Selfcare Summary
Title
Supporting implementation of maternal self-care intervention in South-East Asia Region
Introduction
Self-care in maternal health involves taking proactive steps to maintain physical health, emotional stability, and psychological well-being throughout pregnancy, intrapartum, and postnatal period. With a focus on the importance of self-care in maternal and child health, the following study was done to examine the status of self-care interventions for improving ante-natal, intra-partum, and post-natal care in the South East Asia Region of WHO.
Objectives
The overall goal was to review the status of self-care interventions for improving ante-natal, intrapartum, and post-natal care in countries of the South-East Asia Region of WHO. The specific objectives were:
- Selection of self-care interventions relevant to maternal care on ANC, IPC, and PNC as proposed in WHO recommendations
- Develop an assessment protocol with the proposed methodology
- Review and document the current status of implementation of self-care interventions in Maternal and Reproductive health (MRH) programs for positive pregnancy experience in SEAR Member States.
- Assessment of country readiness to implement self-care interventions in maternal care program and prepare a status report with individual country chapters.
Methodology
WHO recommendations on self-care related to ANC, IPC and PNC were reviewed and selected. Based upon the selected recommendations, anassessment proforma,comprising of three parts, namely, the country profile, policy and strategy related to self-care interventions and their implementationwas developedto assess the status of implementation of self-care interventions in the Southeast Asia Region. The assessment proforma for each country was filled with the help of extensive desk review and subsequently sent to the respective member countries for vetting.
Readiness-criteriato assess and monitor the preparedness level to implement self-care in maternal healthin the member countries on self-care in maternal health policy; level of community empowerment, engagement and participation; government initiatives including social support activities; and the availability and utilization of critical resources i.e. self-testing products and deviceswas developed. Finally, a SWOT analysis was performedto identify the strengths, weaknesses, opportunities, and threats of the countries to gain a comprehensive understanding of the current state of self-care in maternal health and ways to enhance its quality and accessibility.
Results
The study revealed that the implementation of self-care recommendations varies widely across countries. While some countries have made significant progress and demonstrated a satisfactory level of readiness in embracing self-care, others lag behind due to various barriers such as limited healthcare infrastructure, inadequate resources, and lack of awareness and education. Community empowerment was identified as an important area which needs to be strengthened to incorporate self-care in the existing system. By equipping communities with knowledge, skills, resources, and support, individuals can be empowered to actively participate in their own care and make informed decisions that positively impact their health and well-being. The study also helped in identifying the three pillars to strengthen self-care in the community. These include the community health workers (CHW’s), client retained maternal records/ cards and the digital tools to provide awareness. These three pillars help in empowering the community by generating awareness, self-reliance, and confidence.
*3-Fully Present, 2- Partially present, 1- Absent, 0- Data not accessible
*3-Fully Present, 2- Partially present, 1- Absent, 0- Data not accessible
Conclusions: There is a need for incorporating and integrating the self-care interventions in the National policy for maternal health in each country of the region. There is also a need for increased efforts in promoting self-care practices and enhancing their implementation across the region. Also, investment and collaborations are required to strengthen the infrastructure, policies, and mechanisms necessary to support and enable self-care in maternal health. Governments, healthcare professionals, organizations, and individuals must work together to overcome the challenges identified and ensure that self-care becomes an integral part of maternal health. This will in turn help to improve the health outcomes, reduce healthcare costs, and empower women to take charge of their as well as their child’s health and well-being.
PeriNatal Summary
SUMMARY
Title of the Project: To develop a package for self-care during perinatal period to improve maternal and child health as per WHO guidelines (2019)(PO no 202654124)
Introduction
The perinatal period is critical for the health of the mother and her baby. Implementing good perinatal care can reduce the risk of complications during pregnancy, promotes foetal health and development, minimize complications in infants, and reduce the risk of maternal and neonatal tetanus. Self-care interventions are important for empowering mothers and families to take care of themselves and the community healthcare providers to promote health. Strengthening self-care during this critical period through innovative approaches is essential for improving maternal and child health and reducing healthcare costs imposed on healthcare system. Further, the Covid-19 pandemic highlighted the importance of self-care and the need for innovative approaches such as mobile health and telemedicine to supplement healthcare services.
Objectives
- To undertake need assessment for self-care during pregnancy and postnatal period.
- To develop a draft package on self-care during perinatal period based on WHO guidelines. The package will include audios with key messages, text messages and frequently asked questions (FAQs) to address common concerns and promote self-care.
- To field test the package using different social media platforms for delivery of the self-care messages.
Methodology and Results
Staff members were hired and oriented about the project. ASHA workers played an essential role in providing information on pregnancy and childbirth. This data was then utilized to identify and recruit individuals from the target population who possessed smartphones with internet connectivity. Verbal consent was obtained from all participants before proceeding with the project.
