MCHIP/Egypt: Community-based SBC and Gender Interventions for Maternal, Newborn and Child Health

Angie Brasington, Community Health and Social Change Advisor, MCHIP/Save the Children on behalf of MCHIP/Egypt team, especially:Dr. Issam El Adawi, Chief of PartySamah Said Helmy, Gender Advisor

MCHIP/Egypt Context

2-year funding to address high rates of malnutrition and newborn mortality

Atmosphere of political turmoil, rise in religious conservatism.

Unable to work with Ministry of Health (post revolution)

Deep experience working with local Community Development Associations (CDAs)

BUT, CDAs from the neediest places had limited experience, especially in MNCH-focused programming.

Start-up - November 2011Community-based Implementation starts – November 2012CB-implementation ends – Nov/Dec 2013Endline survey – Jan/Feb 2014

1 Umbrella CDA / District

5-10 Local CDAs / Umbrella CDA

12 CHWs / Local CDA (Total ~1,200 CHWs)

6 Governorates

12 Districts(2 per Governorate)

Egypt

120 Villages(1 Village /CDA = ~15-20,000 pop)

Target Population = 2,041,725Pregnant Women = 57,168

U2 = 112,295Newborn = 51,043

Maternal Nutrition and

Birth Preparedness

Newborn Health

Child Spacing

Infant and Young Child

Nutrition

MCHIP TechnicalSupport

SBC and referral by CDA-trained and

supported Female CHWs

Capacity Strengthening of CDAs

Technical Focus

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Core Approach Geographic Coverage

CHWs provide IPC focused on the 1,000 day period.Home visits and group antenatal and birth preparation classes for all pregnant womenPP home-visits for counseling and referralCommunity GMP for 6- 23 month olds (bi-monthly), followed by nutrition-focused home visits and classes.Dialogue sessions with men and women on the influence of gender and social norms on key health practices – Family Solidarity Modules

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MCHIP’s key CB-MNCH Interventions

Family Solidarity - new & appealing

Sessions interwove popular media - Egyptian movies & songs, sayings and mottos that reflect culture

Critical incidents sparked reflection on local customs and discussion about connection between gender, human rights and health

Health messages and gender concepts interlinked social roles and health, including violence against girls and women.

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Hot Topics

Participants liked discussing:Islam and genderGender and leadership Women’s dress codes - changes over time and how dress reflects one’s identity. Shifts in gender and social norms over time.

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Roll out process

1. MCHIP trained and supported CDA board members and staff to conduct Gender Analysis that informed their program strategies and Family Solidarity Modules (Nov 2012)

2. Gender Advisor developed FSMs (Dec 2012)

3. MCHIP supported CDAs to train CHW trainers on FSM content and facilitation skills (Jan – March 2013)

4. CDAs trained and supported CHWs to conduct FSMs, focusing on engaging mothers, fathers and grandmothers of children under two (April – Nov 2013)

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81.9

55.7

70.965.2

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

Endline Endline Endline Endline

Intervention Comparison Intervention Comparison

Upper Egypt Lower Egypt

Husbands went to doctor with their wives for ANC

41.9

22.9

44.938.3

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

Endline Endline Endline Endline

Intervention Comparison Intervention Comparison

Upper Egypt Lower Egypt

Men received advice on Spacing

Results from endline surveyUpper Egypt Lower Egypt

Men participated in group sessions 31.8 19.3

Results from endline survey

52.345.8

30.6 28.6

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

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Endline Endline Endline Endline

Intervention Comparison Intervention Comparison

Upper Egypt Lower Egypt

Knowledge of atleast three newborn danger signs

38.5

16.4 17.9 15.1

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

Upper Lower Upper Lower

Men who participated Men who did not participate

Knowledge to breasfeed more during diarrhea

40.1

12.920.9

16.9

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

Upper Lower Upper Lower

Men who participated Men who did not participate

Joint decision on purchase and selling of animals

Results from endline survey

Learning

CHWs found Family Solidarity content relevant to their outreach work and their own lives

Implementation strategies varied based on levels of religious conservatism

Family Solidarity delivered mid-cycle, + and –

Some sessions conducted jointly, but mainly conducted for women and men separately.

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Learning

Build trust in communities -- health as a non-controversial entry point – then start FSMs

Be flexible and rely on local organizations to refine process and activity plans

Work closely with Village Health Committees Invite participation of religious leaders – and

be prepared for their inputs Train and support male and female facilitators Develop women’s leadership skills

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Thank You