Abstract
BackgroundThe challenge of delivering multiple, complex messages to promote maternal and newborn health in the terai region of Nepal was addressed through training Female Community Health Volunteers (FCHVs) to counsel pregnant women and their families using a flipchart and a pictorial booklet that was distributed to clients. The booklet consists of illustrated messages presented on postcard-sized laminated cards that are joined by a ring. Pregnant women were encouraged to discuss booklet content with their families.MethodsWe examined use of the booklet and factors affecting adoption of practices through semi-structured interviews with district and community-level government health personnel, staff from the Nepal Family Health Program, FCHVs, recently delivered women and their husbands and mothers-in-law.ResultsThe booklet is shared among household members, promotes discussion, and is referred to when questions arise or during emergencies. Booklet cards on danger signs and nutritious foods are particularly well-received. Cards on family planning and certain aspects of birth preparedness generate less interest. Husbands and mothers-in-law control decision-making for maternal and newborn care-seeking and related household-level behaviors.ConclusionsInterpersonal peer communication through trusted community-level volunteers is an acceptable primary strategy in Nepal for promotion of household-level behaviors. The content and number of messages should be simplified or streamlined before being scaled-up to minimize intervention complexity and redundant communication.
Highlights
The challenge of delivering multiple, complex messages to promote maternal and newborn health in the terai region of Nepal was addressed through training Female Community Health Volunteers (FCHVs) to counsel pregnant women and their families using a flipchart and a pictorial booklet that was distributed to clients
New responsibilities that were assigned to FCHVs included identifying every pregnant woman in their catchment areas; counseling her and her family members on all messages contained in the booklet during four antenatal encounters while advocating for mothers to receive quality care; maintaining a pregnancy register that documented the status of each woman's care; making at least one home visit to each recently delivered mother; and attending intermittent training functions as well as monthly meetings at the health post
FCHVs who served as respondents noted that they do not want to retire from their positions due to the appreciation they receive from the community
Summary
The challenge of delivering multiple, complex messages to promote maternal and newborn health in the terai region of Nepal was addressed through training Female Community Health Volunteers (FCHVs) to counsel pregnant women and their families using a flipchart and a pictorial booklet that was distributed to clients. Improved maternal and newborn health (MNH) outcomes can be achieved by improving quality of and access to services and through positive changes in household practices and care-seeking. Messages increasingly promote essential newborn care and recognition of and appropriate response to danger signs [9,10] Targets for these messages may include decision-makers such as husbands [11,12,13] and mothers-inlaw [14,15]
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