The Maternal and Child Health Handbook for Improving the Continuum of Care and Other Maternal and Child Health Indicators in Angola: An Implementation Study Protocol

Ai Aoki; Keiji Mochida; Michiru Kuramata; Toru Sadamori; Helga Reis Freitas; João Domingos da Cunha; Pedro Sapalalo; Lino Tchicondingosse; Olukunmi Omobolanle Balogun; Hisakazu Hiraoka; Hirotsugu Aiga; Kenji Takehara

doi:10.3389/fgwh.2021.638766

The Maternal and Child Health Handbook for Improving the Continuum of Care and Other Maternal and Child Health Indicators in Angola: An Implementation Study Protocol

Front Glob Womens Health. 2021 Mar 25:2:638766. doi: 10.3389/fgwh.2021.638766. eCollection 2021.

Authors

Affiliations

¹ Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan.
² TA Networking Corp., Tokyo, Japan.
³ Department of Global Health, Graduate School of Health Sciences, University of the Ryukyus, Nishihara, Japan.
⁴ Samauma Consulting LLC, Tokyo, Japan.
⁵ National Directorate of Public Health, Ministry of Health, Luanda, Angola.
⁶ Domus Custodius (SU) Lda. Tchikos Agency, Luanda, Angola.
⁷ Japan International Cooperation Agency, Tokyo, Japan.
⁸ School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan.

Abstract

Background: Reducing maternal, neonatal, and infant mortality tops the health targets of sustainable development goals. Many lifesaving interventions are being introduced in antenatal, delivery, and postnatal care. However, many low- and middle-income countries (LMICs) have not reached maternal and child health targets. The Maternal and Child Health Handbook (MCH-HB) is recommended as a home-based record to promote a continuum of care from pregnancy to early childhood, and is gaining increasing attention among LMICs. Several countries have adopted it as national health policy. To effectively utilize the MCH-HB in LMICs, implementation needs to be considered. Angola is an LIMC in Sub-Saharan Africa, where maternal and child health indicators are among the poorest. The Angolan Ministry of Health adopted the MCH-HB program in its national health policy and is currently conducting a cluster randomized controlled trial (MCH-HB RCT) to evaluate its impact on the continuum of care. This study aimed to evaluate implementation status, and barriers and facilitators of MCH-HB program implementation in Angola. Methods: To evaluate implementation status comprehensively, the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework will be used. Four components other than effectiveness will be investigated. A cross-sectional survey will be conducted targeting all health facilities and officers in charge of the MCH-HB at the municipality health office in the intervention group after the MCH-HB RCT. Data from the cross-sectional survey, secondary MCH-HB RCT data, and operational MCH-HB RCT records will be analyzed. Health facilities will be classified into good-implementation and poor-implementation groups using RE-AIM indicators. To identify barriers to and facilitators of MCH-HB implementation, semi-structured interviews/focus group discussions will be conducted among health workers at a sub-sample of health facilities and all municipality health officers in charge of MCH-HB in the intervention group. The Consolidated Framework for Implementation Research will be adopted to develop interview items. Thematic analysis will be performed. By comparing good-implementation and poor-implementation health facilities, factors that differ between groups that contribute to successful implementation can be identified. Discussion: This study's findings are expected to inform MCH-HB implementation policy and guidelines in Angola and in other countries that plan to adopt the MCH-HB program.

Keywords: Angola; developing country; home-based record; implementation; maternal and child health; maternal and child health handbook.