Five in Planning Strategic C4D Programmes to Prevent Maternal, Newborn and Child Mortality and Morbidity and Undernutrition In of this Guide, we presented a five-step process for developing a C4D strategy for health and nutrition behaviour and social change programmes (Figure 3). Following are the five steps with examples relevant to maternal, newborn, and child health and nutrition promotion and mortality prevention programmes. Figure 3. The Five Steps of the Strategic C4D Planning Model Step 1: Data Collection and Analysis
Who indirectly influences people who are directly affected by maternal, newborn, and child mortality (e.g., ministries and policymakers, education, agriculture, gender and children’s services, culture, religion, and social services)? How should we segment our population(s) of interest and use our resources to address the primary and secondary populations? What is the current level of knowledge, attitudes, perceptions (susceptibility, severity, safety of prevention/treatment methods), and practices (including traditional) for each participant group? What is the degree of readiness to change? What misinformation or rumors exist among your population of interest about MNCHN at the different stages of the life cycle? What are the challenges that people face in trying to implement the desired behaviours? (Prioritize those challenges and categorize by social, economic, political, cultural, physical.) What do the participant groups want to know how to prevent maternal, newborn, and child deaths? or from whom do the participant groups get their information about the problem or similar health issues? Who are the opinion leaders/ influential persons in each of the participant groups with regard to the problem? What communication approaches and channels would be most efficient/effective in reaching the participant group to change KAP, self/collective efficacy, etc.? What are the social and media habits of the intended participants groups? How will the participant groups be involved in developing the interventions to address the problem? statistics data, health services records) Donor reports Primary Sources: Household/community survey Focus group discussion In-depth interviews Social mapping Social network survey SWOT analysis Direct observation Existing Programmes and Policies What current or recent programmes exist that address the problem with your intended participant groups? What are the current policies related to the problem? Secondary Sources: Policy briefings/reports Government reports Donor reports Primary Sources: Inventory of organizations/programmes working in same or related
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 Long distance to a health facility and lack of transport Cost of giving in a facility Health provider attitudes Lack of confidence about 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 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 who feel confident in seeking ANC as soon as they know they are pregnant by (date) Increase by X% the number of women 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 women who report positive provider-client interaction on RH by (date) Increase by X% the number of women
Table 6. Examples of Key Messages for Various Intended Populations along the Continuum of Care. Population Group MNCHN Continuum of Care Pre-Pregnancy Pregnancy Birth/Delivery Postnatal (Mother and Newborn) Infancy/Childhood Adolescents 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 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 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 before handling the baby Support your partner with putting the baby to the breast immediately delivery Know the danger signs for newborns Seek care for newborn danger signs 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 modern family planning methods Know how to provide quality antenatal care including nutrition counseling and supplementation with iron & folic acid Know how to provide essential newborn care practices Know the danger signs in newborns Know how to assess danger signs in newborns and start treatment Know how to provide quality postnatal care (e.g., warming, resuscitation, postnatal visits 2-6 days 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 Promote and support early, exclusive and continued breastfeeding Know how to provide growth monitoring and promotion, vitamin A supplementation, etc. Motivate women/families to immunize their children Know how to recognize danger 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 support all adequate practices) Improved health infrastructure (e.g., cash support for transport to health facility during deliveries, good roads, 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 Community surveillance of pregnant women helps to save mothers and children Provide the resources to support BPCR Promote/Support delivery with skilled attendants Support early and exclusive breastfeeding Support timely essential immunizations for children Support all adequate practices, i.e., Support exclusive and continued breastfeeding 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