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Community Interventions

Sleeping newborn wrapped against mother's chest

Rwandan mother practicing kangaroo mother care (KMC)

Barriers—including distance, cost or cultural practices—often prevent pregnant women and mothers with newborns from accessing health care. Improving the quality of maternal and newborn care in the household and at community and district-level health facilities is the principal challenge facing the ACCESS Program. The strategies that the ACCESS Program employs to bring down those barriers focus not only on individuals and families, but also on communities, providers and policymakers.

Through community interventions, ACCESS builds the capacity of individuals, groups, governments and nongovernmental organizations to assess, plan, implement, monitor and evaluate proven, cost-effective maternal and newborn care interventions.

Through targeted evidence-based behavior change communication strategies, ACCESS is improving household maternal and newborn care practices and increasing demand for maternal and newborn care services.

Community Mobilization in Action

ACCESS recognizes the need for collective action at the community level to create demand for essential maternal and newborn care services and an enabling environment to support appropriate care-seeking behaviors. This approach provides the community with the capacity it needs to solve its current health and non-health related issues, and to be able to address problems that might arise later.

See community mobilization in action:
Video | Transcript

Key elements of the ACCESS Program's community interventions:

Formative research (or situation analysis) is the foundation of ACCESS community intervention strategies. Working with the community and other partners, the ACCESS Program uses in-country data to identify barriers to and enhancers of the household-to-hospital continuum of care; the program then selects proven interventions to address the barriers while scaling up the enhancers.
The Community Action Cycle and other participatory approaches promote community ownership and sustained community collective action and shared responsibility. The Community Action Cycle is used to build collective action through the community mobilization process at multiple levels—household, village, district and national. Through this process, community leaders, nongovernmental organizations, faith-based organizations, government officials, providers and policymakers are encouraged to commit necessary resources to strengthen community mechanisms such as emergency funds, transport systems and mother-and baby-friendly health facilities.

Success Story: Community Midwife in Afghanistan Saves Mother and Baby

In rural Badakhshan province, a laboring woman arrived at a basic health center bleeding heavily and in shock. Mahsoma—a midwife and 2006 graduate of the HSSP-supported provincial Community Midwifery Education Program—assessed the woman’s situation and immediately started an intravenous fluid infusion. She then requested the woman’s relatives take her to the comprehensive emergency obstetric care facility in the provincial hospital in Fayzabad, as she did not have the facilities to manage the woman’s complications at the health center.

Unfortunately, the woman's relatives did not have enough money to pay for the transport to the hospital. Moreover, heavy rainfall had caused severe floods which resulted in the collapse of the bridge leading to the main road.

The woman was close to delivering, but there was an added complication—the baby was in the breech position which, if not delivered skillfully, could cause brain damage or death to the newborn. Using the skills she gained in her midwifery training, Mahsoma successfully delivered a healthy baby boy. She then actively managed the third stage of labor and gave the new mother more intravenous fluids.

As a result of her skills and decision-making abilities, Mahsoma saved two lives in a province with the highest recorded maternal mortality rate in the world.

Birth preparedness and complication readiness is used as the technical framework for share responsibility.
Behavior change communication approaches such as positive deviance, trials of improved practices, facilitated group counseling, home visits, and drama allow ACCESS to improve household protective and preventive practices, including birth preparedness and complication readiness and seeking care from skilled providers.
Home based life saving skills (HBLSS), developed by ACCESS partner, the American College of Nurse-Midwives, trains women, family members and community health workers in basic obstetric first aid to address the unpredictability of obstetric and newborn emergencies and the critical need to stabilize and support a mother or newborn with complications until they can reach a skilled provider.
Advocacy activities involve community leaders and public and private organizations, including local nongovernmental and faith-based organizations, in building support for maternal and newborn care, including generating additional resources and building commitment for more comprehensive programs. Advocacy activities support, at all levels, the empowerment of women and marginalized individuals and ensures their involvement in development of appropriate policies, procedures, and care.
The Partnership-Defined Quality approach emphasizes the use of participatory learning methods to determine locally defined household-to-hospital service needs for mothers and newborns. The approach ensures that health providers trained in counseling, behavior change communication, and essential maternal and newborn care will be supported by health facilities that are well managed and responsive to client needs.