To conduct a comprehensive needs assessment, thematic discussions were conducted within WhatsApp groups that were specifically created for this purpose. The topics of these discussions revolved around self-care and care-seeking during pregnancy. Additionally, telephonic interviews were conducted to gather further insights. This combination of methods allowed for a thorough assessment of the needs of the target population.
Based on the findings from the needs assessment and a review of existing literature, a package of resources was developed. This package consisted of:
- 103 frequently asked questions (available in both English and Hindi),
- 33 text-based audio scripts (in English and Hindi),
- 33 audio recordings in Hindi (ranging from 4 to 9 minutes), and
- 30 topics covered in an illustrated guide (available in English and Hindi).
The package was delivered to participants through WhatsApp chats, and 40 thematic discussions were held specifically focused on selected frequently asked questions.During these 40 thematic discussions, a considerable amount of engagement was observed. A total of 641 responses were received regarding topics related to pregnancy, with response numbers varying between 17 to 48. Additionally, 407 responses were received regarding postnatal care, with response numbers ranging between 12 to 29.
To further support the self-care efforts of the participants during the pregnancy, delivery, and postnatal period, a total of 17 Zoom meetings were held over a period of two-months. These meetings had a strong attendance rate, with participant numbers ranging between 23 to 43 individuals. Each meeting lasted between 40 to 57 minutes and included the playing of an audio recording, followed by thorough discussions on the questions and experiences shared by participants. The participants then had the opportunity to share their experiences from the Zoom meetings within the WhatsApp groups. The project received a total of 251 endorsements from participants, indicating the positive impact it had on their experiences.
Conclusions
The feasibility of a multimedia phone package, consisting of FAQs, audios, and an illustrated guide, delivered through WhatsApp chats, thematic discussions, and Zoom meetings during the perinatal period, was successfully demonstrated. This innovative approach has the potential to be applicable even during pandemic emergencies like COVID-19. This study helped to address existing gaps in perinatal care, i.e. inadequate contacts with the health system specifically during COVID-19. The utilization of Zoom meetings revealed promising opportunities for direct communication with beneficiaries and has the potential to greatly improve the quality of perinatal care through increased self-care. Furthermore, the application of this multimedia package proved to be feasible as well as cost-effective. However, the issue of equity remains challenging, as families without access to a smartphone with internet connectivity had to be excluded.
Way forward
It is recommended that efforts be made to promote self-care and strengthen perinatal care through the utilization of such innovative tools. Moreover, further work is necessary to ensure local adaptation in accordance with national health policies.
ES Development of Guide on Safe Abortion
To develop “A Guide for Frontline health workers to support Individual’s Self Care in Sexual and Reproductive health”
Self-care is the ability of individuals, families and communities to promote health, prevent disease, maintain health, and cope with illness and disability. To support evidence-based self-care practices by individuals and families, the front-line health workers/Community health workers need to be well-equipped to provide reliable evidence-based information. An attempt was made by SWACH in the form an Illustrated guide in 2022 to help Community health workers to generate awareness in the community on self-care in relation to safe abortion. Under this project, SWACH revised the illustrated guide developed in 2022 as per the latest guidelines of WHO on Self-care in relation to safe abortion and family planning including Decision Making Tool (DMT) on family planning. In addition, a pictorial booklet was also developed for community on the same theme.
The study was conducted between 10.04.2023 and 09.08.2023 over a period of 4 months with funding from WHO with the following specific objectives:
- To develop an illustrated guide for the front-line health workers/community health workers on safe abortion, post-abortion care and contraception.
- To develop a handbook/booklet for the women with information on self-care with pictures.
The development of the Illustrated guide and the Pictorial booklet was done as follows:
- The draft of the Illustrated guide prepared by SWACH in 2022 was reviewed and updated in light of the “WHO guidelines on self-care interventions for health and well-being, 2022 revision” and other guidelines of WHO on abortion and family planning including “Decision Making Tool (DMT) for family planning clients and providers, 2023.”
- The text was supported by corresponding illustrations. It was ensured that the illustrations are simple, clear, culture neutral and representative of South East Asian region of WHO.
- The drafts of the illustrated guide and pictorial booklet were then shared with the WHO office for feedback. Virtual meetings were held thrice to discuss the drafts and receive the inputs of WHO.
- The draft was revised in light of inputs of WHO office and field test with 30 community health workers and 30 women from the community.
The study resulted in development of two documents:
1. Illustrated guide for Community health workers/volunteers:: It is a flipbook. One side of the flipbook is for the reference of the CHW/CHV and contains text and the other side is for the community and have corresponding illustrations. The Community health workers/volunteers can use the Illustrated guide to counsel the women in the community either in group sessions or individual counselling.
2. Pictorial Booklet for the community: It is a small booklet prepared on the basis of the illustrated guide. It contains mainly illustrations with only relevant text so that it is simple enough to be understood by the women and families. The Community Health Worker can distribute the pictorial booklet to the women in the community after taking the counselling session. This booklet can be kept by women with them for future reference.
