Center for Health Market Innovations (CHMI)

Programs

Scaling Up Home-based Maternal and Postnatal Care

last updated Oct 18, 2011

Overview

Implementing organization: 
Population Council (FRONTIERS program)
Implementation Partner(s): 
Ministry of Health
Legal Status: 
Public-private partnership
Stage: 
Existing/expansion stage
Income Level of Target Population: 
Bottom 20%

Funding

Primary Source of Funding: 
Donor
Additional Source(s) of Funding: 
Donor, Government
Funders: 
United Nations Population Fund ; US Agency for International Development; UNFPA; WHO; DFID-funded Essential Health Services (EHS) and Kenya’s Ministry of Health

Scale

Personnel Employed: 
10-49
Summary: 

The project aims to improve maternal, neonatal and infant health status through increasing the proportion of women delivering with a skilled attendant and receiving essential antenatal, postpartum, newborn care and family planning services.

Program goals/rationale: 

Increasing access to safe delivery and family planning services within rural communities increases the opportunities for women to have positive outcomes for their pregnancies as well as to plan and achieve their desired family size. The Population Council (FRONTIERS program) supported the scale-up of a community-based model that enabled women to give birth safely at home or be referred to a hospital when attended by a self-employed skilled midwife living in the community.

The Council identified an expanded package of safe motherhood services—including postpartum family planning—which is provided by the community midwives with minimal supervision and supply of commodities. Midwives received refresher training on family planning and obstetrics, bicycles to expand their access, and supplies and commodities to encourage home visits. They also received business training to enable them to become self-employed health care providers.

Key program components: 

The project will continue to implement the model through support skills development to maintain quality of care. Professional bodies such as the nursing council, professional associations, and the Ministry of Health need to establish systems to ensure continued professional competency in providing high-quality health care in the community. Such systems could include specified hours for continuous professional development per year that include theory and clinical practice.

  • Support community midwives in achieving financial sustainability: For this model to continue within the public health system, providing a monthly stipend would enable midwives to replenish supplies and allow them to offer services to low-income clients who could not pay full service fees. It is also important to explore developing alternative health financing models that could support the community midwife model, such as the output-based aid (OBA) approach, currently being pilot-tested by the Government of Kenya, or a social franchising model, such as that being undertaken with private midwives in other countries.

  • Strengthen business skills: All community midwives must be provided with basic business skills to enable them to improve their abilities to run the services, regardless of the health financing model through which they are supported. In addition, district health management teams should link with the local offices of micro-finance enterprises to support networks of midwives in developing their business and savings skills.

  • Strengthen and support the links between community midwives and the formal health sector through district health management teams: The community midwife is a potentially important source of information about health status and services at the community level for the health care system. To strengthen links, it is important that appropriate tools for data collection exist in the community, and the MOH would benefit tremendously by developing and providing such tools to collect these data.

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