Household-to-Hospital Continuum of Maternal and Newborn Care

This policy brief outlines an approach to essential maternal and newborn care (EMNC) called household-to-hospital continuum of care (HHCC). Developed by the Access to Clinical and Community Maternal, Neonatal and Women's Health Services (ACCESS) Program, HHCC promotes evidence-based practices and addresses the enabling environment factors that affect care-seeking behaviours in the community. This integrated approach encourages communities and health care providers to work together to provide appropriate and timely care for women and newborns. It has been developed as a response to the fact that, according to ACCESS, every year more than 529,000 women die as a result of pregnancy and childbirth, and 4 million newborns die within the first 28 days of life. The premise is that meeting the Millennium Development Goals (MDGs) of reducing maternal mortality by three-quarters and child mortality by two-thirds by 2015 will require a comprehensive community-based strategy.

The resource outlines the HHCC strategy, beginning with the development of the community-based care component, a process that must include the participation of the full range of community leaders (e.g., political, educational, and religious leaders), as well as health caregivers and non-governmental organisation (NGO) partners. Together, participants identify evidence-based best practices for maternal and newborn health and develop a plan to implement these practices - starting at the household level, where behaviour change communication (BCC) strategies can be used to introduce EMNC practices to pregnant women and family members. Community-based caregivers, such as community health workers (CHWs), traditional birth attendants (TBAs), and others, who are trained to work with families and who are equipped with knowledge about danger signs and core first aid skills, are also key participants in HHCC. Community mobilisation and social mobilisation are other crucial steps in developing community ownership, which is fostered by engaging those most affected to plan and carry out appropriate health actions.

The next section of the policy brief explores strategies for linking the community to the facility, at the heart of which is the development of multisectoral partnerships at the district, provincial, and national levels, as well as alliances among local leaders, NGOs, and other stakeholders. Health care providers also have a role to play, by reaching out to communities and informing women about the available health services. In fact, HHCC stresses efforts to strengthen the capacity of caregivers - whether in households, the community, peripheral health facilities, or hospitals - to manage normal maternal and newborn care, prevent and manage maternal and newborn complications, and provide prompt referrals. In this context, the document also explores implementation of EMNC at peripheral and district facilities.

Next, the resource examines in detail the process for building a successful HHCC, offering a 2-page, multicolumn table to illustrate the key activities for each component. In outline form, these components include:

• Planning and defining success at the community level - emphasises a participatory approach
• Improving the skills of caregivers - supporting and facilitating partnerships among facility-based service providers and community leaders, non-ministry of health (MOH) health staff, donors, and NGOs, is fundamental
• Creating an enabling environment - families, community and facility health workers, community groups and leaders, policymakers, programme managers, and donors must work together
• Ensuring quality care - quality and sustainability of health services is created through building alliances, coordinating activities, and joint oversight
• Committing resources - a strong coalition of MOHs as well as other government agencies and officials, NGOs, and stakeholders is crucial here

The ACCESS Program is the U.S. Agency for International Development (USAID)'s global programme to improve maternal and child health. JHPIEGO implements ACCESS in partnership with Save the Children, the Futures Group, the Academy for Educational Development, the American College of Nurse-Midwives, and Interchurch Medical Assistance.