Integrating Innovations Towards Improved Maternal and Newborn Health in Rural Lesotho

The Trustees of Columbia University in the City of New York
Organization Location: 
New York, NY USA

No single intervention can effectively address the maternal and neonatal health crisis in Lesotho, given the complexity of structural barriers to care; the low demand for services for maternal and neonatal health (MNH) and their low quality; and the unrelenting HIV epidemic. Thus, we propose an innovative combination approach that bundles evidence-based MNH and HIV interventions with incentives for participating individuals and health facilities based on all-or-none accomplishment. The combination of interventions includes 1) a simple mother–newborn safety checklist to be completed by an integrated team comprising pregnant women, community health workers (CHW), and health facility providers; 2) noncash incentives; 3) use of mobile technology for telemedicine and emergency communication; and 4) up referral (with transport, if necessary) of high-risk pregnant women to the district hospital and maternity waiting homes. In addition to being evidence-based, each intervention addresses key reasons reported by Lesotho women for not accessing MNH services and, when combined, has the potential to have a synergistic impact on MNH. We will evaluate the approach’s feasibility and effectiveness at Mount Tabor and Litsoeneng health centers, in Mafeteng District. Success will be determined as >50% of mother–newborn pairs achieving the completed checklist and an increase of >50% utilization of facility-based MNH appointments (including antenatal, delivery, and postnatal care). The government of Lesotho has expressed interest in supporting efforts to scale up this combination intervention if it is proven feasible and effective.