The Drum Beat 820 - Community Engagement and Maternal, Newborn, and Child Health

• 1.Building Community Ownership of Maternal and Child Health Interventions in Rural Nigeria: A Community-Based Participatory Approach
  by Lorretta Favour Chizomam Ntoimo, Igboin Brian, Chioma Ekwo, Sanni Yaya, Wilson Imongan, and Friday Ebhodaghe Okonofua Many previous studies show that community-led approaches to increasing access to and low utilisation of maternal and child health (MCH) services are more productive and sustainable than strategies that engage communities as mere beneficiaries of interventions. This paper details the methods of engagement used in a community-based participatory project that worked to - and ultimately did - increase women's use of primary health centres for skilled pregnancy and child health care in Edo State in Nigeria. The researchers "believe strongly that these results are attributable to the ownership of the project and the interventions by the communities, enabling elements of co-funding and sustainability planning by the communities." [Jun 2021] 
   
• 2.Promoting Respectful Maternity Care Using a Behavioral Design Approach in Zambia: Results from a Mixed-Methods Evaluation
  by Jana Smith, Allison Schachter, Rachel Banay, et al. Formative research conducted through a behavioural science lens in Chipata, Zambia, demonstrated that disrespectful care during childbirth was prevalent, and providers experienced several behavioural barriers to provision of respectful maternity care (RMC). Building on these findings, under the Breakthrough RESEARCH project, ideas42 developed a solution package using an iterative co-design process with a range of different stakeholders. An evaluation found that clients at implementation facilities were 15 percentage points less likely to experience any form of disrespect and abuse compared to clients at comparison facilities. ideas42 is adapting this solution package to Liberia under the Breakthrough ACTION project. [Jun 2022] 
   
• 3.The Use of Design Thinking in MNCH Programs: A Case Study of the Community Benefits Health (CBH) Pilot, Ghana
  by Natasha Kanagat and Anne LaFond This case study focuses on the use of design thinking in the Innovations for Maternal, Newborn, and Child Health (MNCH) Initiative's Community Benefits Health (CBH) pilot, which aimed to improve MNCH-related behaviours among women of childbearing age by influencing community-wide social norms over a 2-year period in select Ghanaian communities. Concern Worldwide applied design thinking techniques to develop and refine the CBH pilot. A ThinkPlace designer worked with project implementers and communities to conduct the design thinking phase. ProNet North, the Ghanaian implementing organisation, facilitated this effort, drawing on their knowledge of and experience in Wa West District. "The most beneficial aspect of design thinking in CBH", which led to significantly improved uptake of early initiation of antenatal care (ANC), ANC4 (fourth visit), and skilled birth attendance, "was the introduction of novel ways of co-designing aspects of the program strategy with communities..." [Apr 2018] 
   
• 4.Behavioral Solutions for Child Feeding During and After Illness
  This resource shares a suite of behavioural solutions to address barriers to optimal complementary feeding during and after illness. It is informed by qualitative research conducted in the Democratic Republic of the Congo by Breakthrough ACTION and USAID Advancing Nutrition to gather the perspectives, experiences, and challenges experienced by caregivers, health workers, and others seeking to ensure that young children experiencing an illness avoid malnutrition as they recover. [Sep 2022] 
   
• See also:
  Removing Barriers to Fistula Care: Applying Appreciative Inquiry to Improve Access to Screening and Treatment in Nigeria and Uganda 
  Caregiving Behaviors for Nutrition and Child Development in Malawi: Maziko Report on People-Driven Design
   

• 5.Qualitative Evaluation of Breakthrough ACTION/Nigeria's Community Capacity Strengthening Approach to Sustaining Integrated Social and Behavior Change Programming: Phase I
  by Martha Silva, Nrupa Jani, Adetayo Adetunji, and Mayokun Adediran Breakthrough ACTION/Nigeria is implementing a community capacity strengthening (CCS) approach (2018-2025) that focuses on engaging ward development committees to increase community self-efficacy, to coordinate and support the health ecosystem in general, and to ensure sustained community-level activities supporting social and behaviour change (SBC) and positive social norms for improved health outcomes. Example evaluation findings: Programme beneficiaries perceive that Breakthrough ACTION/Nigeria's SBC sensitisation messages have led to informed decision-making and healthier choices, such as abandoning harmful traditional nutritional practices like feeding water to newborn babies. They also report that SBC messages have led to more participation of men in healthcare services uptake when taking women for services such as ANC and in increased joint-decision-making between couples regarding health service use. [Jun 2022] 
   
