• Maketwohomevisitstopregnantwomenandthreehomevisitstonewlydeliveredmothersinthefirstweekafterbirth topromoteandsupporteffectivematernalandnewborncare

• Identifymothersornewborndangersignsandreferusinga referral formand/orescort themotherorcaregiver

• Conducttwomorevisitsforlowbirthweightbabiesto promote care including skin to skin/kangaroomothercare

WHAT LESSONS HAVE SO FAR BEEN LEARNT?• Conducting trainings closer to home in the

communityisfeasibleandpreferredbyCHWs• Manystakeholdersneed tobesensitizedprior to

programintroduction• Demand side issues (Quality of facility care)

predominateCHWwork• Training CHWs with health workers good for

referrals,linkagesandsubsequentsupervisions• CHWs need to be commissioned immediately

after training and provided with all logistics andmotivation

• Registeringwomenofchildbearingageisimportantforidentificationofearlypregnancy

WHAT CAN UNEST CONTRIBUTE AT THIS STAGE TOWARDS SCALE UP OF NEWBORN CARE?

• Expertise–wehaveapoolofexperiencednationalanddistricttrainersforCHWs

• Materials–wehaveimprovedandtestedmanualsforCHWstrainingandsupervision

• Advocacy video documentary – Togetherwith stakeholders, UNEST developed a videodocumentary which highlights newborn care inUgandawithpolicyandimplementationchallengesandopportunities

Integrating Community Health Workers in Maternal/Newborn Programming in Uganda

UGANDA NEWBORN SURVIVAL STUDY (UNEST)

FOR FURTHER INFORMATION, CONTACTGeorge Pariyo, The Principal Investigator, UNEST and Assoc. Prof, Makerere University School of Public Health

Email:gpariyo@musph.ac.ug, Tel. 00256414530291Dr. Peter Waiswa, Co-PI and Study Coordinator, UNEST

Email:pwaiswa@musph.ac.ug / pwaiswa2001@yahoo.comTel. 00256772405357

WHAT HEALTH FACILITY STRENGTHENING IS DONE?Health facility strengthening is evolving as we learnwhattodo.Sofarwehavedonethefollowingthroughthedistrictsystem:

• Qualityofcare formaternalandnewborncare inhealthfacilitiesthroughjointproblemidentificationandplanning,traininginbasicandemergencecareincluding newborn resuscitation and care of thesicknewborn.

• Training is through a 5 day course focusing onmaternal,newborncareandaudit (bothmaternaland perinatal). The course is skills based andaddresses the leading killers of mothers andnewbornbabies.

• Support to health facilities in form of basicequipment,drugsandsupplies

What is UNEST?

2. Health facility strengthening aimed at improvingqualityofcareformothersandnewbornbabies

3. Improved linkage between the community andhealthfacilities

EXPECTED POLICY RELEVANT OUTPUTSWehopethatbytheendofthisstudy,wewillhavethefollowingkeyoutputs:• ProgramreadyTrainingandBCCpackagefor

CHWsinmaternalandnewbornhealth

• Costbenefitanalysisofcommunityhealthworkerpackage

• Apackageofhowtostrengthenpublichealthfacilitiesandtheeffectofthisonmaternalandnewbornoutcomes(Healthfacilitystrengtheningcomponent).

• Adocumentationofcontextinwhichtheinterventionworksordoesn’twork

• Peerreviewedpublicationsandotherinformationleaflets

COMMUNITY HEALTH WORKERS SELECTION, TRAINING, SUPPORT AND SUPERVISION• Selection - Selection based on the Uganda

villagehealthteam(VHT)approach–Districtled,community participation, volunteers, resident insaidvillage,someliteracy,andgenderequality

• Training - Non-residential close to home, skillsbasedtrainingwithparticipationofhealthworkersfrom the nearby villages. Focus is on key familycare practices, problem solving, communitymobilization,referral,andmanagementofrecordsandsupplies.

• Supervision – Handed to local leaders andhealth workers. Technical supervision monthlyalongdistricthealthsystemstructuresbyspecially

trained health workers for CHW supervision. Inaddition,regularmeetingsofCHWsareorganizedwithhealthworkers.A“super”CHWateachparishlinksCHWsandhealthworkers.

• Support and motivation– Graduate with acertificate,facilitatedwithabasicpackageincludingademonstrationmamakit,BCCmaterials,andasmalltransportrefundduringmonthlymeetings.

WHAT IS THE AIM OF UNEST?Makerere University School of Public Health withsupportfromtheSavingNewbornLivesProjectofSavethe Children (USA), through a grant from Bill GatesFoundationisconductingaclusterrandomisedstudyinthe Iganga/MayugeHealthDemographicSurveillanceSite (HDSS) in Iganga and Mayuge Districts. Theaim of UNEST is to develop and cost an integratedmaternal-newborncarepackagethatlinkscommunityandfacilitycareandevaluateitseffectonmaternalandneonataloutcomesinordertoinformpolicyandscaleupinUganda

THE RATIONALE OF UNEST• Many Sub-Saharan Africa countries including

Uganda are off track to achieve the MillenniumDevelopment Goal four (Child survival), mainlybecauseneonatalmortalityhasnotreduced.

• Globally, an estimated 4 million babies eachyear, 98% in developing countries. In Uganda,anestimated45,000neonataldeathsand45,100stillbirthsoccurperyearofwhich15-32%(31,800)couldbesavedbysimple interventionsproventowork(LawnJE,KerberK,eds.,2006).

• TheNationalHealthSectorStrategicPlanprioritisesnewbornhealth,initiallytocomplimentcurrentcarewithcommunityinterventions.Ouraimistoprovidealearningexperienceforoperationalisingthepolicyintonationalprogrammingandscaleup.

WHAT ARE THE KEY UNEST COMPONENTS?Theseareevidencebasedandwereagreedonafteraconsultativeprocesswithpolicymakers, expertsandimplementers,andinclude:1. Community based intervention by community

healthworkerstrainedtomake2pregnancyand3postnatalvisitsinthefirstweekafterbirth.

Community sensitization and CHW selection

Training of CHWs: commissioning

ROLES OF A COMMUNITY HEALTH WORKER • Each CHW is responsible for about 100—150

householdsandregistersallwomeninchildbearingage,pregnantandnewlydeliveredmothers