adapting hblss to fit your program_stalls_5.11.11
TRANSCRIPT
HBLSS:An Overview of Methodology and
Applications
Pathway to Survival
Problem
Recognizing
Problem
Receiving First
Aid Care
Deciding to Seek
Care
Reaching
Care
Receiving
Quality EmOC
Survival
Family & Community Referral
Site
Source: Adapted from MotherCare 1995.
Home-Based Life-Saving Skills
• A family-focused community mobilization program that aims to:– Improve problem recognition and first aid response to
maternal and newborn complications– Increase timely access to EmONC (where available)
• Draws heavily upon the WARMI methodology which has demonstrated significant reduction in perinatal mortality, but HBLSS also includes first aid care
HBLSS Essential Elements
• Low-tech and sustainable
• Skills-based, participatory
• Designed for non- or low-literate participants
• Uses a step-wise process that works towards safe, acceptable practices that will be used when needed
• Can be used for any community issue (e.g., water & sanitation, TB, malaria)
Unique Characteristics• Multiple subtle cues set the stage for collaboration
and respect for all types of knowing• Content repeated multiple times in multiple ways
to enhance retention: hear, see, and do• Key facilitation skills build bridges between what
community knows and what “advisors” know • Behaviors/actions are agreed upon as response
to problem recognition• Facilitator is able to negotiate with community
members to incorporate actions that the community wishes to continue
HBLSS Methodology• Clinically simple content with exacting process• Series of facilitated community meetings to
discuss individual topics– Women problems: Too much bleeding, birth delay
sickness with pain and fever, swelling and fits, too many children
– Baby problems: Trouble breathing at birth, baby too small, baby is sick
– Preventing problems: self-care, family planning (LAM), PMTCT
– Referral• Communities prioritize which topics they view as
the most important and common problems
Applying HBLSS Methodology
• Process can be adapted to any area of health: pediatrics, primary care, adult care or any particular disease process such as HIV/AIDS, avian flu, diabetes
• Recently adapted to curriculum of Africa Centre for Holistic Management, an organization in Zimbabwe dedicated to land restoration in semi-arid/arid climates. Africare and Land o’Lakes (Africa) interested in using
methodology for similar community programs. • Use of methodology is crucial to adaptation of new
approaches and behaviors
• Whoever will be present at the time of birth • Pregnant women
• Family caregivers
• Birth attendants
• Community leaders
• Referral facility staff
Who Participates?
Step 1: Review the previous meeting
Step 2: Ask what participants know and do when they see particular problems
Step 3: Share what trained health workers know and do when they see those problems
Step 4: Come to agree on what to do: negotiation
Step 5: Practice the (agreed) actions
Step 6: Discuss how to know if the actions are helpful
Step 7: Decide how to prevent the problem
Interactive Community Meetings
Problem Side Action Side
Take Action CardBleeding Too Much After Baby is Born
Focus group comments• “In the past we sat and watched with
an emergency, now we can seek help.”
• “We are happy that HHF is working here, women are not dying, and we are proud to be so knowledgeable.”
• “When women used to bleed, we used to stick things inside, now we know to take the road to the hospital.”
• “I used the Take Action Card booklet with women who did not attend the training and they understand.”
• “Now we know what to do when a baby is not breathing. It has shone light on us.”
• “We hope to never tell Regine’s story again.”
Evidence to date
• Community members are able to retain information following the training– Enhancing problem recognition
• Community members who are exposed to HBLSS are more likely to take action to:– Provide first aid to respond to a complication– Refer women to a facility
• Community is supportive and actively engaged in MNH issues
Program presentations
• Integration into existing programs
• Lessons learned
• Adaptations
• Challenges
• Costs
• Recommendations
• Surprises