HBLSS: Improving on Innovation

HBLSS: Improving on Innovation

HBLSS Elevator Speech• Family-focused community mobilization program• Series of facilitated community meetings to

discuss and form action plans around individual topics to promote self care & effective referral– Women problems: Too much bleeding, birth delay

sickness with pain and fever, swelling and fits, too many children

– Baby problems: Trouble breathing at birth, baby too small, baby is sick

– Preventing problems: self-care, family planning (LAM), PMTCT

– Referral

Step 1: Review the previous meeting

Step 2: Ask what participants know and do when they see particular problems

Step 3: Share what trained health workers know and do when they see those problems

Step 4: Come to agree on what to do: negotiation

Step 5: Practice the (agreed) actions

Step 6: Discuss how to know if the actions are helpful

Step 7: Decide how to prevent the problem

Interactive Community MeetingsCore Methodology

Problem Side Action Side

Key Tool: Take Action Cards

HBLSS Strengths

• Low-tech and sustainable• Skills-based, participatory• Designed for non- or low-literate participants• Uses a step-wise process that works towards

safe, acceptable practices while recognizing & respecting traditional practices

• Can be used for any community issue (e.g., water & sanitation, TB, malaria)

• Transformative

Evidence to date

• Community members are able to retain information following the training– Enhancing problem recognition

• Community members who are exposed to HBLSS are more likely to take action to:– Provide first aid to respond to a complication– Refer women to a facility

• Community is supportive and actively engaged in MNH issues

Skills Demonstration of Community Facilitators

0%

20%

40%

60%

80%

100%

Too Much Bleeding, Ethiopia

Too much Bleeding, L

iberia

1st Actio

ns, Ethiopia

1st Actio

ns, Liberia

Birth Delay, B

angledesh

Birth Asphyxia, B

angladesh

Womn Referral, L

iberia

Baby referra

l, Liberia

Pre-training

Post-training

1-yr. post-training

Ability to Respond to Identified Complications

0%

20%

40%

60%

80%

100%Unexposed

Exposed

Other Positive Results• Creates a sustainable community resource• Improves problem recognition• Initiates earlier referral of complications • Increases team work and better working relations

between community-based providers/TBAs & clinic/hospital staff

• Puts systems in place to track maternal & infant morbidity and mortality

• Generates support of community leaders and members• Promotes change in peoples’ attitudes related to

reproductive health and the value of individual life• Leads to inclusion of men in the birth process

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1

3

5

7

9

11

13

15

1998-1999 2000-2001 2002-2003 2004-2005 2006-2007 2008-2009

Nu

mb

er

of

Co

un

trie

s

Year of Introduction

India

Ethiopia(Liben)

Ethiopia (Harag)Afghanistan

TibetGhana

HaitiLiberia

Bangladesh

KenyaZambiaGuatemalaIndiaPakistan

Ethiopia (Somali)

Tanzania

Niger, Peru, and Cameroon In planning stage

Expansion of HBLSS Programs

Perceived weaknesses

• Rigid, cumbersome, expensive & un-scalable

• Limited pool of master trainers

• Promotes obstetrical first aid & home birth over skilled attendance at birth

• Inconsistent feel of materials; expense & accessibility of materials

• Methodology not readily apparent

• Concerns r/t evidence based practices

Combating Perceptions & Reality

• Rigidity– Promote the adaptability of HBLSS as a

strength – recently adapted in Zimbabwe to address land restoration. Elegance is in the method, content can be changed!

– Communities can choose priorities– Modular formatting aids ability to mix and

match

Combating Perceptions & Reality

Two key endeavors: • Collaborative 2nd edition Revision

• ACNM/CORE joint HBLSS initiative

2nd Edition Key Objectives & Methods

• Seek expanded input from those with HBLSS implementation experience

• Follow collaborative model of revision– Asked for broad stroke recommendations

from wide field of users– A core group discussed & made changes– Edited version went back to wide field for

review & comments– Comments discussed & incorporated by core

group

2nd Edition Key Objectives & Methods

• Clarify methodology at the outset, make it more accessible– New ‘process explanation’ and introduction

• Produce consistent look and feel of materials– Hired professional editor– Chose standard format to use with all

meetings

2nd Edition Key Objectives & Methods

• Update technical information – Reviewed evidence base & updated references

• Add new proven interventions– Misoprostal

• Make materials more accessible– Previously laminated large picture cards will be

printed in bound book– All materials will be available free of charge in

pdf format on website; possibly sold via Hesperian in the future

Perceived weaknesses

• Rigid, cumbersome, expensive & un-scalable

• Limited pool of master trainers

• Promotes obstetrical first aid & home birth over skilled attendance at birth

• Inconsistent feel of materials; expense & accessibility of materials

• Methodology not readily apparent

• Concerns r/t evidence based practices

ACNM/CORE Joint Initiative: Basic Premise

A model to create a household-to-hospital continuum of care capable of reducing maternal & neonatal morbidity and mortality is not widely available in a field friendly program package

HBLSS IS POISED TO BE THAT PACKAGE

ACNM/CORE Joint Initiative: 5 yr Overview

• Year 1: Repackaging of HBLSS materials• Years 2-4: 4 implementation sub-grants

awarded; implementation and outcomes research carried out

• Year 5: Wrap-up and Dissemination

ACNM/CORE Joint Initiative: Yr1: Repackage & Rebrand HBLSS

• Steering committee will leverage collective experience and expertise of– ACNM– CORE Community Health Network

– SMRH working group– Social and behavior change working group– M&E working group

ACNM/CORE Joint Initiative: Yr1: Repackage & Rebrand HBLSS

• Renewed focus on – Streamlined design of materials, training

cascade, & M&E tools– Practical program guidance– Adaptability, Scalability

• Evaluate need for name change• Co-brand all materials with ACNM/CORE logos

• 1 staff from ACNM & CORE will be dedicated ½ time to this project

ACNM/CORE Joint Initiative: Yr 2: Implementation and Outcomes

Research

Goal: • Yield credibly field tested product that can

perform in diverse settings & foster ownership among wide array of stakeholders

Plan: • Put out call for applications to all CORE

members to compete for 4, 3 year implementation sub-grants

ACNM/CORE Joint Initiative: Yr 2: Implementation and Outcomes

Research• Grantees will conduct research on process &

outcomes of repackaged model using incorporated M&E tools

• M&E experts will assist to ensure effectiveness of research protocols & data collection tools/methods

• ACNM/CORE staff will visit implementation sites

ACNM/CORE Joint Initiative: Dissemination

• Partners will analyze data, synthesize lessons, and refine model and tools as needed.

• Dissemination will target a range of global health channels and networks & use a variety of media.

Perceived weaknesses

• Rigid, cumbersome, expensive & un-scalable

• Limited pool of master trainers

• Promotes obstetrical first aid & home birth over skilled attendance at birth

• Inconsistent feel of materials; expense & accessibility of materials

• Methodology not readily apparent

• Concerns r/t evidence based practices

Work to ensure that all births are accompanied by skilled attendants must continue, but the needs of women and their infants who deliver in the absence of a skilled attendant must not be ignored as a result. This proposed package can be put into action immediately, contributing to reducing maternal & neonatal mortality, empowering communities, and fostering a stronger continuum of care