Ashley Ambrose | October 2015
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Presentation at the Global Maternal Newborn Health Conference, October 20, 2015

Background: Traditional birth attendants (TBAs) are crucial, under-utilized resources for community-based maternal and newborn health (MNH) care, however are commonly perceived to hinder skilled delivery. To harness the influence of TBAs, Concern Worldwide’s Innovations for Maternal, Newborn & Child Health initiative launched the Essential Newborn Care Corps (ENCC) in Bo District, Sierra Leone. Together with Health Poverty Action, John Snow Inc, and the government, ENCC is evaluating how trained, non-literate TBAs can serve as Maternal Newborn Health Promoters (MNHPs) linking communities with the government health system through referrals and counseling on antenatal, delivery, and postnatal care, while simultaneously testing a small commodities business scheme aimed to incentivize their work.

Methodology: ENCC uses a pre-post, quasi-experimental, three-arm study design – two intervention groups and a control – evaluating care-seeking in 344 villages served by 18 peripheral health units. Each intervention group consists of 100 trained MNHPs with one group receiving additional business training and a start-up loan to support a small-scale social enterprise. ENCC uses a mixed-methods approach including quantitative data on referrals, home visit timeliness, quality of counselling delivered and goods sold; and qualitative data on acceptability of MNHPs.

Results: Engagement with the new MNHP role is high with retention and participation of MNHPs at nearly 100% and MNHPs generating high numbers of referrals to health facilities. Improved relationships between MNHPs and nurses have also been reported. The social enterprise incentive scheme shows promise with the majority of MNHPs making timely monthly loan payments and continuing to reinvest in their businesses.

Conclusions: Learning from ENCC has the potential to play an important role in how to integrate and incentivize TBAs in national MNCH policies and programs. This innovative approach has the capability to unite the long-standing community trust of TBAs with formal skilled care, particularly in rural, hard-to-reach areas.