The "Strengthening Maternal and Newborn Care Services" project draws on one of the key lessons learned from the community-based newborn care study project called "Projahnmo": interpersonal communication (IPC) in or near the household is "the most effective means for behavior change." Supported by the United States Agency for International Development (USAID) and the Saving Newborn Lives (SNL) initiative, Projahnmo was carried out in 3 of Sylhet's upazilas; ACCESS scaled up the project by extending it into additional areas within the district. (Click here to download a PowerPoint presentation from ICDDR,B with further details about Projahnmo.)
As with the Projahnmo initiative, and in concert with the Household-to-Hospital Continuum of Care (HHCC) Model, ACCESS is carrying out IPC with the specific goal of involving the entire range of important decision-makers in the lives of pregnant women. To this end, community-based interventions are tailored to reach people at multiple levels – community, family, and individual. At the community level, resident community mobilisers (CMs) conduct group meetings with both men (husbands of pregnant women and heads of households) and women (pregnant and senior family members). These meetings are held at clusters of households or at locations in the community (shops, mosques, etc.). During the group meetings, CMs share information about maternal and newborn health; they also facilitate role-plays around improved practices.
Another key focus is negotiation at the home level to identify specific household barriers to maternal and neonatal health, and to arrive at viable solutions. Group-based meetings are supplemented by one-on-one counselling with pregnant women and their families. Resident literate women were trained as community health workers (CHWs). During the visits in pregnancy, CHWs emphasise BCC messages, encourage women to seek antenatal care at the health centre or satellite clinic, and negotiate maternal and newborn care practices with the family. During the postpartum visits, the CHWs assess the health of mother and baby and encourage use of postpartum care. During inclement weather such as floods, the counsellors travel to homes by boat.
This effort to support behaviour change also involves strengthening the capacity of the implementing NGOs to provide services, counselling, community mobilisation, and leadership. ACCESS focused on: (1) training Family Welfare Visitors (FWVs), paramedics, and doctors working in the government and NGO sectors, (2) setting up functional logistics and supply systems for obstetric and neonatal care services, (3) strengthening referral services, and (4) involving local and national managers in programme review and operations.
Local participation is central to ensuring that this system runs smoothly. Community and religious leaders, members of women's groups, and local officials play a critical role in involving community members at the local level. Community mobilisers work with women's and men's groups in the community to encourage and educate them on appropriate home care techniques for both mother and newborn, the need for a birth and newborn preparedness plan for every expectant mother, and their rights as a community to adequate health care.
Community mobilisers also encourage the groups to work for change and to feel empowered to make a difference. In addition, to effect change at the policy level, ACCESS is conducting advocacy activities to build commitment, mobilise and leverage resources, and ensure ultimate sustainability and scale-up.