Date of Defense:
Around the globe, one woman dies each minute as a result of complications related to pregnancy and childbirth. In the country of Bangladesh, a woman’s lifetime risk of maternal death is 1 in 51.
Home-Based Life-Saving Skills (HBLSS) is a community-based, family-centered program developed by the American College of Nurse-Midwives (ACNM) Department of Global Outreach. The aim of HBLSS was implemented in Matlab, Bangladesh in March 2007 as one component of a Maternal, Newborn, and Child Health Program at the International Center for Diarrheal Disease Research, Bangladesh (ICDDR,B).
In April 2008, an evaluation study was conducted one year post-implementation of HBLSS in order to gather information on the implementation process in the ICDDR,B service area. Data were collected through review of process data and utilization of qualitative methods, including observation, key information interviews, and group discussions. Additionally, all 41 Community Health Research Workers (CHRWs) were post-tested on the topics of Birth Delay and Baby Has Trouble Breathing one year following training. Over the past year, the CHRWs were responsible for implementing the HBLSS program at the community level. Each CHRW received HBLSS training in 2007 and underwent pre- and immediate post-testing of skills.
Results revealed rapid integration of the program into the Matlab community. Between June 2007 and March 2008, nearly 4500 HBLSS contacts were made with pregnant women and their support persons. All (100%) pregnant women received at least one HBLSS meeting, 85.5% received at least two, 69.5% received three, and 51.1% received all four meetings. CHRW knowledge retention on the topics of Birth Delay and Baby Has Trouble Breathing was strong with an increase in mean scores of 14% and 20%, respectively from immediate post-testing.
Group discussions and individual interviews demonstrated high satisfaction with the HBLSS program. Several strengths of the HBLSS program were identified including: 1) overall enthusiasm for the HBLSS program, 2) commitment of CHRWs to the Matlab community, and 3) organization and supervision of the HBLSS program by ICDDR,B staff. Challenges of the program were also identified: 1) lack of involvement of men in the program, 2) high workload of CHRWs, 3) limited space to conduct HBLSS meetings, 4) loss of master trainers, and 5) inability of referral sites to provide emergency obstetric care.
Several short and long-term priorities were identified and recommendations were made to improve the HBLSS program. Two key short-term recommendations include: 1) identifying tow HBLSS co-coordinators to monitor the program and 2) beginning monthly male-only HBLSS meetings focused on mother/baby problems and community transportation and money plans. Three chief long-term priorities include: 1) hiring and training an additional stand-by CHRW for each block, 2) providing advanced skills training for medical officers at Matlab Hospital in forceps and symphysiotomy, and 3) development of an insurance system with a private clinic in Chandpur to increase access to emergency obstetric care.
Data from this evaluation will be used to improve the HBLSS program in Matlab, Bangladesh and in other sites around the world.