Development and implementation of the maternal and child health Handbook in Angola

Abstract

Although the maternal and child health (MCH) Handbook is widely used in many countries, its development and implementation process has not been sufficiently documented in scientific publications. This is a report of how the Angola MCH Handbook was developed, what challenges we encountered during its implementation and how they were solved. Leading the process was the MCH Handbook Committee set up to develop the MCH Handbook and implement the programme in liaison with various stakeholders. We developed the MCH Handbook through participatory workshops with the objective of producing user-responsive content and designs, foster healthy interaction and build common understanding among stakeholders. After pilot use in select health facilities, the MCH Handbook programme, which included training, monitoring and supervision, mothers’ class and community awareness raising activities, was gradually implemented in three model provinces. Core members of the committee closely observed each step of the programme to identify challenges in each field, and revised the tool and programme throughout the process. As nationwide implementation of the MCH Handbook Programme progresses, it is important to continually identify challenges specific to different localities while taking measures to address them. In our experience, stakeholder involvement from the early planning and preparation stages was critical to ensure their continued commitment at later stages and for programme continuity. Our approach of tool development involving various stakeholders and flexible implementation strategies were key elements for user acceptance and programme sustainability that may be applicable for introduction of similar interventions in other settings.

Effectiveness of the maternal and child health handbook for improving continuum of care and other maternal and child health indicators: A cluster randomized controlled trial in Angola

“…Preliminary findings from its pilot use prior to intervention launch [ 13 ] showed the MCH handbook was well received (unpublished results), and mothers may have actively sought to attend antenatal care to get the handbook. Consequently, the MCH handbook intervention may have worked as an incentive to modify demand-side factors in initiating antenatal care use consistent with the trial hypothesis.…”

“…Subsequently, we administered our intervention package after the MCH handbook was designed through the MCH handbook committee comprising members from the Ministry of Health in Angola, the WHO, UNICEF, JICA, and local bodies (including the Angolan Pediatric Society). The MCH handbook development process in Angola has been previously reported [ 12 , 13 ]. The study design identified in the formative phase involved a community-wide distribution of the MCH handbook with its supplementary interventions.…”

Scoping review of interventions to improve continuity of postdischarge care for newborns in LMICs

“…17 Several interventions have been implemented to improve continuity, for example, MCH booklets introduced in Angola. 18 Previous reviews on MCH in high-income countries have also emphasised the importance of strengthening continuity, highlighting this as a priority area for research in LMICs. 19 Participatory approaches by engaging with the people who will ultimately interact with the intervention have drawn interest in recent years.…”

“…Continuity can have a positive effect on maternal and child healthcare (MCH), including improving breastfeeding initiation and duration, and outcomes related to maternal and newborn health status, such as improved maternal mental health 17. Several interventions have been implemented to improve continuity, for example, MCH booklets introduced in Angola 18. Previous reviews on MCH in high-income countries have also emphasised the importance of strengthening continuity, highlighting this as a priority area for research in LMICs 19…”

Association between the quality of care and continuous maternal and child health service utilisation in Angola: Longitudinal data analysis

“…Hence, efforts to improve the quality of care and sensitise users should be simultaneously undertaken to promote maternal and child health in Angola. To bridge the gap in quality of care, health workers should be trained adequately before and during an intervention is introduced [28,36]. Third, the results suggest that pregnant women in low socioeconomic groups, especially those with lower education, on lower economic levels, and living in rural areas, require intensive support to utilise MNCH services at recommended levels.…”