Abstract
BackgroundIn India, community health workers’ (CHW) effectiveness in providing home-based neonatal care (HBNC) has been well documented. The nature of challenges faced and strategies adopted while providing HBNC services need to be studied in-depth.MethodsA qualitative study to understand the challenges faced and strategies used by Sakhis (women CHW) while providing services as part of a HBNC program implemented by a non-profit organization. Data consisted of 20 in-depth interviews and three focus group discussions (FGD) with Sakhis.ResultsSakhis negotiated with the community to start working as a CHW. They faced challenges while changing behaviors at individual level and also while bringing about a change in harmful normative practices that increased chances of maternal and neonatal mortality. Managing crises at the time of deliveries and facilitating a safe delivery was the most critical challenge faced by many Sakhis.The key strategies used by Sakhis included: proactively and persistently providing services even when they faced resistance from the woman or her family; evolving contextually suitable counseling techniques and tactics to bring about behavioral change; balancing compliance to traditional practices and promoting HBNC; defying traditional practices and assisting the woman in times of an emergency to save lives. Having on-call support from supervisors and cultivating a good working relationship with health providers facilitated effective service provision by Sakhis.ConclusionCHWs having a strong sense of commitment can develop strategies to address challenges and provide HBNC services effectively if they also have strong supervisory support.
Highlights
In India, community health workers’ (CHW) effectiveness in providing home-based neonatal care (HBNC) has been well documented
The setting The study was conducted with CHWs called Sakhis who have worked in a Maternal and Child Health (MCH) program initiated by Ambuja Cement Foundation (ACF) in 2005
Number of study participants (Sakhis) Number of Sakhis interviewed Number of Sakhis participating in focus group discussions (FGD) Age [Mean] Years of experience of providing HBNC [Mean] a6 interviewed Sakhis participated in FGD
Summary
In India, community health workers’ (CHW) effectiveness in providing home-based neonatal care (HBNC) has been well documented. Community health workers (CHW) play a crucial role in ensuring availability of basic healthcare services They are at the core of the public health strategies to ensure access to primary health care for all populations. A landmark study by Bang et al [1] demonstrated the effectiveness of home based neonatal care (HBNC) provided by CHW in reducing neonatal mortality in rural Indian communities. This is widely recognized as the HBNC model and the government of India has adopted it with the objective of reducing morbidity and mortality among women and children in the country. The lessons from this study will be valuable to planners and implementers involved in the scale-up
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