• 6.Global Research Priorities for Social, Behavioural and Community Engagement Interventions for Maternal, Newborn and Child Health
  by Geoffrey Chan, J. Douglas Storey, Manoja Kumar Das, Emma Sacks, Mira Johri, Tamar Kabakian-Khasholian, Deepak Paudel, Sachiyo Yoshida, Anayda Portela Social, behavioural, and community engagement (SBCE) interventions aim to strengthen the capabilities of individuals, families, and communities to contribute to improving their own health. Past efforts to synthesise research on SBCE interventions for MNCH identified a need for clear global priorities to guide research in the period up to 2030. This paper presents the priorities that were identified through a consultative exercise. For example, 2 of the top 10 maternal health priorities were concerned with research on interventions that strengthen community capabilities and meaningful community involvement in shaping the responsiveness of health services to needs. [Aug 2020] 
   
• 7.Integrating Stakeholder and Community Engagement in Quality of Care Initiatives for Maternal, Newborn and Child Health
  Stakeholder and community engagement can provide opportunities to better understand quality of care from service users' and communities' perspectives and to develop context-relevant quality improvement (QI) initiatives that integrate social norms of acceptability and quality across the continuum of MNCH care. This module from the World Health Organization (WHO) and United Nations Children's Fund (UNICEF) aims to guide policymakers and programme implementers in making stakeholder and community engagement comprehensive and meaningful. [Oct 2020] 
   

• If you have experience in SBC and/or family planning/reproductive health programming or research and have insights to share about client/provider or community/health facility trust and accountability, please consider participating in Breakthrough ACTION's expert consultation scheduled for the second quarter of 2023. Click here to sign up.
  
   

• 8.Re-envisioning Kangaroo Mother Care Implementation Through a Socioecological Model: Lessons From Malawi
  by Megan M. Lydon, Victoria Lwesha, Dyson Likomwa, et al. Kangaroo mother care (KMC) offers a potential solution in resource-constrained settings with high rates of preterm or low birth weight infants, but research within Malawi has identified striking sociocultural barriers to KMC engagement. In 2015, Save the Children conducted research to inform the design, development, and implementation of a pilot KMC social and behaviour change communication (SBCC) programme in the districts of Machinga and Thyolo in the Southern Region of Malawi. Based on findings of the formative research: "KMC efforts can be strengthened by incorporating context-specific actions to bolster social norms that align with KMC and shift those that discourage it. Activities must include a focus on the community and family levels to engender meaningful change..." [Jul 2022] 
   
• 9.The Case for Using a Behavior Change Model to Design Interventions to Promote Respectful Maternal Care
  by Nadia Diamond-Smith, Dilys Walker, Patience A. Afulani, et al. Grounded in the belief that viewing RMC interventions through a behaviour change lens can support a systematic approach, this article provides an example of how RMC interventions could be informed by an implementation science framework using the COM-B model (capability-opportunity-motivation that leads to behaviour change) and related behaviour change wheel (BCW). Among the takeaways from the analysis is that "supporting providers to enable them to act upon the knowledge gained is essential and requires activities at multiple levels. For example, changing norms, such as around accepting women's agency to advocate for the care she desires and other gender norms, at the community level and engaging supervisors at the facility level may create the enabling environment needed for lasting provider behavior change." [Jan 2023] 
   
• 10.The Role of Maternal Ideations on Breastfeeding Practices in Northwestern Nigeria: A Cross-section Study
  by Udochisom C. Anaba, Emily White Johansson, Dele Abegunde, Gloria Adoyi, Olayinka Umar‑Farouk, Shittu Abdu‑Aguye, Paul C. Hewett, and Paul L. Hutchinson This study builds on the Ideation Model of Strategic Communication and Behavior Change to examine the relationship between women's breastfeeding behaviours and ideations (e.g., knowledge, beliefs, norms) in northwestern Nigeria to understand which ideations that could influence early initiation of breastfeeding and exclusive breastfeeding practices to inform SBC programmes in this region. 
   
