A Community Intervention Package of Demandable Services for Improving Care Practices in Antenatal, Labour and Post-Natal Care

Abstract

To improve the quality of care, most interventions concentrate on services and systems strengthening, without a major focus to empower clients as owners of health and agents of change. This research was conducted to explore, develop and evaluate a package of services for improving knowledge and demand for care practices from antenatal to postnatal as one of the means to improve service provision. To explore the package, the researchers used eight FGDs with 64 mothers, KIIs with 12 health workers and four psychologists, and 12 vignettes with 26 mothers and 26 health workers. To evaluate impact, 1,040 mothers were interviewed at intervention and a comparison site. The researchers used Interpretative Phenomenological Analysis to generate themes and Stata 16 to estimate statistical significance of changes in knowledge, demand and service provision. The study showed that empowered clients can contribute to improvements in service provision. Women exposed to the package were 50% more likely to demand a service (RR = 1.5, p<0.001) and service provision was 16.3% higher (38.5% to 51.7%, p= 0.04) at the intervention site. In addition, there were reported positive shifts in individual agency and norms to demand care and increased rapport between women and health workers.