Comprehensive review of the evidence regarding the effectiveness of community–based primary health care in improving maternal, neonatal and child health: 6. strategies used by effective projects

Perry, Henry B.; Sacks, Emma; Schleiff, Meike; Kumapley, Richard; Gupta, Sundeep; Rassekh, Bahie Mary; Freeman, Paul

doi:10.7189/jogh.07.010906

Cited by 50 publications

(60 citation statements)

References 57 publications

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“…These are described in greater detail in paper 4 in this series [6]. Clearly no one size fits all situations, and contextual considerations have a major influence on project operations.…”

Section: Resultsmentioning

confidence: 99%

Comprehensive review of the evidence regarding the effectiveness of community–based primary health care in improving maternal, neonatal and child health: 8. summary and recommendations of the Expert Panel

Black¹,

Taylor²,

Arole³

et al. 2017

Journal of Global Health

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127

119

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BackgroundThe contributions that community–based primary health care (CBPHC) and engaging with communities as valued partners can make to the improvement of maternal, neonatal and child health (MNCH) is not widely appreciated. This unfortunate reality is one of the reasons why so few priority countries failed to achieve the health–related Millennium Development Goals by 2015. This article provides a summary of a series of articles about the effectiveness of CBPHC in improving MNCH and offers recommendations from an Expert Panel for strengthening CBPHC that were formulated in 2008 and have been updated on the basis of more recent evidence.MethodsAn Expert Panel convened to guide the review of the effectiveness of community–based primary health care (CBPHC). The Expert Panel met in 2008 in New York City with senior UNICEF staff. In 2016, following the completion of the review, the Panel considered the review’s findings and made recommendations. The review consisted of an analysis of 661 unique reports, including 583 peer–reviewed journal articles, 12 books/monographs, 4 book chapters, and 72 reports from the gray literature. The analysis consisted of 700 assessments since 39 were analyzed twice (once for an assessment of improvements in neonatal and/or child health and once for an assessment in maternal health).ResultsThe Expert Panel recommends that CBPHC should be a priority for strengthening health systems, accelerating progress in achieving universal health coverage, and ending preventable child and maternal deaths. The Panel also recommends that expenditures for CBPHC be monitored against expenditures for primary health care facilities and hospitals and reflect the importance of CBPHC for averting mortality. Governments, government health programs, and NGOs should develop health systems that respect and value communities as full partners and work collaboratively with them in building and strengthening CBPHC programs – through engagement with planning, implementation (including the full use of community–level workers), and evaluation. CBPHC programs need to reach every community and household in order to achieve universal coverage of key evidence–based interventions that can be implemented in the community outside of health facilities and assure that those most in need are reached.ConclusionsStronger CBPHC programs that foster community engagement/empowerment with the implementation of evidence–based interventions will be essential for achieving universal coverage of health services by 2030 (as called for by the Sustainable Development Goals recently adopted by the United Nations), ending preventable child and maternal deaths by 2030 (as called for by the World Health Organization, UNICEF, and many countries around the world), and eventually achieving Health for All as envisioned at the International Conference on Primary Health Care in 1978. Stronger CBPHC programs can also create entry points and synergies for expanding the coverage of family planning services as well as for accelerating progress in the detec...

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“…These are described in greater detail in paper 4 in this series [6]. Clearly no one size fits all situations, and contextual considerations have a major influence on project operations.…”

Section: Resultsmentioning

confidence: 99%

Comprehensive review of the evidence regarding the effectiveness of community–based primary health care in improving maternal, neonatal and child health: 8. summary and recommendations of the Expert Panel

Black¹,

Taylor²,

Arole³

et al. 2017

Journal of Global Health

Self Cite

127

119

View full text Add to dashboard Cite

show abstract

“…Strategies to implement community–based interventions for improving neonatal and child health are reported elsewhere [13]. These common strategies include:…”

Section: Resultsmentioning

confidence: 99%

Comprehensive review of the evidence regarding the effectiveness of community–based primary health care in improving maternal, neonatal and child health: 2. maternal health findings

