An intrapartum care strategy with two distribution points model: The right move to improve provision and use of maternal health care in underserved and poor areas

Limited access to maternal and neonatal health care is one of the most critical public health issues globally and in the Americas. CCF  in partnership with MOH-District level and communities implemented a community-based service delivery strategy to address obstetric and neonatal health care in rural communities of Bolivia, Honduras, and Guatemala. The intra-partum strategy consisted of provision of an evidence-based intervention package to women in labor and newborns via two distribution points: a community-based distribution point (care administered during home births by a trained traditional birth attendant) and an institutional distribution point (care administered during birth by professional health care personnel).

A quantitative descriptive transversal study was conducted with a sample design using “Lot Quality Assurance Sampling” (LQAS) method, in 2006 and 2008. The universe included women of reproductive age with children under the age of 12 months, who were interviewed with closed questions about prenatal care, care during childbirth, postnatal care. A total of 171 interviews in Honduras, 95 in Guatemala and 76 in Bolivia were conducted.

Overall danger signs knowledge rose by 38 percentage points. Thus, knowledge of danger signs during pregnancy rose from 5% to 46%, during childbirth from 5% to 34%, and danger signs in the newborn from 3% to 33%. Access to care during childbirth by professional health care providers increased by an average of 18 percentage points (equivalent to an 86% increase), while access to postpartum care increased by 45 percentage points (equivalent to a 450% increase). The average improvement in quality of care was 27 percentage points.   An impact measurement model (Impact Calculator: Child Health Epidemiology Reference Group) on neonatal mortality showed that neonatal mortality had decreased by 31.3% in Guatemala, 16% in Bolivia, and 12.5% in Honduras.

A community-based intra-partum care strategy must likely increases the chances of maternal and newborn survival