The Power of Design:
A demand Creation Strategy for Maternal, Newborn and
Child Health and Community Based Newborn Care
(MNCH/CBNC) in Ethiopia
Author: Asayehegn Tekeste
Save the Children
1
Background
•
Low illnesses
recognition and
care-seeking which
continues to drive
high mortality
rates.
•
A comprehensive
MNCH/CBNC
Demand Creation
Strategy needed
2
Background
•
The Ethiopian Federal Ministry of Health (FMOH) launched
the Community-Based Newborn Care (CBNC) package in
2013.
– Includes evidence-based interventions targeting mothers and
their newborns during pregnancy, childbirth, and the postnatal period.
– Integrated into the existing maternal and child health interventions
•
SCI supporting the CBNC implementation in the 4 agrarian
regions – total 21 Zones and 2 special woredas through funds
from USAID and UNICEF
•
Started with a few learning Zones and now at scale
3
Methodology
•
A participatory design process engaged leadership from FMOH, MNCH
Technical Working Group and national stakeholders.
•
Major determinants of Maternal Newborn, and Child Health (MNCH) service
utilization, existing health and community systems, and platforms for
improving family and social norms were analyzed.
•
Learning exchange visits, a barriers analysis, a systematic desk review of the
local and global evidence-base, and a design workshop yielded experience on
improving MNCH.
•
Key approaches demonstrating effectiveness were analyzed for feasibility,
scalability and sustainability.
4
Results
• MNCH demand creation strategy was designed
– Scalable and potentially sustainable
– Well aligned with national systems, tools and guidelines
• 5 P’s: Purpose, Principles, People/Platforms, Processes
and Products
• Purposes: To improve maternal and newborn outcomes
• through increased demand creation for CBNC.
• Principles: Community strengthening, Sustainability, Scalability, Equity, Multi-sectoral
collaboration, Enabling environment, Continuum of care, Quality-Matching-Demand
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Result
•
Peoples and Platforms:
•
Those closest to the mother and
newborns including family members
and community leaders and decision
makers
•
Peoples and Platforms:
•
Health Development Army, Kebele
Command Posts/health Steering
Committees, Health Workers, Service
Providers
6
Results
•
Process: Community capacity strengthening approaches leveraging multi-sectoral social
networks; formal and informal leaders and traditional systems
Explore
Issues & Set
Priorities
Prepare
to
Mobilize
Prepare to
Scale-up
Organize
Community
for Action
Evaluate
Together
Plan
Together
Act
Together
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Results
Effective Community strategies selected include:
– Engaging family decision makers;
– Strengthening pregnant women’s forums;
– Active male involvement;
– Leveraging the non- delivery role of TBAs;
– Service quality improvements;
– Support to the woman development army;
– Community use of data and
– Creating conducive environment for demand generation
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Results
•
Orientation and Capacity building for DCS roll out
– Regional, zonal & Woreda (district), Primary Health Care Unit (PHCU) and Kebele
levels.
•
WrHO and PHCU routinely support Kebele Command Posts and HPs
•
Supportive supervision guidelines and tools developed and used
•
M&E and documentation systems (DHIS-2) put in place
– Strength of implementation, service utilization trends,
MNCH practices, and community capacity.
•
Project Baseline addressed family health practice and service utilization
9
Discussion/Lessons
•
Encouraging support from all counterparts FMOH,
RHBs and sector offices
– Alignment with policy priorities
– Strengthening existing systems - PHCUs SS
•
Step-by-step process for capacity building
(Learning-by-doing)
•
Demand without Services Quality improvement?
•
Health system had a huge need for support on DC
•
Strategy should respond to varying contexts, flexible to
accommodate emerging themes and challenges
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Conclusion:
•
Thorough analysis of health and community systems
coupled with sound program design can help to
effectively integrate MNCH demand creation
strategies into national health systems.
•
Demand creation strategies designed
primarily with, and not secondary to, service
delivery improve the strength of
implementation for improved MNCH.
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Thank you!
Amasaginalehu!
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