A predominant proportion of deliveries in Pakistan take place at home, conducted by a traditional birth attendant (TBAs). TBAs, also known as Dais, are unskilled and unable to identify and manage any birth and neonatal complications. A large proportion of the newborns born in Pakistan experience a number of neonatal insults that lead to morbidity and mortality—especially those babies born at home.

This innovation seeks to develop and test the efficacy of a low cost evidence based toolkit and improvement in parental interaction aimed at improving brain development in newborns in a rural setting of Pakistan. The toolkit will include a safe delivery kit, nutritional supplementation, and various trainings on topics such as cord care, hypothermia management, and more. A year-long parenting program (divided into twelve monthly sessions) will be implemented by the link workers to improve parent-child interaction behaviours. The parenting program will cover developmental skill areas such as cognitive and fine motor, social and self-help and gross motor skills aimed at augmenting brain development among newborns, including those neonates who might have suffered a neonatal insult at birth.

• 1000 parents will be trained in the parenting program and will receive the toolkit.
• 30 link workers will be trained in the parenting program.
• 30 Birth Attendants will be trained in the toolkit.

Key Drivers

Public sector – community synergies

The successful implementation of this project lays in the development of synergies between public sector stakeholders and the community members and “influential”. The former provides a stake of the public sector health care providers, and its associated sustainability, while the latter ensures the support and buy-in of the community in taking up the proposed project interventions through the establishment of Village Health Committees

The effectiveness of this implementation design will be assessed by evaluating:

• The feasibility of the link worker working alongside other birth attendants within the community, including on the performance of birth attendants and on the delivery of the parenting curriculum.
• The impact of the intervention package on the reduction of neonatal insults and developmental delays.

The project will establish an integrated monitoring system that will be coherent from the field level to project management. The basis of the system will be an individual based (i.e. line listed) computerized management information system.

Field link workers will develop a full census of pregnant and newly-delivered women and their families within their focus communities. For each family, the link worker will use simple field monitoring tools to document their interactions, services provide, referrals made, toolkit used, number of sessions of the parenting program attended and its implementation. This will be charted and tracked by link workers and their supervisors at the field level.

This information will be rolled up at the community and overall project levels of aggregation to provide information on the number and proportion of individuals and families who have received different project services. Indicators will be calculated and reported on a monthly basis at the field (i.e. link worker), supervisor and project level. To assess the neonate’s status at birth, the apgar score will be noted, while at the end of the study period, the children and their parents will be assessed.

Funders

Grand Challenges Canada