Table 2 Community-based management of PSBI implementation strategies during the COVID-19 pandemic in Ethiopia, 2021
Determinants | Strategies from literature | Management of PSBI implementation strategies |
|---|---|---|
Low competency and confidence of HEWs (inner) • Lack of training and mentoring • Low competency and self-efficacy of HEWs | • Training of health care providers • Standardization of treatment protocols at the health center and HP levels • Active case finding • Integration of COVID-19 guidelines and materials into the IMNCI/PSBI training curriculum • Recruitment of community health volunteers (CHVs) • HEWs incentives | • Coach and train HEWs on-site (case demonstrations and scenarios-based coaching) • Train HEWs and their supervisors on PSBI treatment • Strengthen the implementation of home visits by WDA leaders and HEWs • Leverage the existing HEW workforce and activate engagement of HEWs |
Weak primary health care system (inner) • Weak support system and low engagement of the PHCU • Inefficient service and health system linkages • Service availability and access (HP closure and declining HEP) • Weak M&E and learning systems • Erratic supply (and poor forecast and requisition) • Non-resilient PHC and negative impact of COVID-19 • No/weak motivation mechanisms | • Supportive supervision • Community-facility referral link • Quarterly review meetings with the responsible stakeholders • Data audit and feedback • National protocol and guideline development • Community-based surveillance of pregnant women and birth; home-based postpartum visits and identification of SYIs and treatment or referral • Strengthen implementation of home visits by WDA leaders and HEWs • Referral system strengthening (communication, referrals) • Strengthening data capture • Review and adaptation of digital platforms to capture data on the management of PSBI activities • Health system strengthening (supply chain management strengthening) • Supply provision • Advocacy and training for supply chain strengthening and management | • Activate engagement of PHCUs, HEWs, and WDAs • Strengthen regular PHCU-level integrated PRCMM and support (focused on PSBI intervention implementation challenges and skill gaps) • Strengthen health center and HP links (e.g., assign a focal person for PSBI treatment) • Introduction of management of PSBI module into eCHIS (clinical decision support tool) • Strengthen implementation of home visits by WDA leaders • Integrate COVID-19 and routine services • Strengthen facility-level IPC practices • Monitor the regional COVID-19 situation • Strengthen supply chain and logistics management system (e.g., strengthen resource quantification and forecasting both at HP and facility level; follow the use of bin cards) • Advocacy for procurement of gentamicin • Redistribution of gentamicin 20 mg/ml |
Suboptimal community engagement and outreach (outer) • Low functionality of WDAs • Low trust in HEWs’ capacity to manage PSBI Community perceptions about newborn illnesses | • Community engagement • Community mobilization and linkages • Consultative meetings with stakeholders • Working with Women Development Army • Community education • Community sensitization and awareness campaigns | • Community mobilization and links • Community sensitization and SBCC activities • Work with kebele managers to make WDA structure functional |
Other systemic factors (inner) • HEW workload and engagement in non-health activities are too high |  | • Introduce regular kebele-level multi-sectoral meetings |
Weak coordination and integration (outer) • Suboptimal ownership • Poor integration of management of PSBI service delivery and support | • Policy dialogue and consultative process • Technical support units for technical back-up • Memorandum of understanding between technical support unit and stakeholders that defines roles and responsibilities • Alignment with national protocols • County-level sensitization, buy-in, and support • Engagement of Ministry of Health (MOH) leadership • Non-government organization-delivered support | • Participatory design and implementation with national and district-level stakeholders • Strengthen woreda-level integrated performance reviews • Monitor visits from the woreda health office and the IR Project • Integrate PSBI treatment into the pre-existing systems for review and accountability at each health system level • Organize technical support units • Integration of COVID-19 and other services • Conduct advocacy meetings (with woreda administration for free ambulance service for SYI emergencies) • Provide on-site orientation for kebele managers to prioritize CBNC activities |