• 11.Community Interventions with Women's Groups to Improve Women's and Children's Health in India: A Mixed-methods Systematic Review of Effects, Enablers and Barriers
  by Sapna Desai, Madhavi Misra, Aikantika Das, Roopal Jyoti Singh, Mrignyani Sehgal, Lu Gram, Neha Kumar, and Audrey Prost This systematic review sought to identify: what is the evidence on the effects of different kinds of women's groups interventions on women's and children's health in India, which SBC strategies work best and for what, and what are the barriers and enablers to effectiveness. Evidence of positive effects was strongest for community mobilisation interventions that built communities' capabilities and went beyond sharing information. Successful interventions tended to use a combination of: (i) individual techniques aiming to increase knowledge and risk perception and (ii) techniques to foster wider social and environmental change, including techniques to change social norms, and participatory problem posing and solving. [Dec 2020] 
   

• 12.Community Resource Centres to Improve the Health of Women and Children in Informal Settlements in Mumbai: A Cluster-Randomised, Controlled Trial
  by Neena Shah More, Sushmita Das, Ujwala Bapat, Glyn Alcock, Shreya Manjrekar, Vikas Kamble, Rijuta Sawant, Sushma Shende, Nayreen Daruwalla, Shanti Pantvaidya, and David Osrin This cluster randomised controlled trial (RCT) investigated an intervention model, developed by India's Society for Nutrition, Education and Health Action (SNEHA), that revolved around community resource centres providing health service, outreach, and community mobilisation activities in two Mumbai wards with the lowest Human Development Indices. Sample finding: Feeding exclusively with breastmilk up to age 6 months and achieving minimum dietary diversity in children aged 6-23 months were increased in the intervention group compared with in the control group after the intervention (OR 1.54, 95% CI 1.02-2.33 and 1.48, 1.01-2.17). [Mar 2017] 
   
• 13.Involving Male Partners in Maternity Care in Burkina Faso: A Randomized Controlled Trial
  by Marina AS Daniele, Rasmané Ganaba, Sophie Sarrassat, et al. Recognising that ending preventable maternal and perinatal mortality necessarily involves engaging with communities and families, an intervention was designed to involve the male partners of pregnant women in Burkina Faso in facility-based maternity care. This paper reports on a non-blinded, multicentre, parallel-group, superiority trial of the intervention, which sought to influence care-seeking, healthy breastfeeding, and contraceptive practices after childbirth. The intervention was associated with higher rates (i) of attendance at 2 or more scheduled, outpatient, postnatal care consultations (risk difference (RD): 11.7%; 95% confidence interval (CI): 6.0 to 17.5), (ii) of exclusive breastfeeding 3 months postpartum (RD: 11.4%; 95% CI: 5.8 to 17.2), and (iii) of effective modern contraception use 8 months postpartum (RD: 6.4%; 95% CI: 0.50 to 12.3). [Jun 2018] 
   
• 14.Role of Community Engagement in Maternal Health in Rural Pakistan: Findings from the CLIP Randomized Trial
  by Zahra Hoodbhoy, Sana Sadiq Sheikh, Rahat Qureshi, Javed Memon, Farrukh Raza, Mai-Lei Woo Kinshella, Jeffrey N Bone, Marianne Vidler, Sumedha Sharma, Beth A Payne, Laura A Magee, Peter von Dadelszen, Zulfiqar A Bhutta, and The CLIP Pakistan Working Group As part of community engagement (CE) activities in rural Pakistan during the Community Level Interventions for Pre-eclampsia (CLIP) trial, there were 15,137 home-based CE sessions with pregnant women and families (n = 46,614) and 695 village meetings with male stakeholders (n = 7,784) over two years. Pregnant women in the intervention clusters were twice as likely to know that seizures could be a complication of pregnancy and 2.5 times more likely to know that high blood pressure is potentially life-threatening during pregnancy vs. control clusters. [Jul 2021] 
   
