Process evaluation of the community-based newborn care program implementation in Geze Gofa district, south Ethiopia: a case study evaluation design

Abstract

BackgroundThe Community-Based Newborn Care (CBNC) program is a comprehensive strategy designed to improve the health of newborns during pregnancy, childbirth, and the postnatal period through health extension workers at community levels, although the implementation has not been evaluated yet. Therefore, this study aimed to evaluate the process of the CBNC program implementation in Geze Gofa district, south Ethiopia.MethodsA case study evaluation design with a mixed method was employed from May 1 to 31, 2017. A total of 321 mothers who gave birth from September 01, 2016 to February 29, 2017, were interviewed. Similarly, 27 direct observations, six-month document reviews, and 14 key informant interviews were conducted. The quantitative data were entered into Epi-Data version 3.1 and exported to SPSS version 20 for analysis. In the multivariable logistic regression analysis, variables with < 0.05 p-values and Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) were used to declare factors associated with maternal satisfaction. The qualitative data were transcribed, translated, coded, and analyzed using thematic analysis. The overall process of program implementation was measured based on pre-determined judgmental criteria.ResultsThe overall level of the implementation process of the CBNC program was 72.7%, to which maternal satisfaction, availability of resources, and healthcare providers’ compliance with the national guideline contributed 75.0, 81.0, and 68.0%, respectively. Essential drugs and medical equipment, like vitamin K, chlorohexidine ointment, neonatal resuscitation bags, and masks used in the program were out of stock. Very severe diseases were not treated according to the national guidelines, and the identification of neonatal sepsis cases was poor. Trading occupation (AOR: 0.16, 95% CI: 0.03–0.97) and low wealth status (AOR: 3.11, 95% CI: 1.16–8.36) were factors associated with maternal satisfaction.ConclusionThe process of CBNC program implementation was relatively good, although the compliance of healthcare providers with the national guideline and maternal satisfaction with the services was low. Some essential drugs and medical equipment were out of stock. Merchant and low wealth status affected maternal satisfaction. Therefore, healthcare offices should provide crucial medicines and equipment for better program implementation and improve the wealth status of mothers to enhance maternal satisfaction.

District health managers perspectives of introducing a new service: a qualitative study of the community-based newborn care programme in Ethiopia

“…However, the CBNC programme training was considered to be of low intensity by health centre staff and district health managers. Indeed there is some evidence that HEWs were not treating young infants with possible severe bacterial infection according to national guidelines [ 21 ]. Further, studies have shown that training alone has little effect in improving health care provider performance [ 22 ].…”

Exploration of facilitators of and barriers to the community-based service utilization for newborn possible serious bacterial infection management in Debre Libanos District, Ethiopia: descriptive qualitative study

“…The program also utilizes health developmental armies [HDA] and other existing effective community mobilization mechanisms to scale up the service and to improve maternal and newborn care practices and careseeking [13]. There is also evidence that showed community-based service utilization is being provided for newborn PSBI management [12,19,20]. But, the study findings also showed that there were newborns that did not get treatment service besides the presence of signs or symptoms suggestive to PSBI [12,19].…”

Evaluation of Comprehensive Emergency Management of Obstetric and Newborn Care Program Implementation at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia: A Case Study Design

“…This evaluation assessed the implementation status of CEmONC program, using availability, compliance and acceptability dimensions based on the interests of stakeholders. Availability is the sub-dimensions to measure access to health care in relation with the volume and types of services, and adequacy of resources (physical and human) used to provide CEmONC services [17]. Compliance is the degree to which CEmONC services is being implemented in UoGCSH by health care providers complies with the national standards and clinical protocols [17].…”

“…Availability is the sub-dimensions to measure access to health care in relation with the volume and types of services, and adequacy of resources (physical and human) used to provide CEmONC services [17]. Compliance is the degree to which CEmONC services is being implemented in UoGCSH by health care providers complies with the national standards and clinical protocols [17]. Acceptability determines the level of care givers perceptions of care received from CEmONC services by health care providers [17].…”