Lessons Learned from Two Decades of Community-Based Newborn Care

Session: Community Health: Supporting Community Health Workers, Strengthening Systems

Presenter: Kate Kerber, Save the Children

Background: A number of influential trials over the past two decades have generated evidence on where, why and how to deliver care for pregnant women and newborns in low-resource settings, especially at community level. This research posited that substantial reductions in neonatal mortality could be achieved through use of low-technology, community-based interventions, and an integrated package throughout pregnancy and the postnatal period.

Methodology:  A systematic review was conducted to identify trials of community-based pregnancy and postnatal care. The intervention package, outcomes, and underlying context were assessed to understand the differences and similarities in each setting, particularly related to the characteristics of the community health worker/change agent, the time allotted for the intervention to ‘take root,’ and the key role-players. Where available, the cost of the package was also extracted and compared.

Results: Over 30 randomised control trials and quasi-experimental studies in 20 countries were included. They employed a mix of participatory action groups, preventive home visits, and in certain settings, case management of newborn illness at home. While some had positive and influential results, others showed less or no effect on neonatal mortality, even when combined with efforts to improve facility-community linkages and continuity of care. Importantly, there were large differences in the training and scope of the workers liaising with families. ‘Softer’ benefits such as reduced direct costs for families, lessened travel time, and equitable service delivery have not been afforded the same weight and in many cases, not documented.

Conclusion: Intervention packages must be adapted for the local context but varying results demonstrate that the adaptation process may not always be sufficient to achieve desired outcomes. This review provides critical information on the specific conditions that need to be met for successful development and delivery of community-based newborn care within the overall health system and socio-political context.