Jennings¹,

Pradhan²,

Schleiff³

et al. 2017

Journal of Global Health

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BackgroundWe summarize the findings of assessments of projects, programs, and research studies (collectively referred to as projects) included in a larger review of the effectiveness of community–based primary health care (CBPHC) in improving maternal, neonatal and child health (MNCH). Findings on neonatal and child health are reported elsewhere in this series.MethodsWe searched PUBMED and other databases through December 2015, and included assessments that underwent data extraction. Data were analyzed to identify themes in interventions implemented, health outcomes, and strategies used in implementation.Results152 assessments met inclusion criteria. The majority of assessments were set in rural communities. 72% of assessments included 1–10 specific interventions aimed at improving maternal health. A total of 1298 discrete interventions were assessed. Outcome measures were grouped into five main categories: maternal mortality (19% of assessments); maternal morbidity (21%); antenatal care attendance (50%); attended delivery (66%) and facility delivery (69%), with many assessments reporting results on multiple indicators. 15 assessments reported maternal mortality as a primary outcome, and of the seven that performed statistical testing, six reported significant decreases. Seven assessments measured changes in maternal morbidity: postpartum hemorrhage, malaria or eclampsia. Of those, six reported significant decreases and one did not find a significant effect. Assessments of community–based interventions on antenatal care attendance, attended delivery and facility–based deliveries all showed a positive impact. The community–based strategies used to achieve these results often involved community collaboration, home visits, formation of participatory women’s groups, and provision of services by outreach teams from peripheral health facilities.ConclusionsThis comprehensive and systematic review provides evidence of the effectiveness of CBPHC in improving key indicators of maternal morbidity and mortality. Most projects combined community– and facility–based approaches, emphasizing potential added benefits from such holistic approaches. Community–based interventions will be an important component of a comprehensive approach to accelerate improvements in maternal health and to end preventable maternal deaths by 2030.

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“…23 Others contend that community engagement has had to take a backseat to those activities that are considered easier to address and measure. 11,25 For funding agencies and governments, addressing the supply side of health service delivery still provides a less complex, structured, and measurable process and outcome than the demand (community) side. Some studies have argued that though individuals and communities may like the idea of engagement, they would be reluctant to be involved in broader policy-level discussions beyond those decisions that might have a direct impact on them.…”

Section: Community Engagement For Uhc-the Challengementioning

confidence: 99%

“…8,9 The outcomes of poor engagement of consumers of health care services include, among others, poor uptake of services, inappropriate overuse of services, low health literacy, and poor understanding of health and health care. 10,11 The need for engagement is normative and recognized not only as inextricably linked to democratic principles but also as integral to the right to health. 12 The Sustainable Development Goals call for integrated, intersectoral approaches that are underpinned by social justice, equity, and human rights.…”

Section: Introductionmentioning

confidence: 99%

Community Engagement in Support of Moving Toward Universal Health Coverage

Allotey

Tan

Kirby

et al. 2019

Health Systems & Reform

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Community engagement describes a complex political process with dynamic negotiation and renegotiation of power and authority between providers and recipients of health care in order to achieve a shared goal of universal health care coverage. Though examples exist of community engagement projects, there is very little guidance on how to implement and embed community engagement as a concerted, integrated, strategic, and sustained component of health systems. Through a series of case studies, this article explores the factors that enable community engagement particularly with a direct impact on health systems.

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Comprehensive review of the evidence regarding the effectiveness of community–based primary health care in improving maternal, neonatal and child health: 6. strategies used by effective projects

Cited by 50 publications

References 57 publications

Comprehensive review of the evidence regarding the effectiveness of community–based primary health care in improving maternal, neonatal and child health: 8. summary and recommendations of the Expert Panel

Comprehensive review of the evidence regarding the effectiveness of community–based primary health care in improving maternal, neonatal and child health: 8. summary and recommendations of the Expert Panel

Comprehensive review of the evidence regarding the effectiveness of community–based primary health care in improving maternal, neonatal and child health: 2. maternal health findings

Community Engagement in Support of Moving Toward Universal Health Coverage

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