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Scaling up community mobilisation through women's groups for maternal and neonatal health: experiences from rural Bangladesh.

Nahar T, Azad K, Aumon BH, Younes L, Shaha S, Kuddus A, Prost A, Houweling TA, Costello A, Fottrell E - BMC Pregnancy Childbirth (2012)

Bottom Line: Program coverage is likely to be an important determinant of the effectiveness of community interventions to reduce neonatal mortality.Examination and documentation of how scaling-up was successfully initiated, led, managed and monitored in rural Bangladesh provide a deeper knowledge base and valuable lessons.Strong operational capabilities and institutional knowledge of the implementing organisation were critical to the success of scale-up.Monitoring and feedback systems that allow for periodic programme corrections and continued innovation are central to successful scale-up and require programmatic and operational flexibility.

View Article: PubMed Central - HTML - PubMed

Affiliation: University College, London, UK. e.fottrell@ich.ucl.ac.uk

ABSTRACT

Background: Program coverage is likely to be an important determinant of the effectiveness of community interventions to reduce neonatal mortality. Rigorous examination and documentation of methods to scale-up interventions and measure coverage are scarce, however. To address this knowledge gap, this paper describes the process and measurement of scaling-up coverage of a community mobilisation intervention for maternal, child and neonatal health in rural Bangladesh and critiques this real-life experience in relation to available literature on scaling-up.

Methods: Scale-up activities took place in nine unions in rural Bangladesh. Recruitment and training of those who deliver the intervention, communication and engagement with the community and other stakeholders and active dissemination of intervention activities are described. Process evaluation and population survey data are presented and used to measure coverage and the success of scale-up.

Results: The intervention was scaled-up from 162 women's groups to 810, representing a five-fold increase in population coverage. The proportion of women of reproductive age and pregnant women who were engaged in the intervention increased from 9% and 3%, respectively, to 23% and 29%.

Conclusions: Examination and documentation of how scaling-up was successfully initiated, led, managed and monitored in rural Bangladesh provide a deeper knowledge base and valuable lessons.Strong operational capabilities and institutional knowledge of the implementing organisation were critical to the success of scale-up. It was possible to increase community engagement with the intervention without financial incentives and without an increase in managerial staff. Monitoring and feedback systems that allow for periodic programme corrections and continued innovation are central to successful scale-up and require programmatic and operational flexibility.

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Average attendance of participants (members and non-members) at women's group meetings by district in intervention areas.
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Figure 2: Average attendance of participants (members and non-members) at women's group meetings by district in intervention areas.

Mentions: In a population of 243,341 people in the nine intervention unions, 648 new women's groups were added to the pre-scale-up 162 groups. All 810 groups continue to run to date. The population coverage is estimated at one women's group per 300 population (Table 1), an approximately five-fold increase in coverage relative to pre-scale-up levels. Following scale up, there is approximately one women's group per 57 ever-married women of reproductive age, compared to one group per 283 prior to scale-up and 23% of the 45,820 ever-married women in reproductive age living in the intervention areas are women's group members. Approximately 29% of women who gave birth and were interviewed as part of the community-surveillance system during the period January 2009 to June 2010 reported attending women's groups, compared to 3% prior to scale-up. Average attendance at each women's group meeting in the newly-formed groups is shown in Figure 2.


Scaling up community mobilisation through women's groups for maternal and neonatal health: experiences from rural Bangladesh.

Nahar T, Azad K, Aumon BH, Younes L, Shaha S, Kuddus A, Prost A, Houweling TA, Costello A, Fottrell E - BMC Pregnancy Childbirth (2012)

Average attendance of participants (members and non-members) at women's group meetings by district in intervention areas.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3298477&req=5

Figure 2: Average attendance of participants (members and non-members) at women's group meetings by district in intervention areas.
Mentions: In a population of 243,341 people in the nine intervention unions, 648 new women's groups were added to the pre-scale-up 162 groups. All 810 groups continue to run to date. The population coverage is estimated at one women's group per 300 population (Table 1), an approximately five-fold increase in coverage relative to pre-scale-up levels. Following scale up, there is approximately one women's group per 57 ever-married women of reproductive age, compared to one group per 283 prior to scale-up and 23% of the 45,820 ever-married women in reproductive age living in the intervention areas are women's group members. Approximately 29% of women who gave birth and were interviewed as part of the community-surveillance system during the period January 2009 to June 2010 reported attending women's groups, compared to 3% prior to scale-up. Average attendance at each women's group meeting in the newly-formed groups is shown in Figure 2.

Bottom Line: Program coverage is likely to be an important determinant of the effectiveness of community interventions to reduce neonatal mortality.Examination and documentation of how scaling-up was successfully initiated, led, managed and monitored in rural Bangladesh provide a deeper knowledge base and valuable lessons.Strong operational capabilities and institutional knowledge of the implementing organisation were critical to the success of scale-up.Monitoring and feedback systems that allow for periodic programme corrections and continued innovation are central to successful scale-up and require programmatic and operational flexibility.

View Article: PubMed Central - HTML - PubMed

Affiliation: University College, London, UK. e.fottrell@ich.ucl.ac.uk

ABSTRACT

Background: Program coverage is likely to be an important determinant of the effectiveness of community interventions to reduce neonatal mortality. Rigorous examination and documentation of methods to scale-up interventions and measure coverage are scarce, however. To address this knowledge gap, this paper describes the process and measurement of scaling-up coverage of a community mobilisation intervention for maternal, child and neonatal health in rural Bangladesh and critiques this real-life experience in relation to available literature on scaling-up.

Methods: Scale-up activities took place in nine unions in rural Bangladesh. Recruitment and training of those who deliver the intervention, communication and engagement with the community and other stakeholders and active dissemination of intervention activities are described. Process evaluation and population survey data are presented and used to measure coverage and the success of scale-up.

Results: The intervention was scaled-up from 162 women's groups to 810, representing a five-fold increase in population coverage. The proportion of women of reproductive age and pregnant women who were engaged in the intervention increased from 9% and 3%, respectively, to 23% and 29%.

Conclusions: Examination and documentation of how scaling-up was successfully initiated, led, managed and monitored in rural Bangladesh provide a deeper knowledge base and valuable lessons.Strong operational capabilities and institutional knowledge of the implementing organisation were critical to the success of scale-up. It was possible to increase community engagement with the intervention without financial incentives and without an increase in managerial staff. Monitoring and feedback systems that allow for periodic programme corrections and continued innovation are central to successful scale-up and require programmatic and operational flexibility.

Show MeSH