1. Applying a Community Action Cycle to Improve MNCH Outcomes: A Best Practice from Ethiopia By Getaneh Assefa (MA, Sociology ; BSc Public Health) 9 Feb 2016

2. Presentation outlines Background Methods Results Key lessons Conclusion

3. Back Ground (1) Ethiopia is making committed efforts to improve MNCH services. Low care seeking behavior for MNCH services is among the major challenges Save the Children implemented a demand creation initiative that have potential for replication at large scale to address the challenges

4. Back Ground (2) Funded by Save the Children Italy, implemented by Saving Children’s and Mothers’ Lives Project in Konso Wored, Jan 2010 to Jun 2013. The project improved MNCH outcomes by applying effective demand creation approach.

5. Methods (1) Organize Community for Action Explore Issues & Set Priorities Plan Together Act Together Evaluate Together Prepare to Mobilize Prepare to Scale-up Community Action Cycle (CAC) approach was used to mobilize the community.

6. Methods (2) Baseline survey and community social network analysis was undertaken prior the implementation. Woreda level multi-setor community mobilization team was formed and trained. Kebele command post (KCP) was strengthened and served as a core group which applied the CAC at the grassroots level.

7. Methods (3) KCP included the most affected and interested as core group members to be more representative

8. Methods (4) Capacity strengthening was provided to KCPs The CAC was started in 2 kebels and scaled up to additional 6 kebeles.

9. Methods (5) Participatory tools such as Problem Tree Analysis and Community Resource Maps were used.

10. Methods (6) Communities developed a community MNCH action plan, implemented monitored, evaluated, learned and re-planed.

11. Results (1) :Maternal Health Outcomes

12. Results (2): Child Health Outcomes

13. Results 4 The CAC approach strengthened community capacity in organizing itself, identifying MNCH challenges, addressing it collectively, monitoring and evaluating results, learning and re-planning.

14. Results (5) The CAC process leveraged existing community social systems, trusted groups, leaders, and male involvement.

15. Results (6) The implementation process ensured active participation and ownership of interested, marginalized and influential community groups and individuals.

16. Key Lessons (1) Community Organizing for Demand Creation “ The approach works extremely well. It takes time in the beginning but now there is so much MNCH action by communities.” – Woreda MCH Office r

17. Key Lessons (2) Creating demand requires understanding of cultural and religious context with a focus on building ‘trust’ in the health system. Community ownership is key to success Behaviour change is not necessarily message driven – but dialogue driven around cultural, power and decision-making

18. Key Lessons (3) It needs commitment of all stakeholders. It takes ongoing capacity building and system strengthening Demand side of the equation has to be balanced with supply side – Two-sided coin! Bringing services closer to families builds understanding and trust, and ‘they will come.

19. Conclusion Implemented well, the CAC is an effective community systems strengthening approach which creates an enabling environment for behavior change leading to positive health practices at individual, household and community level, and builds community capacity to improve MNCH on a sustained basis.

20. Thank You!