Targeting a Community-based intervention for Improving Maternal Health
Authors: Silwal, R.C., Pradhan, S., Fanning, P., Simkhada, S. and van Teijlingen, E.
Conference: Second National Summit of Health and Population Scientists in Nepal
Dates: 11-12 April 2016
Background: The World Health Organization (WHO) highlighted Continuum of Care (CoC) as a key action to improve maternal health for more than a decade. Many Nepali women fail to receive CoC due to barriers at the household and facility level . Nepal demographic health survey (2011) showed that 64% of births took place at home and 56% of new mothers did not receive post-natal check-ups in the period of 2006 to 2011. Low awareness, inaccessibility, unavailability of services were among the major constraints for CoC from both demand and supply side perspectives. Green Tara Nepal (GTN) implemented a community focused health promotion project in Nawalparasi district since 2012 to support equitable access to CoC by mobilising local health promoters. GTN targeted women of childbearing age and their families to utilise rural birthing centres. We aimed to improve maternal health using health promotion techniques and strengthening existing services.
Methods: This before and after study conducted in two rural Village Development Committees of Nawalparasi, bordering India, with total population of nearly 15,000. A total of 1,116 women with children under the age two were interviewed using pre-tested semistructured questionnaire. We used SPSS version 16.0 for data analysis.
Results: The WHO recommended four ANC check-ups increased from 56% to 62% whilst first ANC check-up at four months doubled, 54% in endline than 24% in baseline. Institutional delivery increased to 55% from 29%. Post-natal check-ups within 24 hours of birth steep to 54% in 2015 compared to 27% in 2012. In particular, Muslim and Terai Dalit women benefited more from this intervention.
Conclusion: Community-based health promotion programmes can bring positive changes in behaviours and uptake of services. Health facility and community programmes need to work together to complement each other to achieve improved health in individuals, communities and the healthcare system.