Table 4. Examples of How Desired Changes, Perceived Barriers and Perceived Benefits Feed Forward Into SMART C4D Objectives. Population: Women of Reproductive Age Desired Changes Perceived Barriers Perceived Benefits SMART C4D Objectives Increased utilization of ANC and skilled attendance at delivery Increase in prompt healthcare for complications of delivery (emergency obstetric care and services) Increased practice of exclusive breastfeeding for at six months after delivery Lack of knowledge about when ANC visits should begin and how many are necessary Lack of confidence about benefits of skilled attendants during delivery Lack of knowledge regarding postpartum care and warning signs Long distance to a health facility and lack of transport Cost of giving birth in a facility Health provider attitudes Lack of confidence the benefits of breastfeeding and how long it should be continued Religious and traditional beliefs Lack of male involvement in decision-making on RH issues Improves health of mothers and their children Reduces major causes of maternal deaths, for example, obstructed labor, high blood pressure, and infections Increase by X% the number of women who can explain the importance of seeking a minimum of four ANC visits during pregnancy – that it will improve their health and the health of their babies by (date) Increase by X% the number of women who feel confident in seeking ANC as soon as they know they are pregnant by (date) Increase by X% the number of who plan to deliver their babies at a health facility and have a transportation plan by (date) Increase by X% the number of women who think the benefits of ANC and delivering at a health facility outweigh the costs by (date) Increase by X% the number of who report positive provider-client interaction on RH by (date) Increase by X% the number of women who know warning
6. Examples of Key Messages for Various Intended Populations along the Continuum of Care. Population MNCHN Continuum of Care Pre-Pregnancy Pregnancy Birth/Delivery Postnatal (Mother and Newborn) Infancy/Childhood Adolescents girls and boys Parents of adolescents Delay marriage Delay first birth Prevent unwanted pregnancy by accessing contraceptive counseling and family planning services Abandon social norm on early marriage Women of reproductive age Prevent unwanted pregnancy by accessing contraceptive counseling and family planning services Seek antenatal care as soon as you learn you are pregnant Take daily supplements of iron & folic acid Make at least 4 antenatal care visits during your pregnancy Use bed nets to prevent malaria Every pregnancy faces risks, know the danger signs Ensure skilled attendance at delivery Wash your before handling the baby Put your baby to the breast immediately after delivery Keep the baby warm after delivery Breastfeed your baby exclusively for six months Know the danger signs for newborns Seek immediate care for newborn danger signs Continue breastfeeding and, at 6 months, introduce adequate complementary food Know the danger signs of diarrhea,pneumonia, malaria and wasting Seek immediate attention for diarrhea, pneumonia, malaria and wasting
Seek immediate care for danger signs Plan to deliver you baby at a health facility If you deliver at home, plan for a skilled attendant to be present Men Discuss family planning, including the number and spacing of children workload especially in the last trimester of pregnancy Know the elements of birth preparedness and complication readiness (BPCR) Ensure skilled attendance at delivery Wash your hands before handling the baby Support your partner with putting the baby to the breast immediately after delivery Know the danger for newborns Seek care for newborn danger Know the danger signs for newborns Seek immediate care for newborn danger signs Support your partner in exclusive breastfeeding Support your partner in excusive breastfeeding and complementary feeding Know the danger signs of diarrhea, pneumonia, malaria and wasting Seek immediate attention for diarrhea, pneumonia, malaria and wasting Family Members Discourage child marriage and adolescent pregnancy Encourage birth spacing Know the elements of birth preparedness and complication readiness (BPCR) Support mother/couple to deliver with a skilled attendant Support breastfeeding and timely essential immunizations for children Support IYCF practices, vitamin A supplementation and timely essential immunizations for children Healthcare Providers Motivate women and men to utilize Know how to provide quality Know how to provide essential Know how to provide quality Promote and support
modern family planning methods antenatal care including nutrition counseling and supplementation with iron & folic acid newborn care practices Know the danger signs in newborns Know how to assess danger signs in newborns and start treatment postnatal care (e.g., warming, resuscitation, postnatal visits days after delivery) Promote and support early and exclusive breastfeeding Know the danger signs for newborns and how to treat them or when to refer to another level of care exclusive and continued breastfeeding Know how to provide growth monitoring and prmotion, vitamin A supplementation, etc. Motivate women/families to immunize their children Know how to recognize danger signs of diarrhoea, pneumonia, malaria, malnutrition and other conditions, and refer to a higher level of care as necessary Provide ART for pregnant and lactating women as per the national protocol and early identification and management of HIV infected children Community Leaders (in general terms, advocacy would need to be done with them to Improved health infrastructure (e.g., cash support for transport to health facility during deliveries, Community surveillance of pregnant women helps to save mothers and children Promote/Support delivery with skilled birth attendants Support early and exclusive breastfeeding Support timely essential Support all adequate practices, i.e., Support exclusive and continued breastfeeding
support all adequate practices) good transportation, water and sanitation services) in the community leads to saving mothers and children Support environmental hygiene Support birth spacing and family planning; act against child marriage and adolescent pregnancy Provide the resources to support BPCR immunizations for children Support adequate complementary feeding practices Support timely essential immunizations for children Support household hygiene practices Support timely care seeking for danger signs Policymakers Policies to delay age of marriage and keep girls in school Promote maternal, newborn, and child health and nutrition as human rights Promote maternal, newborn, and child health and nutrition as vital economic and social investments Provide human and material resources to support maternal, newborn, and child health and nutrition promotion and services Ensure the availability and accessibility of essential commodities (e.g., vaccines) at the central, district, and village levels Religious Leaders Discuss MNCH&N recommended practices with your religious groups Support timely essential immunizations and other adequate health and nutrition practices for children
Revising and Re-Planning the Program The program evaluation will reveal (1) the weaknesses of the interventions in achieving the program objectives, and point to areas that can be revised and strengthened, and (2) highlight what worked well and how those positive outcomes can replicated, and even scale up. The evaluation findings should feed forward into the design of similar, future programs.