Joyce*, a healthy mother, glows as she admires her new baby. Her husband collects her belongings as she prepares to leave Jacaranda Maternity, and she hugs the community health worker who provided her discharge education: “See you in a few days,” she says. Most health care providers in Kenya – or across the developing world –would schedule a new mother’s six week postnatal visit, hope she returns for it, and call it a day. Jacaranda thinks otherwise.
In the past decade there have been significant resources invested in pre-natal healthcare in resource-poor settings: expectant women are encouraged to attend four antenatal care visits, receive nutrition training, and are linked to malaria and HIV treatment. However, we have all too often ignored the most vulnerable part of the maternity experience: The postnatal period. Approximately 75% of neonatal deaths occur in the first week after delivery and in Kenya alone, 31 newborn deaths occur per 1,000 live births.
It’s not as if the evidence for how to close this gap is lacking: Research from countries like Bangladesh, Ghana, Nepal and Malawi has shown that community-based early postpartum care in the first week after delivery has great potential to increase newborn survival and reduce death. Contact with trained health workers can improve early initiation of breastfeeding, thermal care, infection prevention and clean umbilical cord care – all practices that can save newborn’s lives. However, there are still too many babies dying in the few days after birth, and new mothers often find it difficult – if not impossible – to recognize danger signs when she takes her new baby home. If we can get hands-on education and care to women in the critical first few days after delivery, we can cut down on delays in seeking care and reduce the risk of newborn death.
Jacaranda Health is working to close this gap. Through a partnership with Saving Lives at Birth and building on a previous collaboration with Population Council’s BabyMonitor project, we are employing community health workers (CHWs) to bring community-based early postnatal care and education to new mothers. Under this initiative, CHWs go to the homes of new mothers to conduct newborn screening assessments and circumvent risk. The CHWs are equipped with an evidence-based checklist, developed with guidance from the World Health Organization and UNICEF. The checklist is designed to ensure a safe transition home, and guides the CHW to assess the newborn’s health, identify danger signs like infection and jaundice, and reinforce targeted health education. If the CHW identifies a complication on this home visit, she will provide a quick referral to a health facility for curative care. Our CHWs maintain a direct link to facility-based Jacaranda midwives, which helps to ensure consistent quality of home-based care and provide decision-support for the CHWs.
In addition to home visits, we’re also leveraging the fact that 85% of Nairobi-dwellers have mobile phones and administering the postnatal checklist assessment over the phone. By pairing the phone assessment with SMS-based postnatal health messaging, we’re exploring the many ways to reach mothers where they are.
We’re hopeful that by investing in postnatal care in targeted and innovative ways, we can equip mothers and caregivers with vital health information to increase safe practices like hand hygiene, thermal care, and breastfeeding. Beginning with CHWs and a checklist, Jacaranda is taking strides to ensure that others like Joyce and her baby don’t fall through the cracks in the critical few days after delivery.
*Name changed for privacy