Scaling up an integrated intervention package
Deaths from PPH, eclampsia, infection and obstructed labour are the major obstacles in achieving MDG5; and infection, birth asphyxia and low-birth weight are for MDG4 in resource poor countries in Asia and Africa. These deaths are preventable, but, treatments along with functional health system are not always available and accessible in these countries. However, low-cost evidence-based solutions implementable at community level are available to prevent mortality from these causes. Packaging selected evidence-based interventions and delivering through skilled community providers supported by CEmOC facilities could be an alternative for resource poor settings. ICDDR,B, in collaboration with government and NGOs tested a package of evidence- based interventions in one sub-district in Bangladesh. The package included ensuring skilled attendance at delivery through public private partnership (PPP), identification and immediate management of PPH before referral (blood measuring mat and Oxytocin/Misoprostol), Magnesium sulphate for controlling eclamptic fits, use of CDK, mobile phone communication system for complication management and referral, home based essential newborn care, and community support group for awareness and referral. Evaluation after one year showed promising results in increased skilled delivery attendance from 26% to 42%, increased met need for obstetric complications from 18% to 41%, reduced neonatal mortality from 32 to 22 per 1000 live births and improved quality of care. This study proposes to scale up the integrated maternal and neonatal intervention package at community level through PPP in a larger population to reduce severe maternal and neonatal outcomes (near-miss cases and deaths), the major obstacles in achieving MDG 4 and 5.