• 15.Effects of a Social Accountability Approach, CARE's Community Score Card, on Reproductive Health-Related Outcomes in Malawi: A Cluster-Randomized Controlled Evaluation
  by Sara Gullo, Christine Galavotti, Anne Sebert Kuhlmann, et al. The Community Score Card (CSC), developed by CARE Malawi in 2002 as a social accountability tool, seeks to empower and support service users and service providers to work together to improve responsiveness of the health system to the community's needs. This cluster RCT found that the CSC intervention in Ntcheu, Malawi, increased community health worker visits to women during pregnancy by 20% and during the postnatal period by 6%, compared to control. There were also significant improvements in overall service satisfaction in intervention compared to control areas. All 13 community- and provider-developed indicators improved, with 6 of them showing significant improvements. [Feb 2017] 
   
• 16.Effects of Family Conversation on Health Care Practices in Ethiopia: A Propensity Score Matched Analysis
  by Dessalew Emaway Altaye, Ali Mehryar Karim, Wuleta Betemariam, et al. This cross-sectional study examines one component of the Last Ten Kilometers (L10 K) Project called the Family Conversation, an informal meeting between a health worker and several household and community members who potentially play a role in decision-making around the care of a pregnant woman and/or her newborn. In 115 woredas (districts) of 4 agrarian regions of Ethiopia, exposure to Family Conversations had statistically significant (p < 0.05) associations with higher institutional delivery, early postnatal care, clean cord care for the newborn, and thermal care for the newborn. The treatment effect for thermal care of the newborn showed the highest effect: 16 percentage points (p = 0.001). [Sep 2018] 
   
• 17.Effectiveness of Participatory Women's Groups Scaled Up by the Public Health System to Improve Birth Outcomes in Jharkhand, Eastern India: A Pragmatic Cluster Non-Randomised Controlled Trial
  by Nirmala Nair, Prasanta K Tripathy, Rajkumar Gope, Shibanand Rath, Hemanta Pradhan, Suchitra Rath, Amit Kumar, Vikash Nath, Parabita Basu, Amit Ojha, Andrew Copas, Tanja AJ Houweling, Hassan Haghparast-Bidgoli, Akay Minz, Pradeep Baskey, Manir Ahmed, Vasudha Chakravarthy, Riza Mahanta, and Audrey Prost This paper reports the results of a trial testing the effectiveness of participatory women's groups facilitated by government-incentivised frontline workers called Accredited Social Health Activists (ASHAs) and their supervisors on birth outcomes at scale in Jharkhand, eastern India. Groups identified and prioritised locally feasible strategies to implement solutions in their communities and organised a larger meeting in which they shared their prioritised problems with the wider community. Over 24 months of intervention, there was a 24% reduction in neonatal mortality, including 26% among the most deprived. [Nov 2021] 
   
• 18.The Effect of the Alive & Thrive Initiative on Exclusive Breastfeeding in Rural Burkina Faso: A Repeated Cross-sectional Cluster Randomised Controlled Trial
  by Jenny A Cresswell, Rasmané Ganaba, Sophie Sarrassat, et al. The Alive & Thrive (A&T) initiative combines different programme components, in both community and facility settings, to improve infant feeding in low-income regions, including in Burkina Faso. Only interpersonal communication and community mobilisation activities were randomly assigned, and hence assessed, in this study. One finding: At endline, there was a risk difference of 38.9% (95% CI 32.2-45.6, p<0.001) between the reported prevalence of exclusive breastfeeding among infants younger than 6 months in the intervention group and that of the control group. [Mar 2019] 
   
• 19.Community Mobilization to Strengthen Support for Appropriate and Timely Use of Antenatal and Postnatal Care: A Review of Reviews
  by Sara Dada, Özge Tunçalp, Anayda Portela, et al. This systematic review of reviews synthesises existing evidence on which community mobilisation strategies are effective in increasing family and community support for appropriate and timely use of ANC and postnatal care (PNC) in low- and middle-income countries (LMICs). Overall, 16 reviews reported at least one positive association between community mobilisation activities and ANC/PNC uptake, while five reviews presented primary studies with no statistically significant change in ANC uptake, and one included a primary study with a decrease in use of antenatal facilities. The researchers explore which components and strategies from community mobilisation activities could possibly influence behavioural beliefs, normative beliefs, and control beliefs that would increase community support for ANC/PNC uptake. [Dec 2021] 
   
• See also:
  An Evidence Map of Social, Behavioural and Community Engagement Interventions for Reproductive, Maternal, Newborn and Child Health
   

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