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      Explaining the impact of a women's group led community mobilisation intervention on maternal and newborn health outcomes: the Ekjut trial process evaluation.

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          Few large and rigorous evaluations of participatory interventions systematically describe their context and implementation, or attempt to explain the mechanisms behind their impact. This study reports process evaluation data from the Ekjut cluster-randomised controlled trial of a participatory learning and action cycle with women's groups to improve maternal and newborn health outcomes in Jharkhand and Orissa, eastern India (2005-2008). The study demonstrated a 45% reduction in neonatal mortality in the last two years of the intervention, largely driven by improvements in safe practices for home deliveries.

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          Effect of community-based behaviour change management on neonatal mortality in Shivgarh, Uttar Pradesh, India: a cluster-randomised controlled trial.

          Vishwajeet Kumar, Saroj Mohanty, Aarti Kumar … (2008)
          In rural India, most births take place in the home, where high-risk care practices are common. We developed an intervention of behaviour change management, with a focus on prevention of hypothermia, aimed at modifying practices and reducing neonatal mortality. We did a cluster-randomised controlled efficacy trial in Shivgarh, a rural area in Uttar Pradesh. 39 village administrative units (population 104,123) were allocated to one of three groups: a control group, which received the usual services of governmental and non-governmental organisations in the area; an intervention group, which received a preventive package of interventions for essential newborn care (birth preparedness, clean delivery and cord care, thermal care [including skin-to-skin care], breastfeeding promotion, and danger sign recognition); or another intervention group, which received the package of essential newborn care plus use of a liquid crystal hypothermia indicator (ThermoSpot). In the intervention clusters, community health workers delivered the packages via collective meetings and two antenatal and two postnatal household visitations. Outcome measures included changes in newborn-care practices and neonatal mortality rate compared with the control group. Analysis was by intention to treat. This study is registered as International Standard Randomised Control Trial, number NCT00198653. Improvements in birth preparedness, hygienic delivery, thermal care (including skin-to-skin care), umbilical cord care, skin care, and breastfeeding were seen in intervention arms. There was little change in care-seeking. Compared with controls, neonatal mortality rate was reduced by 54% in the essential newborn-care intervention (rate ratio 0.46 [95% CI 0.35-0.60], p<0.0001) and by 52% in the essential newborn care plus ThermoSpot arm (0.48 [95% CI 0.35-0.66], p<0.0001). A socioculturally contextualised, community-based intervention, targeted at high-risk newborn-care practices, can lead to substantial behavioural modification and reduction in neonatal mortality. This approach can be applied to behaviour change along the continuum of care, harmonise vertical interventions, and build community capacity for sustained development. USAID and Save the Children-US through a grant from the Bill & Melinda Gates Foundation.
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            Alma-Ata 30 years on: revolutionary, relevant, and time to revitalise.

            Joy E. Lawn, Jon Rohde, Susan B. Rifkin … (2008)
            In this paper, we revisit the revolutionary principles-equity, social justice, and health for all; community participation; health promotion; appropriate use of resources; and intersectoral action-raised by the 1978 Alma-Ata Declaration, a historic event for health and primary health care. Old health challenges remain and new priorities have emerged (eg, HIV/AIDS, chronic diseases, and mental health), ensuring that the tenets of Alma-Ata remain relevant. We examine 30 years of changes in global policy to identify the lessons learned that are of relevance today, particularly for accelerated scale-up of primary health-care services necessary to achieve the Millennium Development Goals, the modern iteration of the "health for all" goals. Health has moved from under-investment, to single disease focus, and now to increased funding and multiple new initiatives. For primary health care, the debate of the past two decades focused on selective (or vertical) versus comprehensive (horizontal) delivery, but is now shifting towards combining the strengths of both approaches in health systems. Debates of community versus facility-based health care are starting to shift towards building integrated health systems. Achievement of high and equitable coverage of integrated primary health-care services requires consistent political and financial commitment, incremental implementation based on local epidemiology, use of data to direct priorities and assess progress, especially at district level, and effective linkages with communities and non-health sectors. Community participation and intersectoral engagement seem to be the weakest strands in primary health care. Burgeoning task lists for primary health-care workers require long-term human resource planning and better training and supportive supervision. Essential drugs policies have made an important contribution to primary health care, but other appropriate technology lags behind. Revitalisng Alma-Ata and learning from three decades of experience is crucial to reach the ambitious goal of health for all in all countries, both rich and poor.
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              Process evaluation for community participation.

              Frances Dunn Butterfoss (2005)
              This review provides a synthesis of published public health and social science literature to determine how process evaluation has been used to examine community participation and its intermediary role in health and social change outcomes. Community participation is defined, and its relationship to other community-development principles and evaluation and research methods is described. Then, case studies and research initiatives help answer questions such as who participates and why? What are the benefits and challenges of community participation? What qualitative and quantitative methods are used in process evaluations to measure community participation? What measures are used to help define the influence of community participation in community-based interventions? A better understanding of these issues is needed to ensure that community participation is valued and used effectively to plan and implement health-promotion initiatives and evaluate their processes and outcomes.
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                Author and article information

                Journal
                Journal ID (iso-abbrev): BMC Int Health Hum Rights
                Title: BMC international health and human rights
                Publisher: Springer Science and Business Media LLC
                ISSN (Electronic): 1472-698X
                ISSN (Print): 1472-698X
                Publication date (Electronic): Oct 22 2010
                Volume: 10
                Affiliations
                [1 ] UCL Centre for International Health and Development, Institute of Child Health, University College London, 30 Guilford Street, London WC1N 1EH, UK. audrey.prost@ucl.ac.uk.
                Article
                Publisher Item ID: 1472-698X-10-25
                DOI: 10.1186/1472-698X-10-25
                PMC ID: 2987759
                PubMed ID: 20969787
                SO-VID: c9d8bfa9-8dcf-4d7f-b080-5c8865f69ace
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