial registration The systematic review protocol was registered: PROSPERO 2018 CRD42018107054.

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“…There is also generally a lack of staff trained and competent to provide basic content and more specifically to support and manage women with complicated pregnancies. Recently there have been suggestions that community‐based healthcare workers and/or volunteers may be better placed to provide postnatal care and follow‐up 35,36 . Although this is likely to be cost‐effective and may result in more women receiving a visit in the postnatal period, careful planning is needed for effective implementation 37,38 A multi‐country mapping shows that few community‐based healthcare providers are adequately trained and competent, legislated and/or supported to provide all of the essential components of either ANC or PNC 39,40 …”

Section: Discussionmentioning

confidence: 99%

Where is the ‘C’ in antenatal care and postnatal care: A multi‐country survey of availability of antenatal and postnatal care in low‐ and middle‐income settings

Madaj

Gopalakrishnan

Quach

et al. 2022

BJOG

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Community-based postnatal care services for women and newborns in Kenya: an opportunity to improve quality and access?

Cited by 12 publications

References 27 publications

Community health workers at the dawn of a new era: 9. CHWs’ relationships with the health system and communities

Community health workers at the dawn of a new era: 9. CHWs’ relationships with the health system and communities

Essential components of postnatal care – a systematic literature review and development of signal functions to guide monitoring and evaluation

Where is the ‘C’ in antenatal care and postnatal care: A multi‐country survey of availability of antenatal and postnatal care in low‐ and middle‐income settings

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