Presentation on theme: "A COMMUNITY-BASED MATERNITY CARE PROGRAM IMPROVES UTILIZATION OF ANTENATAL CARE AND REFERRAL OBSTETRIC SERVICES IN KONO DISTRICT, SIERRA LEONE: 12-MONTH."— Presentation transcript:
A COMMUNITY-BASED MATERNITY CARE PROGRAM IMPROVES UTILIZATION OF ANTENATAL CARE AND REFERRAL OBSTETRIC SERVICES IN KONO DISTRICT, SIERRA LEONE: 12-MONTH OUTCOMES M. Bailor Barrie, M.B.Ch.B., 1 J. Daniel Kelly, M.D. 1,2 1 Wellbody Alliance, Koidu Town, Sierra Leone 2 Baylor College of Medicine, Houston, TX, USA
Background Why maternal deaths? Utilization of services Emergent obstetric services Drop-offs in ANC visits Home-based deliveries Lack of referral system
Program Goal Implement a community- based program designed to increase utilization of maternal health services. Support PHUs Strengthen the referral system Support Koidu Government Hospital Prior experience in community-based program implementation Adapted our model to maternal health In Kono District, we work in partnership with the Ministry of Health and Sanitation
Methods In August 2011, WA trained 45 former traditional birth attendants and traditional health care providers to serve as community health workers. WA launched its maternal mortality reduction program in September 2011 at three peripheral health clinics in Kono District, Sierra Leone. They received monthly incentives for accompanying pregnant women to the clinic for their antenatal (ANC) care, delivery, and postnatal care, tracing those who missed appointments, referring women with pregnancy- related complications to the clinic, and educating them about the value of facility-based care.
Methods Clinic staff performed deliveries and decided when to refer women with pregnancy- related complications from the clinic to the district hospital. We analyzed data routinely collected from ANC and delivery registers to compare service utilization 12-months before and 12-months after implementation of the program.
Results The average number of first and fourth ANC visits increased from 48.3 to 56.9 per month and from 22.5 to 30.7 per month, respectively. *statistically significant 1st ANC visit4th ANC visit Facility2010-112011-122010-112011-12 Manjama183181141184 Small Sefadu1421218497 Koeyer*255381*4587* Total580683270368
Our program demonstrated higher rates of women being initiated and retained in antenatal care. Conclusion
Results During the first year of the program, 83 women with complications were successfully referred to the district hospital compared to 27 in the preceding year. Emergent caesarean sections decreased from 11 to 8. No maternal deaths occurred among the women served by the program.
Referral rates to the hospital dramatically improved. Conclusion
Results Facility-based deliveries increased on average from 27.4 to 31.5 per month. *statistically significant Facility-based deliveries PHUs 2010-112011-12 Manjama107105 Small Sefadu10282 Koeyer*120191 Total 329378
Home-based deliveries remain a common practice, and further studies need to develop an intervention that de-incentivizes them. Conclusion
Limitations Quality of facility-based care Strength of overall health system and referral services Cultural barriers of home-based deliveries Supervisor system of community-based program Variable performance of facilities
Further investigations need to be conducted to fully understand the reasons for Koeyer’s success Why was Koeyer successful?
Way forward Strengthening of facility-based care Essential to the development of a community-based program Accompaniment of family members to initial ANC visit to discuss value of facility-based delivery Incentive packages for mother and child if facility- based delivery occurs Expansion of emergent obstetric referral services Restructuring of supervision system Integration of community health work