Providing women-centered maternal health care at the community level
All women deserve respectful, culturally sensitive, women-centered care that takes into account how, where and with whom they want to receive maternal health care. In order to ensure that this happens, health systems must meet women where they are—both literally and figuratively. Community-based approaches can be effective strategies for providing women with the kind of care they want and need in the place they choose. Unfortunately, many health systems do not currently have the capacity or infrastructure to offer high quality maternal health care at the community level. Doing so requires a strong, well-trained health workforce, efficient referral and transport systems and physical infrastructure. Nevertheless, a number of programs have delivered antenatal, intrapartum and postpartum care at the community level. Many of these programs, particularly those implemented in rural areas with severe health worker shortages, have involved task-shifting with the use of community health workers (CHWs). Common roles for CHWs include providing basic maternal and newborn care, distributing essential medicines such as misoprostol for postpartum hemorrhage and conducting antenatal and postnatal home visits.
Community health workers (CHWs)
A CHW is defined by the World Health Organization as “any health worker who performs functions related to health care delivery and was trained in some way in the context of the intervention, but has received no formal professional or paraprofessional or tertiary education.” CHWs should be members of, selected by and accountable to the communities in which they work.
One large-scale intervention that has successfully employed CHWs to improve maternal health outcomes is the Lady Health Workers (LHWs) program in Pakistan, which was established in 1994. In the current system, LHWs are responsible for identifying pregnant women in rural areas, providing them with comprehensive antenatal services and basic newborn care and referring them to higher level care when necessary. Between 1994 and 2007, the decline in maternal and infant mortality rates was steeper in areas with LHWs compared to the national average.
Successful programs involving CHWs have been implemented in many other countries as well including Burma, Ethiopia, Kenya, Nigeria, Tanzania, Uganda, Afghanistan, Nepal and Rwanda.
A 2013 systematic review concluded that CHWs can effectively deliver educational messages, increase the acceptability of newborn care practices such as skin-to-skin contact and exclusive breastfeeding and provide interventions including intermittent preventative treatment for malaria and psychosocial services. However, additional research on different kinds of CHW programs in diverse settings is needed to identify the most successful models for scale-up.
Women’s preferences for receiving maternal health care, including where and with whom that care takes place, are diverse, and health systems should reflect that by offering choices. Providing high quality maternal health care at the community level can be a powerful tool for promoting women-centered care and health equity.
Are you interested in learning more about community health?
Tune into the Institutionalizing Community Health Conference (ICHC) in Johannesburg, South Africa from 27 – 30 March 2017 by watching the live-stream.
Attending the conference? Join us at the following MHTF-supported panels:
Session 26: Community empowerment and gender
Session 30: Building national capacity and demand for implementation research to take forward the community health agenda
Session 32: Selected topics in implementation research for community-based service delivery
Graphic: HSPH, MHTF and Integrare. Lady Health Workers in Pakistan: Improving access to health care for rural women and families, 2014.
Learn more about the upcoming Institutionalizing Community Health Conference.
Watch a webinar hosted by the White Ribbon Alliance in which Rima Jolivet, the MHTF’s Maternal Health Technical Director, explains the foundations of women-centered care.
Read a commentary written by members of the MHTF team calling for respectful, women-centered health care.
Access resources for training community health workers.