Integrated community health package for maternal and newborn care in remote areas
Supporting SDG 3: towards universal coverage
Nutrition International is focused on improving nutrition for the world’s most vulnerable, especially women and girls
From 2011 to 2015, as part of our efforts to improve women’s nutrition, Nutrition International worked with communities in Kolda, in collaboration with national governments and partners, to increase access to antenatal care (ANC), birth care and postnatal care (PNC) for pregnant women and their newborns. This community-based approach included increasing access to essential healthcare services, medicines and other commodities, such as vitamins and minerals.
The lessons learned from the project in Kolda, Senegal, could be adopted in other communities faced with similar challenges for pregnant women and their newborns.
The challenge in Kolda, Senegal
Pregnancy and childbirth can be a difficult time for Senegalese women and their newborns. As of 2010, the maternal mortality rate was 392 deaths per 100,000 live births. It is estimated that fewer than half of pregnant women visit a healthcare worker more than once during pregnancy or give birth with a skilled attendant.
This is especially true in Kolda, Senegal, where the region’s remote location makes it difficult for women to access quality health care. Fewer than half of all pregnant women give birth with a skilled attendant.
The Government of Senegal has made maternal and newborn health a top priority. One of the key objectives of its Strategic Plan is to improve community-based neonatal services.
Approximately 2,000 community members access health huts in Kolda, which are run by volunteers providing some basic health services as well as referring patients to health centres and hospitals when needed.
The nearest regional health centre can sometimes be up to 40 km away and, without access to transportation, pregnant women are less likely to go there for care. Thus, the services health huts provide to communities are essential to improving maternal and child health outcomes; they serve as a vital link between community and facilities.
The approach taken in Senegal was to develop and demonstrate an integrated package of community-level interventions to increase uptake and improve the quality of maternal and newborn health services.
This included the development of a package of interventions geared toward mobilizing community health huts to provide the best care possible for women and children. Improving local health huts so they could serve as a gateway to access, overcoming barriers of transportation and distance, was key to strengthen the link between the community and the facility.
In addition, the entire community was engaged to support pregnant women through the creation of five different types of support groups, including the government-conceived community watch group, or Comités de Veille et d’Alerte Communautaire (CVAC), which provided accurate information and dispelled common myths around maternal and child health.
Learn more about the project in Kolda.
The community watch group, or Comités de Veille et d’Alerte Communautaire (CVAC), groups were composed of the Bajenou Gox, traditional birth attendants, traditional healers, and other respected women in the community.
CVAC groups engaged the community, identified and supported pregnant women, promoted childbirth in health facilities rather than at home, and encouraged the use of postnatal services available from trained healthcare providers. In addition, they worked to create an accurate and up-to-date record of pregnancies, births, maternal mortality and breastfeeding by new mothers.
Through the education and support provided by the CVAC groups, communities were able to integrate healthcare into their values, traditions and cultures for the benefit of good maternal and child health.
Overall, the relationship between facility-based staff and community actors was reinforced, bringing quality care to women and newborns who otherwise may not have been able to access it.
Based on the project outcomes, the Ministry of Health is scaling up the Community Watch (CVAC) groups across the country.
Key highlights of the project results include:
- 95,685 pregnant women & newborns reached.
- 67,087 pregnant women prescribed iron-folic acid supplements.
- 2,800 community health workers, nurses, midwives & district/regional health teams trained on maternal & newborn health & nutrition package.
- Community Watch (CVAC) groups,
- 244 community-level health huts equipped with essential maternal & newborn medicines/tools.
- 90 health huts completely renovated.
- More than 2,500 outreach activities conducted by health facility nurse/midwife at newly equipped community health huts; completed 39,424 antenatal care visits.
- 3 waiting homes, an innovative way of overcoming the weak referral system, equipped and receiving pregnant women and their families.
We worked with the following partners to address the challenge of how to effectively deliver, prove update of and monitor maternal and newborn health services at the community level for severely underserved areas:
- Senegal Ministry of Health
- Child Fund, Senegal
- Santé Plus, Senegal
- Institut de Santé & Développement, Senegal