NGO facilitation of a government community-based maternal and neonatal health programme in rural India: improvements in equity

Abstract

Socio-economic disparities in health have been well documented around the world. This study examines whether NGO facilitation of the government's community-based health programme improved the equity of maternal and newborn health in rural Uttar Pradesh, India. A quasi-experimental study design included one intervention district and one comparison district of rural Uttar Pradesh. A household survey conducted between January and June 2003 established baseline rates of programme coverage, maternal and newborn care practices, and health care utilization during 2001-02. An endline household survey was conducted after 30 months of programme implementation between January and March 2006 to measure the same indicators during 2004-05. The changes in the indicators from baseline to endline in the intervention and comparison districts were calculated by socio-economic quintiles, and concentration indices were constructed to measure the equity of programme indicators. The equity of programme coverage and antenatal and newborn care practices improved from baseline to endline in the intervention district while showing little change in the comparison district. Equity in health care utilization for mothers and newborns also showed some improvements in the intervention district, but notable socio-economic differentials remained, with the poor demonstrating less ability to access health services. NGO facilitation of government programmes is a feasible strategy to improve equity of maternal and neonatal health programmes. Improvements in equity were most pronounced for household practices, and inequities were still apparent in health care utilization. Furthermore, overall programme coverage remained low, limiting the ability to address equity. Programmes need to identify and address barriers to universal coverage and care utilization, particularly in the poorest segments of the population.

Improvement of perinatal and newborn care in rural Pakistan through community-based strategies: a cluster-randomised effectiveness trial

“…[12][13][14][15] The scale-up phase of the Hala eff ectiveness trial was three times larger than the initial pilot and was much bigger than other studies in the region. It also diff ered from other studies in the region [12][13][14][15]17,18 in that the intervention was principally delivered through the government health system rather than by workers employed directly by the research team. Referral health facilities serving both intervention and control clusters were strengthened and the population in the control clusters received basic maternal and newborn care through the existing LHW programme.…”

“…8,9 The potential of community-based interventions to reduce newborn morbidity and mortality is well recognised. 10,11 Such interventions include community health workers (CHWs) delivering preventive and therapeutic interventions such as antibiotics at home, 12,13 community mobilisation through women's support groups 14,15 or community mobilisers working through individual and group sessions, 16 and community-based interventions delivered through non-governmental organisations 17 or community volunteers. 18 Common features of these interventions include civil society engagement, fl exibility of approaches, community volunteers, social mobilisers, or CHWs dedicated to the designated tasks through home visits or group sessions.…”

Debt, Structural Adjustment, and Non-Governmental Organizations: A Cross-National Analysis of Maternal Mortality

“…The effectiveness of such programs in decreasing maternal mortality has been documented in poor nations (Baqui et al 2008;Mercer et al 2006;Mercer et al 2004). For example, Mercer et al (2006) find that maternal mortality declined in areas of Bangladesh where health non-governmental organizations were operating.…”

Cost-effectiveness of skin-barrier-enhancing emollients among preterm infants in Bangladesh

“…In many South Asian societies, new mothers enter a period of seclusion from society after delivery, which means that they often do not seek care from the formal health sector for themselves or for their babies. 48 As community health workers (CHWs) have been shown to be effective providers in such circumstances, 3,49-52 and community-based care has been shown to improve the equity of care distribution, 53 research on community-based delivery of emollients is recommended. However, the limitations of the CHW model should be recognized, and the sustainability of behaviour change in non-facility settings should be explored.…”