Information sheet: Community mobilisation and health management
committee strengthening to increase birth attendance by trained health
workers in rural Makwanpur, Nepal: a cluster randomised controlled trial.
How can we improve newborn and maternal health at the community level?
Maternal and newborn survival are key development indicators, and the United
Nations Millennium Development Goals (MDG) have set targets to encourage
countries to reduce maternal and child mortality by 20151. In Nepal, there has
been progress towards MDG targets, but most women still deliver at home
without trained health workers, particularly in rural areas2. We are working in
Makwanpur District of Nepal, to improve access to health care, through a
process of community mobilisation.
What is community mobilisation?
Community mobilisation is “a capacitybuilding process through which community
individuals, groups, or organisations plan,
carry out, and evaluate activities on a
participatory and sustained basis to improve
their health and other needs, either on their
own initiative or stimulated by others”3. We
are working with women’s groups, female
community health volunteers, and health
management committees, on a process of
community mobilisation4,5.
Women’s groups
203 groups of women meet
every month and a local
female community health
volunteer leads the group
discussion.
We support the volunteers, providing a government recommended incentive
per meeting, and monthly feedback and briefing meetings where nine
volunteers meet to discuss meetings with a supervisor. Groups discuss why so
few women have trained health workers at their deliveries, and work with their
communities on addressing these issues. In the past, communities have
started funds to address financial barriers, and awareness raising activities to
address knowledge gaps. We will support them in reviewing their progress and
taking further actions.
Health Management Committees
Every health facility has a management committee (HMC) that develops needs
based plans, audits quality of care and takes steps to improve services. We are
supporting HMCs to make and implement plans to improve maternal and
newborn health facilities. We support them through an initial three day workshop,
and subsequent follow up meetings to review plans and progress.
Evaluation – Cluster Randomised Controlled Trial
To evaluate how effective our work is, we will compare the numbers of neonatal
deaths, institutional deliveries, and deliveries with a trained health worker in
clusters receiving the intervention, with the 22 clusters where we are not
mobilising communities. We will also collect demographic information,
information on socioeconomic status and information on previous pregnancies
from all women in the study. We will also collect information to help us explain
why and how our intervention affected communities. Our study will run until
October 2012.
Ethical concerns
We believe that control areas should
also benefit from this research, and
therefore we will train health workers
throughout the district on Emergency
Obstetric First Aid.
We have received ethical approval
from the Nepal Health Research
Council and the University College
London Ethics Committee, and we
have informed community consent from
cluster administrators, and the district
public health office.
We will disseminate the results locally,
nationally
and
internationally
to
maximise
public
and
policy
engagement with this research.
Who are we?
This research is being conducted by MIRA Nepal (www.mira.org.np) in
collaboration with the UCL Centre for International Health and Development
(www.ucl.ac.uk/cihd), with funding from the Wellcome Trust. MIRA is a Nepali
research organisation working to improve maternal, newborn and child survival
by conducting community based research, developing locally appropriate
neonatal care equipment, training of health workers, and through national and
international advocacy.
1
Millennium Development Goals www.un.org/millenniumgoals/
Ministry of Health and Population (2006) Nepal Demographic and Health Survey Kathmandu,
Nepal
3
Howard-Grabman, L. (2003) How to mobilise communities for health and social change
Baltimore, USA
4
Manandhar D et al. (2004) Effect of a participatory intervention with women’s groups on
birth outcomes in Nepal: a cluster randomised controlled trial Lancet 364 970-974
5
Morrison J et al. (2010) Understanding how women’s groups improve maternal and
newborn health in Makwanpur, Nepal: a qualitative study International Health 2 25-35
2