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Table 4 Heshima process description (including interventions)

From: Sowing the seeds of transformative practice to actualize women’s rights to respectful maternity care: reflections from Kenya using the consolidated framework for implementation research

 

Intervention Activity

Purpose

Participants

Frequency

Duration

Location

Policy level

 1.

Project Launch

High level MOH officials launched Heshima. Media invited. Participants invited to Project Steering Committee to guide/monitor activities.

80

One time

One morning

Nairobi

 2.

Project Steering Committee

Maternal health champions known to Heshima with mandate to support quality childbirth met routinely to review project progress

See Table 4

12

Half day

Nairobi

 3.

Global Policy Review

Desk review of international conventions, treaties, signed by Kenya, national laws, and the new constitution for relevant policies and guidelines on human and childbearing rights for promoting and strategizing for RMC by The Council and FIDA.

FIDA lead

One time

20 days

Nairobi

 4.

Baseline questionnaire development training of data collectors

Formative research conducted to understand the context and mistreatment terminology by communities and provider motivation and accountability issues prior baseline questionnaire development.

Health managers from national nursing and reproductive health units were invited to be part of the data collector training. Specifically requested to coordinate observations of client provider interactions during labor and delivery in the 13 study facilities.

Heshima and steering committee

Heshima (Council led), MOH, data collectors

Ad hoc meetings

30 days

Nairobi & non- study site

One time

1 week

Nairobi

 5.

Community Dialogue and National Stakeholder Forum

Community level findings disseminated in each facility catchment area

Stakeholders: community, facility, national, global representatives. Baseline findings – drivers of disrespect and abuse (See Fig. 2) – disseminated then group work by level and county to suggest interventions to mitigate disrespect and abuse.

1996 community members 100 stakeholders

One time

1 day

Nairobi

 6.

Participatory Intervention Development

Meetings with Heshima members and Steering Committee to review discussions from No.5.

20

Series of meetings

1 month

Nairobi

 7.

Development of RMC Resources and Curricula

1) Baseline results and stakeholder consensus on the content of training materials; 2) Values components adapted from IPAS training materials; 3) Sessions on rights based approach, service charter including accountability. 4) Added professional code of ethics. 5) MOH convened national meetings on RMC curricula development for both pre- and in-service training; 6) Final face to face meeting with project partners and steering committee members refined the RMC resource package; and 7) Two international experts reviewed final version prior to completion. RMC components were incorporated into national curriculum.

10–15 national maternal health stakeholders 7 members Nursing Council of Kenya

3 meetings plus virtual experts in training material development

7 days

30 days

Nairobi

 8.

National Policy Dialogue and Development

Policy engagement through the national reproductive health interagency coordination committee, technical working groups for maternal and newborn health, Human Resource and monitoring and evaluation. Presentations of results to get buy in prior to national dissemination. Meetings continued for scale up plans.

20–40 stakeholders /meeting

4–8 meetings (quarterly)

half day

Nairobi

The Council participated in small expert meetings (invitees only) to draft Maternal Health Bill and ensure disrespect and abuse during facility based childbirth incorporated.

10–15 national stakeholders

15 meetings

Half day /meetings

Nairobi

Working with the high level policy makers such as Kenya Women’s Parliamentary Association, the Parliamentary Health Committee and the first Lady to advocate for Reproductive /Maternal Health Rights.

Over 50

3 strategic meetings Plus ongoing

Half day meetings

Nairobi

 9.

Advocacy

National conferences and meetings with media (e. g. Kenya Media Network), researchers, professional associations (midwifery, ObGyn and medical) and policy makers on health rights and promoting RMC. Continuous advocacy by MOH and Heshima.

120 national stakeholders

12 targeted meetings.

Half day national meetings

Nairobi / county level

Health system - Facility level

 10.

VCAT Workshops

RMC workshop (1–2 days) for county health managers, facility and maternity in charges, i.e. those who supervise /support frontline providers

Three day workshop for facility staff. Each of the study facilities developed action plans to institutionalize RMC in maternity units.

132

146

Maternity providers

One time /county

Facility reps to one meeting

2 -day workshop 3- days /workshop

All study Counties and facilities

 11.

Mentorship

Following VCAT workshops, on-the-job role-modeling for provider behavior change by facility champions as part of routine continuous professional development.

13 identified, 4 actively engaged

Conducted as part of routine work

continuous on job session

4 sites: 2 public, 2 private

 12.

Quality Improvements teams

Strengthened facility management and quality improvement teams to monitor, address, and resolve incidents of mistreatment. Address infrastructure, drugs and commodity supply concerns. Quality improvement teams trained on rights and obligations related to childbirth, developed protocol for reporting and monitoring, and encouraged community membership.

Established mechanisms for transparency and accountability of health facilities to communities, increase awareness of maternal healthcare rights.

Public facilities −10; private facilities −0) 3–6 members

Quarterly review meetings 4 x year

Ongoing and 2–3 h meeting

All study counties

 13

Counseling for providers

Counseling for providers at the group and/or individual levels to support providers with coping mechanisms to overcome experiences related to high workload, trauma or critical incidents. Conducted by FIDA counselors (one counseling session per site) and role modelled sessions with the facility or county counsellors. Counselors continued with counseling sessions in their respective sites.

113 providers (8–12/ site)

26 sessions; 9 sites one each. 4 sites; 3–4.

45 min- 1 h per session

All study counties

 14

Maternity Open Days

Trust-building with local communities: men and women visit the facility to learn about procedures in the maternity wards and interact with staff.

100–300 depends on facility size

24 (total)

1 day each

All study counties

 15

Monitoring of disrespect and abuse

Provided mechanisms to report incidents of disrespect and abuse such as customer service desks, suggestion boxes and through Heshima/MOH supervision. County health teams and facility quality improvement teams conducted monitoring and supervision as part of their routine work.

~350 community members

~35 at facilities

17 county visits 22 community health units; 13 facility visits**

½ day community health units and ½ day facility

All study counties

Community level

 16

Community workshops

One day workshop held for community resource persons (community health volunteers, legal aids, chiefs, religious leaders/village elders) on civic education of community rights to sexual and reproductive health including maternal health care. FIDA facilitated the workshop. CHEWs support community health volunteers to develop action plans.

154 community people trained

5 times (1 per county)

1 day each workshop

Catchment of all facilities

 17.

Community education and male involvement

Community health volunteers, CHEWs, opinion leaders, civil and legal aids) conducted RMC sensitization meetings for community members with support from county mangers.

Deliberate efforts were made to involve men in the community workshops as participants and facilitators. Targeted meetings for men: ‘calling them to action’ to demand RMC for their wives and partners.

1996 people: 287 male only, 871 female only, 838 mixed groups

27 meetings

Half day

Catchment areas from around facilities

 18.

Mediation training for society leaders

Trained society leaders (e. g. CHVs), on mediation skills, to act as intermediaries between community members and health facility to address issues of disrespect and abuse. Mediators selected by communities and facilities (on set criteria) and trained by FIDA. ***

Counseling community members who have experienced mistreatment. Led by FIDA and other professional counselors. Referrals from CHVs or community legal aids.

22 from community health units, 13 from facilities 2 out of 6 women

5 times (1 per county)

Twice

1 day per session

1 h per session

All study counties

One site

  1. *FIDA uses routine lobbying processes on civic and women’s health issues to advocate of behalf of Heshima. **In some counties, community units shared between multiple facilities. *** In RMC Resource Package Manual