Table 1 Overview of the contextual barriers , HSS programme components, HSS interventions and data collection methods
Contextual Barriers | HSS programme components | HSS interventions | Collection methods |
|---|---|---|---|
Poor patient knowledge and health seeking behaviour; high levels of stigma | Health promotion and awareness raising - delivery of health promotion and awareness raising talks • Provider – lay healthcare workers • Recipient – perinatal women • Place – waiting areas at MOU and BANC clinics • Time – in the morning • Frequency – daily • Tools – ASSET provided flipchart | Training – to equip healthcare workers with the knowledge, skills and tools to deliver the talks Health education – to provide pregnant women with health information Delivery of group care – to deliver talks to groups of women Role expansion – to task healthcare workers with delivering the talks in addition to their usual responsibilities Audit and feedback – to assess and discuss the delivery of talks with healthcare workers involved | Qualitative interviews with healthcare workers Observation of the health promotion and awareness talks and completion of a checklist used to capture healthcare worker competency, adherence to the structure, and environmental factors such as noise, lighting and size of area Patient survey – a self-administered survey questionnaire, completed during baseline and after the talks |
Low levels of detection | Detection - of symptoms of CMDs and domestic violence in pregnant women as part of routine antenatal care • Provider – antenatal care nurses • Recipient – pregnant women • Place – at MOU and BANC clinics • Time – during routine consultations • Frequency – at every antenatal visit • Tools – Maternity Case Record (MCR) [17] and PACK guide [18] | Training – to equip healthcare workers with the knowledge and skills to detect women with CMDs and domestic violence Delivery of individual-level care – to detect women with symptoms of CMDs and domestic violence during private consultations Audit and feedback – to assess and discuss screening rates with healthcare workers involved | Qualitative interviews with pregnant women and ANC nurses Documentation review - review of patient files and documents used to record detection rates |
Poor linkages to care | Referral - of pregnant women with symptoms of CMDs and domestic violence • Provider – antenatal care nurses • Recipient – pregnant women with CMDs or domestic violence • Place – at MOU and BANC clinics • Time – during routine consultations • Frequency – when a woman screens positive and consents to counselling • Tools – Referral form – Section A | Training – to equip ANC nurses with the tools and processes to link pregnant women who screen positive to care Referral systems – development of standardised referral pathways Audit and feedback – to assess and discuss referral rates with healthcare workers involved | Qualitative interviews with pregnant women and ANC nurses Documentation review - review of registers and referral forms used during the referral process |
Limited availability of treatment | Treatment - provision of counselling sessions to perinatal women with symptoms of CMDs and domestic violence • Provider – community health workers • Recipient – perinatal women with symptoms of CMDs or domestic violence • Place – in patients’ homes • Time – as agreed by CHW and patient • Frequency – 3 sessions • Tools – Referral feedback – Section B | Training – to equip CHWs and OTLs with the knowledge, skills and tools to deliver psychological counselling Task-sharing – to task CHWs with delivering a psychological counselling program Delivery of individual-level care – to provide women with symptoms of CMDs and domestic violence with private psychological counselling sessions Change to healthcare environment – to provide psychological counselling in women’s homes or at off-site venues Audit and feedback – to assess and discuss counselling rates with CHWs and OTLs Performance monitoring – for OTLs to monitor the delivery of counselling sessions by CHWs | Qualitative interviews with pregnant women, OTLs and CHWs Documentation review – weekly reports on counselling progress |