As an applied knowledge institute KIT Royal Tropical Institute regularly conducts evaluations of health programmes – such as postnatal care systems. Evaluations help by critically looking at and learning from a programme and its outcomes: What is effective and how can we improve it? What works and in which context? And how can we scale it up and make more people benefit from it? In this blog one of our Health Advisors reflects on evaluation activities in Gaza.
“I feel precious”
by Irene de Vries
She is proudly looking around the room. Sitting in a big, elegant bed surrounded by female family members. A headscarf has just been draped around her head, especially for the photograph. In her arms is her eight days-old, first-born baby – delivered by cesarean section because of breech presentation. She is doing well – quite mobile actually – regaining a lot of her strength only eight days after the cesarean. Every look at her beautiful baby girl produces a huge smile on her face.
We are in Gaza, State of Palestine, for the start of an evaluation of postnatal home visits. Since 2011 home visits to deliver postnatal care have regained attention in the State of Palestine, with the support of UNICEF. But despite huge improvements in the past 15 years, maternal and infant mortality can still be reduced. A majority of the maternal mortality cases happen in the postnatal period and infants are most at risk in the first 28 days of life, so an increased focus on postnatal care should attack a big part of the problem.
Having just delivered a baby poses physical challenges on women visiting a clinic. These challenges are complicated further in an environment where access to care is already limited due to transport issues, overcrowded health facilities, and lack of privacy. During home visits a midwife or trained nurse visits women and their babies one day, three days, and one week after birth in the comfort of their own homes. Apart from doing physical check-ups to detect problems in an early stage, this also gives the midwife the opportunity to spend more time with the mother, baby, and their family members and council them on care for the baby, breastfeeding, physical exercises and family planning.
For women in some parts of the world these home visits seem the natural order of things. In the Netherlands community midwives visit frequently at home after a new baby is born; we also have maternity nurses teaching you all the skills you need as a mum, from breastfeeding to bathing, three-six hours a day. Unfortunately, this ‘luxury’ is not reserved for all women in the world. In Gaza, only women who have a high-risk pregnancy or delivery – about 26% of the total deliveries – are eligible to be visited at home. And due to staff and funding constraints even they do not all get the visits they require.
On the ground in Gaza
The young mother that we are visiting now at least gets some of the attention she deserves. While her mother and mother in law are spoiling us with sweets and lemonade, she gets her vitals done and is assisted in breastfeeding the baby. One thing that emerges – in the room stuffed with family members – is that the father is not around.
When asking about him, it appears he is in the room next door and he enters our room to say hello. While he is not part of the counseling session during the day, he is indispensable during the nights. Alternately they will walk around hushing the baby when she is crying too much. And when his wife is too tired to breastfeed, he will give his daughter a bottle. Changing a nappy is something he has never done, but who says he never will.
There are many things to find out for these young new parents. And many things to find out for the home visiting programme as well. How do we engage the fathers? How do we reach most mothers and especially those most in need? Are we doing the right job or does our strategy need to change? And how do we make sure postnatal home visits can be sustained?
All questions that this evaluation should address, and during this first visit we can see there is room for many improvements. But while trying to find out how programmes can be improved and sustained, for the young mother there is only one thing that counts: the health of her and her baby. She is delighted with the attention she gets within the walls of her own home: “I feel precious.”