Content of the two documents:
Section: Introduction (only in illustrated guide)
- Instructions to use the illustrated guide
- Guiding principles for counselling
Section A: Safe Abortion/span>
- Self-testing of pregnancy
- Estimating duration of pregnancy
- Spontaneous abortion
- Self-care during spontaneous abortion
- Intra-uterine fetal demise
- Induced abortion and their legal aspects
- Medical abortion
- Abortion of pregnancy less than 12 weeks
- Abortion of pregnancy more than 12 weeks
- Harms of traditional practices for abortion
- Myths and facts about abortion
Section B: Post Abortion Care
- Danger signs during abortion and post-abortion
- Self-care during post-abortion period
- Restoration of physical health
- Restoration of reproductive health
- Restoration on mental health
Section C: Post abortion Family planning
- Importance of post-abortion contraception
- Choice of contraceptive method
- Condoms
- Contraceptive pills
- Injectable contraceptives
- Intrauterine devices
- Emergency contraception
ES Developing awareness package on safe abortion
Developing awareness package on self-care- Abortion, post abortion care and Contraception
World Health Organization (WHO) has provided a framework of self care interventions for health. Based on these a need assessment and a feasibility study was conducted by Foundation for Survival for Women and Children (SWACH) to understand the awareness of the women regarding Medical Termination of Pregnancy. The target audiences were women in pre-conception and peri-conception period and it was concluded that there were gaps in the knowledge of the women regarding abortion laws, risks and complications of pregnancy, restoring health after undergoing abortion and prevention and control of sexually transmitted infections (STIs). Keeping in mind that a lot of scope exists for Self care interventions in managing abortions, post abortion complications and contraception, SWACH planned another study with the following goal and objectives:
Goal
To develop and check the feasibility of implementation of an awareness package on self-care relating to abortion, post abortion complications and contraception.
Objectives
- To develop a package for awareness generation in the community regarding self care in relation to abortion, post abortion complications and contraception by frontline health workers based on guidelines of WHO.
- To check the feasibility of the implementation of the package in raising awareness in the community about self care in managing abortion, post abortion complications and contraception.
The study was conducted over a period of five months (May to Sept 2022). The implementation part of the study was conducted in the rural areas of the state of Haryana in north India.
Development of the awareness package
The process of development of the awareness package began with the brainstorming exercise to define the key areas to be included in it. During the brainstorming exercise, learning of SWACH from its previous studies which included a Need Assessment study was reviewed. After the review four key areas were finalized- Safe abortion, Post abortion care, Contraception and Prevention of STI-HIV. Self care interventions and awareness messages to promote good health and prevention of the complications related to the key areas were then enlisted based on the Guidelines of WHO on Self Care for promoting Sexual and Reproductive Health and other guidelines related to safe abortion, contraception and sexually transmitted diseases. The awareness package which consisted of an Illustrated Guide and audio-visuals was developed.
Feasibility of the awareness package
To check the feasibility of implementation of the awareness package- the illustrated guide and the audio-visuals, awareness courses were organized within the community. The local language (Hindi) versions of both the illustrated guide and audio-visuals were created to use as tools for conducting the courses. Each course consisted of four sessions, one each on Safe abortion, post-abortion complications, contraception and prevention of STI-HIV. Only one session was conducted per day. The participants were literate females of the age group 25-40 from the study area. Courses were conducted in two settings - onsite and online. The results were as follows:
- Awareness package was developed in the form of an illustrated guide and four audiovisuals for the use of frontline health workers. Both cover interventions and awareness messages for self care to be adopted by community to maintain good health and prevent complications related to abortion, post-abortion care, contraception and sexually transmitted infections.
- A total of 41 awareness courses, 36 on-site and 5 on-line, were organized successfully in the study area. Participants were literate females of the age group 25-40.
- The overall percentage gain in the knowledge level of the participants (community females) related to the issues of safe abortion, post abortion care, contraception and sexually transmitted diseases after attending the full course was 32.0% in case of onsite courses and 61.5% in case of online courses.
- The overall percentage gain in the knowledge level of the frontline health workers related to the subjects taught in the training was 30.4%.
- Findings of the focus groups revealed a change in the attitude of community towards practices and beliefs related to abortion.
The following were concluded from the study
An illustrated guide supported by audio-visual presentations on abortion, post abortion complications, contraception and STI-HIV has been prepared and field tested with frontline health workers.
- The package was implemented in onsite and online settings in rural and semi-urban community.
- There was a significant improvement in knowledge of women 20-35 years of age in each of the four domains. These improvements were significant in frontline health workers also.
- Experience with training of frontline health workers shows a need for improvement in cascade model training.
- The experience with online capacity building provides optimism for their application amongst communities and frontline health worker where smart phone possession is high and internet connectivity is good.
- Experience with focus group discussion has provided insights in the improvement in attitude and removal of myths and misconceptions in the areas of abortion, post abortion care, contraception and STI-HIV.
- Experience of the study shows promising findings in opening the potential for the application of mobile technology as a complimentary strategy to sustain information on self care related to abortion and its complications.