IDEAS project - Community based newborn care evaluation: first round qualitative study field notes

The IDEAS project sought to improve the health and survival of mothers and babies through generating evidence to inform policy and practice. One strand of work was an evaluation of Community Based Newborn Care (CBNC), a care package rolled out across the country by the Federal Government of Ethiopia. Under CBNC, frontline health workers provide ‘Four Cs’: contact with newborns; case identification of neotnatal sepsis; and care and completion of treatment. The aim of this study was to develop an understanding of the challenges to and opportunities for delivering the Four Cs; factors affecting the motivation of frontline health workers in delivering the Four Cs; factors affecting demand for newborn care – from the perspective of the frontline health workers; and the opportunities and challenges for communication, supervision and referral linkages. This data collection contains interview field notes, pre-analysis templates and supporting information from 16 randomly selected woredas – four each from four regions in Ethiopia: Oromia, Amhara, Southern Nations, Nationalities and Peoples (SNNP) and Tigray

Community Base Newborn Care Evaluation, Ethiopia 2013-2017 - Household Survey Data

The IDEAS Community Base Newborn Care (CBNC) evaluation surveys were conducted in Ethiopia in the last quarter of 2013, 2015 and 2017. Across four regions; Amhara, Oromiya, SNNP and Tigray, 206 Primary Healthcare Units (PHCU) were randomly selected from 12 zones and surveyed at all three time points. Household surveys of women who delivered in the previous 3-15 months collected demographic and healthcare data during the antenatal, delivery and postnatal period. Health facility surveys of the health centre and health post collected data on facility staff, supportive supervision services and availability of supplies as well as a register review of the target population. Health worker surveys of health extension workers and woman’s development army volunteers collected data on demographics, care provision, MNH knowledge, training and supervisions. This contains data collected from Household survey data

Community Base Newborn Care Evaluation, Ethiopia 2013-2017 - Contextual

The IDEAS Community Base Newborn Care (CBNC) evaluation surveys were conducted in Ethiopia in the last quarter of 2013, 2015 and 2017. Across four regions; Amhara, Oromiya, SNNP and Tigray, 206 Primary Healthcare Units (PHCU) were randomly selected from 12 zones and surveyed at all three time points. Household surveys of women who delivered in the previous 3-15 months collected demographic and healthcare data during the antenatal, delivery and postnatal period. The selection of zones was based on the phasic implementation plan on the CBNC programme and therefore not random. This dataset covers health worker surveys of woman’s development army volunteers. Collected data covers demographics, care provision, MNH knowledge, training and supervisions. This contains contextual data

Community Base Newborn Care Evaluation, Ethiopia 2013-2017 - Health Centre Survey Data

The IDEAS Community Base Newborn Care (CBNC) evaluation surveys were conducted in Ethiopia in the last quarter of 2013, 2015 and 2017. Across four regions; Amhara, Oromiya, SNNP and Tigray, 206 Primary Healthcare Units (PHCU) were randomly selected from 12 zones and surveyed at all three time points. These datasets contain anonymised data collected via health facility surveys of a health centre and satellite health post in each Primary Healthcare Units (PHCU). This contains data collected from the Health Centre

Community Base Newborn Care Evaluation, Ethiopia 2013-2017 - Health Post and Health Extension Work Survey Data

The IDEAS Community Base Newborn Care (CBNC) evaluation surveys were conducted in Ethiopia in the last quarter of 2013, 2015 and 2017. Across four regions; Amhara, Oromiya, SNNP and Tigray, 206 Primary Healthcare Units (PHCU) were randomly selected from 12 zones and surveyed at all three time points. These datasets contain anonymised data collected via health facility surveys of a health centre and satellite health post in each Primary Healthcare Units (PHCU). This contains data collected from the Health Post and Health Extension Workers

Associations between increased intervention coverage for mothers and newborns and the number and quality of contacts between families and health workers: An analysis of cluster level repeat cross sectional survey data in Ethiopia.

BACKGROUND: Survival of mothers and newborns depends on life-saving interventions reaching those in need. Recent evidence suggests that indicators of contact with health services are poor proxies for measures of coverage of life saving care and attention has shifted towards the quality of care provided during contacts. METHODS AND FINDINGS: Regression analysis using data from representative cluster-based household surveys and surveys of the frontline health workers and primary health facilities in four regions of Ethiopia in 2012 and 2015 was used to explore associations between increased numbers of contacts or improvements in quality and any change in the coverage of interventions (intervention coverage). In pregnancy, in multiple regression, an increase in the quality indicator 'focused ANC behaviours' was associated with a change in both the coverage of iron supplementation and syphilis prevention ((regression coefficients (95% CI)) 0·06 (0·01, 0·11); 0·07 (0·04, 0·10)). This equates to a 0.6% increase in the proportion of women taking iron supplementation and a 0.7% in women receiving syphilis prevention for a 10% increase in the quality indicator 'focused ANC behaviours'. At delivery, in multiple regression the quality indicator 'availability of uterotonic supplies amongst birth attendants' was associated with improved coverage of prophylactic uterotonics (0·72 (0·50, 0·94)). No evidence of any relationships between contacts, quality and intervention coverage were observed within the early postnatal period. CONCLUSIONS: Increases in both contacts and in quality of care are needed to increase the coverage of life saving interventions. For interventions that need to be delivered at multiple visits, such as antenatal vaccination, increasing the number of contacts had the strongest association with coverage. For those relying on a single point of contact, such as those delivered at birth, we found strong evidence to support current commitments to invest in both input and process quality

