Postnatal Home Visits: Effective in Field Trials, What About in the Real World?

Session: Postnatal Care: Reaching Newborn Infants and Mothers with Preventative and Curative Care

Presenter: Robert McPherson, Independent Consultant
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Background: There is growing realization that implementation research in realistic field settings is at least as important as the rigorous randomized controlled trials studies that guide the content of interventions. New service delivery strategies must be tested under real-world conditions before being taken to scale. WHO and UNICEF issued a joint statement in 2009 urging ministries of health to implement programs that use community health workers to conduct postnatal home visits (PN HVs) in order to reduce newborn mortality. While the literature contains evidence that newborn mortality can be reduced when PN HVs are delivered in carefully controlled field trials, little is known regarding how these programs perform when implemented at scale through regular government services. A team from Save the Children (SC), WHO, UNICEF, USAID, and the Maternal Child Survival Program (“Team”) is conducting a global review (“Review”) of country-level experience with the implementation of PN HVs at scale.

Methodology:  The Team assessed ten countries during Phase One of the Review for their potential to provide rich learning opportunities. The Team selected Bangladesh, India, Malawi, Ethiopia, Nepal and Rwanda for more comprehensive review during Phase Two. The Team reviewed existing data and reports, conducted interviews with key informants, and collected primary quantitative data through small-scale surveys in order to develop findings and conclusions across focus countries.

Results:  The Review is currently in process (as of April 2015). Specific findings to be presented at the conference will include what has been learned from successful and unsatisfactory experiences implementing PN HVs at scale; which components of programming have performed well and which require further strengthening; and, which factors drive positive performance or constrain its achievement.

Conclusions: The review will highlight the key requirements for effective delivery of PN HVs at high levels of coverage at scale through government health services.