The Power of Design: A demand Creation Strategy for Maternal, Newborn and Child Health and Community Based Newborn Care (MNCH/CBNC) in Ethiopia Author: Asayehegn Tekeste

Background Low illnesses recognition and care-seeking which continues to drive high mortality rates. A comprehensive MNCH/CBNC Demand Creation Strategy needed

Background The Ethiopian Federal Ministry of Health (FMOH) launched the Community-Based Newborn Care (CBNC) package in 2013. Includes evidence-based interventions targeting mothers and their newborns during pregnancy, childbirth, and the postnatal period. Integrated into the existing maternal and child health interventions SCI supporting the CBNC implementation in the 4 agrarian regions – total 21 Zones and 2 special woredas through funds from USAID and UNICEF Started with a few learning Zones and now at scale

Methodology A participatory design process engaged leadership from FMOH, MNCH Technical Working Group and national stakeholders. Major determinants of Maternal Newborn, and Child Health (MNCH) service utilization, existing health and community systems, and platforms for improving family and social norms were analyzed. Learning exchange visits, a barriers analysis, a systematic desk review of the local and global evidence-base, and a design workshop yielded experience on improving MNCH. Key approaches demonstrating effectiveness were analyzed for feasibility, scalability and sustainability. To answer:-What was working and in what context? - Which of those could be taken to scale? How can they be integrated in to the existing systems? - How can we select the appropriate mix of strategies or the strategy that works best? - What should be the central strategy for the proposed model? -How can that be sustained?

Results MNCH demand creation strategy was designed Scalable and potentially sustainable Well aligned with national systems, tools and guidelines 5 P’s: Purpose, Principles, People/Platforms, Processes and Products Purposes: To improve maternal and newborn outcomes through increased demand creation for CBNC. Principles: Community strengthening, Sustainability, Scalability, Equity, Multi-sectoral collaboration, Enabling environment, Continuum of care, Quality-Matching-Demand

Result Peoples and Platforms: Those closest to the mother and newborns including family members and community leaders and decision makers Health Development Army, Kebele Command Posts/health Steering Committees, Health Workers, Service Providers

Results Process: Community capacity strengthening approaches leveraging multi-sectoral social networks; formal and informal leaders and traditional systems Organize Community for Action Explore Issues & Set Priorities Plan Together Act Together Evaluate Together Prepare to Mobilize Prepare to Scale-up

Results Effective Community strategies selected include: Engaging family decision makers; Strengthening pregnant women’s forums; Active male involvement; Leveraging the non- delivery role of TBAs; Service quality improvements; Support to the woman development army; Community use of data and Creating conducive environment for demand generation

Results Orientation and Capacity building for DCS roll out Regional, zonal & Woreda (district), Primary Health Care Unit (PHCU) and Kebele levels. WrHO and PHCU routinely support Kebele Command Posts and HPs Supportive supervision guidelines and tools developed and used M&E and documentation systems (DHIS-2) put in place Strength of implementation, service utilization trends, MNCH practices, and community capacity. Project Baseline addressed family health practice and service utilization

Discussion/Lessons Encouraging support from all counterparts FMOH, RHBs and sector offices Alignment with policy priorities Strengthening existing systems - PHCUs SS Step-by-step process for capacity building (Learning-by-doing) Demand without Services Quality improvement? Health system had a huge need for support on DC Strategy should respond to varying contexts, flexible to accommodate emerging themes and challenges

Conclusion: Thorough analysis of health and community systems coupled with sound program design can help to effectively integrate MNCH demand creation strategies into national health systems. Demand creation strategies designed primarily with, and not secondary to, service delivery improve the strength of implementation for improved MNCH.

Thank you! Amasaginalehu!