How Do Frontline Workers Provide the Four Cs of CBNC? Contact with newborns, Case identification, Care and Completion of treatment

Community Based Newborn Care (CBNC) Qualitative Research conducted by Della Berhanu and supervised by Bilal Avan. In partnership with JaRco: -Qualitative lead Nolawi Tadesse -Social science specialist: Ayalew Gebre -Research advisor: Tsegahun Tessema This research was conducted by IDEAS, for the FMOH Ethiopia, funded by BMFG under the IDEAS project. Joanna Schellenberg is the PI of IDEAS

Early postnatal home visits: a qualitative study of barriers and facilitators to achieving high coverage.

BACKGROUND: Timely interventions in the postnatal period are important for reducing newborn mortality, and early home visits to provide postnatal care are recommended. There has been limited success in achieving timely visits, and a better understanding of the realities of programmes is needed if improvements are to be made. METHODS: We explored barriers and facilitators to timely postnatal visits through 20 qualitative interviews and 16 focus group discussions with families and Health Extension Workers in four Ethiopian sites. RESULTS: All sites reported some inaccessible areas that did not receive visits, but, Health Extension Workers in the sites with more difficult terrain were reported to make more visits that those in the more accessible areas. This suggests that information and work issues can be more important than moderate physical issues. The sites where visits were common had functioning mechanisms for alerting workers to a birth; these were not related to postnatal visits but to families informing Health Extension Workers of labour so they could call an ambulance. In the other sites, families did not know they should alert workers about a delivery, and other alert mechanisms were not functioning well. Competing activities reducing Health Extension Worker availability for visits, but in some areas workers were more organized in their division of their work and this facilitated visits. The main difference between the areas where visits were reported as common or uncommon was the general activity level of the Health Extension Worker. In the sites where workers were active and connected to the community visits occurred more often. CONCLUSIONS: If timely postnatal home visits are to occur, CHWs need realistic catchment areas that reflect their workload. Inaccessible areas may need their own CHW. Good notification systems are essential, families will notify CHWs if they have a clear reasons to do so, and more work is needed on how to ensure notification systems function. Work ethic was a clear influencer on whether home visits occur, studies to date have focused on understanding the motivation of CHWs as a group, more studies on understanding motivation at an individual level are needed

Major gaps in child survival by ethnic group.

Comment - No abstract available

"It's About the Idea Hitting the Bull's Eye": How Aid Effectiveness Can Catalyse the Scale-up of Health Innovations.

BACKGROUND: Since the global economic crisis, a harsher economic climate and global commitments to address the problems of global health and poverty have led to increased donor interest to fund effective health innovations that offer value for money. Simultaneously, further aid effectiveness is being sought through encouraging governments in low- and middle-income countries (LMICs) to strengthen their capacity to be self-supporting, rather than donor reliant. In practice, this often means donors fund pilot innovations for three to five years to demonstrate effectiveness and then advocate to the national government to adopt them for scale-up within country-wide health systems. We aim to connect the literature on scaling-up health innovations in LMICs with six key principles of aid effectiveness: country ownership; alignment; harmonisation; transparency and accountability; predictability; and civil society engagement and participation, based on our analysis of interviewees' accounts of scale-up in such settings. METHODS: We analysed 150 semi-structured qualitative interviews, to explore the factors catalysing and inhibiting the scale-up of maternal and newborn health (MNH) innovations in Ethiopia, northeast Nigeria and the State of Uttar Pradesh, India and identified links with the aid effectiveness principles. Our interviewees were purposively selected for their knowledge of scale-up in these settings, and represented a range of constituencies. We conducted a systematic analysis of the expanded field notes, using a framework approach to code a priori themes and identify emerging themes in NVivo 10. RESULTS: Our analysis revealed that actions by donors, implementers and recipient governments to promote the scale-up of innovations strongly reflected many of the aid effectiveness principles embraced by well-known international agreements - including the Paris Declaration of Aid Effectiveness. Our findings show variations in the extent to which these six principles have been adopted in what are three diverse geographical settings, raising important implications for scaling health innovations in low- and middle-income countries. CONCLUSION: Our findings suggest that if donors, implementers and recipient governments were better able to put these principles into practice, the prospects for scaling externally funded health innovations as part of country health policies and programmes would be enhanced