I just returned from an evaluation of a two-country, 3.5 year Maternal, Newborn, and Child Health (MNCH) project funded through the Department of Foreign Affairs, Trade and Development Canada (DFATD) and carried out by World Renew in Bangladesh and Malawi. Maternal and neonatal/infant mortality in these countries, although improving, remain high, as does the number of malnourished children. Projects in both countries aimed to reduce mother and child death rates by:
1) increasing access of women to health services,
2) improving the quality of care provided by public health facilities,
3) increasing women’s rights to make decisions about health care for themselves and serve in leadership roles in the community, and
4) improving nutrition and maternal newborn child health practices.
The evaluation confirmed that these results were achieved.
In both countries, communities and governments were mobilized for maternal child health utilizing a community-based integrated management of childhood illness (C-IMCI) approach. Community groups and volunteers (CHVs) were empowered, trained and supported to use behavior change communication messaging at both the village and household levels to promote utilization of health facility services as well as appropriate maternal and child nutrition and health practices. Bangladesh used the People’s Institution Self-Help group model as the delivery platform, while Malawi utilized Care Groups. Group volunteers developed mother/child village registries and networked with local government health facilities to improve the quality and acceptability of services and address gaps. They also met monthly with local health workers and other community leaders to coordinate messaging and follow-up.
Project staff networked with health officials and other NGOs at district and sub-district levels to provide training to health workers, increase local access to care, and develop complementary strategies to achieve project goals. To increase access to care, emergency transport systems were set-up and emergency health funds established. Project staff and volunteers worked with beneficiaries to enhance the availability and utilization of locally available foods through kitchen gardens and cooking demonstrations/clubs that emphasized appropriate nutrition for pregnancy, exclusive breastfeeding, complementary feeding and family health. The project gave volunteers and beneficiaries knowledge and skills for health, no other incentives were given.
In both countries women with few financial resources were empowered to develop social capital as they gained knowledge about maternal child health and nutrition and skills in group functioning, leadership, networking and advocacy. These women became the link between the community and health facility that insured households knew about and received services available to them and that health facility workers were aware of community needs, especially those of mothers and children.
By the end of the project all villages and beneficiaries had more accessible health facilities and providers linked to CHVs and groups working together to prevent mother and child death. Improvements were seen in antenatal care, institutional delivery, postnatal care, number of underweight children, exclusive breastfeeding and appropriate complementary feeding practices, and families eating more diverse health diets using locally available foods.