Guatemala | ProCONE Community Spread Collaborative
Reduce maternal and neonatal mortality by scaling up EONC best practices at the community level, specifically relating to the recognition of danger signs and emergency planning at individual, family and community levels and to ensure that the delivery of services are culturally adaptive.
In 2009, HCI initiated a program to provide assistance to the Guatemala MOH to build on the lessons learned in a demonstration collaborative implemented in the San Marcos Health Area under the Calidad en Salud Project. The ProCONE (Promotion and Essential Obstetric and Neonatal Care strategy) project package, consist of interventions of prenatal, delivery, postpartum, and newborn care across the community-to-facility continuum. There three collaboratives under the ProCONE umbrella: the Basic ProCONE addresses prenatal, postpartum, and neonatal care at ambulatory facilities and use of the partograph and active management of the third stage of labor (AMTSL) during delivery services; The Comprehensive ProCONE focuses on the management of obstetric and neonatal complications; and Community ProCONE focuses on improving pregnant women’s knowledge of dangers signs, family, and the community preparation of emergency plans, traditional midwives’ participation in referrals, and cultural adequacy of delivery services. This collaborative, The ProCONE Community spread collaborative, was scaled up in 2010 to eight additional health areas, focusing on improving pregnant women’s knowledge of dangers signs, family, and community preparation of emergency plans, traditional midwives’ participation in referrals, and cultural adequacy of delivery services;
Key measures for the collaborative work include the following:
• Recognition of danger signs during pregnancy, delivery and postpartum
• Recognition of neonatal danger signs
• Pregnant women with emergency plan
• Proportion of communities with a community emergency plan
In collaboration with the MOH Quality Management Unit, HCI has focused on implementing a spread strategy for overall QI approaches. HCI supported the certification of 8 additional facilities (2 HIV/STI clinics and 6 basic MNH care centers), which adapted QI best practices to achieve certification. As a part of its spread strategy, HCI is concentrating QI efforts in 12 priority municipalities.
Community ProCONE spread collaborative is taking place in the original collaborative sites (San Marcos) and includes additional 7 new Health Areas.
The HCI Child Health and Nutrition facilitator accompanied by the Health Area nurse and nutritionists conducted supervisory/ coaching visits to 20 health facilities. Through direct observations they were able to ascertain that providers are following norms, using clinical records, monitoring clinical records for quality improvement, attempting to strengthen integrated care of the infant and child, and guaranteeing supplies, especially micronutrients.
In January 2010, the first learning session of the expansion phase of the Community ProCONE Collaborative was held with teams from the seven new health areas. Baseline data were collected in January and February 2010 in 16 districts using Lot Quality Assurance Sampling (LQAS) to interview samples of 19 women in each district (N=304). Women were asked about their recognition of danger signs in pregnancy/delivery/postpartum, recognition of danger signs in the neonate, and presence of a family and community emergency plans. The second learning session was held in March 2010. HCI also conducted advocacy with local authorities and leaders to support community mobilization around birth emergencies and assisted the MOH to implement a behavior change communication strategy that included counseling in health facilities, home visits, mass media campaigns, radio spots, group talks, pregnant women clubs, and parades and distribution of educational brochures in such public locations as buses, pharmacies, stores, and bars.
Three key measurements tracked by the quality improvement teams in the collaboratives reveal improvements across the three collaborative indicators measured through interviews of a sample of pregnant women in each district/ municipality. In 16 health districts, LQAS samples of 19 pregnant women each (N=304) were drawn to measure recognition of danger signs in pregnancy/delivery/postpartum, recognition of danger signs in the neonate, and having a family emergency plan. One of the indicators monitored closely was the possession of a family emergency card as this indicator requires women to clearly mention at least three danger signs, the place they would go to if presented with a danger sign, and to show a completed emergency planning card. A slow but constant improvement has been seen in the possession of these cards due to better prenatal counseling, encouraging completing, and signing the card, putting it in a visible place at home, and finding new ways to present the same information.
Collaboration with authorities and local leaders has played a major role in contributing to obtaining improvements in monitored indicators. HCI Guatemala staff have also worked closely with the MOH in the implementation of a wider SBCC strategy that includes counseling in health services, home visits, mass media campaigns, radio spots, group talks, pregnant women clubs, parades and handing out educational brochures to individuals, and placed in locations such as buses, pharmacies, stores, and bars. In addition, community mobilization of assemblies where members of health committees were identified and trained was an important factor.