Menu ENN Search

Strengthening postnatal care in Gaza: A home-visiting programme for mothers and newborns

Lisez cet article en français ici

View this article as a pdf

Amani Jouda is the Early Childhood and Development Officer in the UNICEF Gaza field office.

Selena Bajraktarevic is Chief of the Health and Nutrition programme with UNICEF, State of Palestine.

Younis AwadAllah is a health specialist in the UNICEF Gaza Field Office. 

Shereen Obaid is a monitoring and evaluation specialist with UNICEF, State of Palestine.

Background

The Gaza Strip, or Gaza, is a self-governing Palestinian territory with a population of around 1.85 million on the eastern coast of the Mediterranean, bordering Egypt and Israel. The health sector in Gaza has been heavily disrupted by years of conflict, sanctions and socioeconomic decline. Healthcare services and clinical staff are overstretched and lack basic resources, with frequent power cuts and stock-outs of essential drugs and equipment1.  

Maternal healthcare in Gaza is an integral component of the health service. Annually in Gaza there are between 50,000 to 60,000 deliveries, with around 160 children born per day. Nearly all deliveries are institutionalised; a quarter of women gave birth with assistance from a midwife/nurse and three quarters by a physician2. However, more than half of the women (58%) stay less than six hours in the facility after they give birth due to overcrowding in maternity wards, and postnatal care remains at an unacceptable level in terms of coverage, quality and the frequency of visits of women to health centres for postnatal checkups. 

Strengthening postnatal care 

Postnatal home visits in the first week of life are strongly recommended by the World Health Organization (WHO) to improve maternal and checkups outcomes. Considering the context and the current situation in Gaza, the nutrition risks and vulnerabilities among pregnant and lactating women and infants, particularly newborns, are high. For example, micronutrient deficiencies are high, with 75% of children under one year of age being anaemic and an estimated 30% of pregnant and lactating women suffering from anaemia3.  Less than 50% of infants are exclusively breastfed to six months of age4.

In 2011 a postnatal home visiting (PNHV) programme was set up to tackle these issues for high-risk pregnant and lactating women and newborns, usually within the first three days following delivery. The Ministry of Health (MoH) is the main partner, with support from UNICEF, and aims to offer the programme to 6,000 women and their newborns in all five governorates in Gaza. 

The programme has helped to establish stronger relationships between health providers and mothers.

Developing the programme

The PNHV programme is implemented by a cadre of 45 trained midwives from MoH and partners, who receive annual refresher training. The main maternal nutrition care provided to the mother includes measuring haemoglobin and blood glucose levels. Mothers are counselled on the importance of nutritious food and taking iron tablets and they are referred to health centres for iron supplements where required. Such advice is provided alongside other services, including checking the mother’s vital signs (temperature, pulse, respiration and blood pressure). Care for the infant includes weighing and measuring length and providing advice on exclusive breastfeeding and responsive parenting, alongside assessing the newborn for any developmental delays, with referral if needed. 

Programme evaluation

An external evaluation of the PNHV programme was conducted in June 2018, covering the 2011-2016 period. Around 130 people, including home visitor midwives, mothers, fathers and key informants, were interviewed. However, the lack of a baseline and a robust monitoring and evaluation system has made it difficult to give statistical evidence on programme impact, so findings of programme effectiveness are limited to qualitative and observational data. 

In general, the PNHV programme is thought to have increased the capacity for home visits to promote infant and young child feeding, and encourage exclusive breastfeeding and support for non-breastfed infants where needed. The evaluation found that community and home-based activities had increased mutual understanding and respect between health providers and women. This had helped midwives conducting the home visits to establish stronger relationships with mothers, building trust and enabling mothers to ask more questions about their own health and that of their babies. 

Benefits to mothers and midwives

Mothers interviewed said the programme had been quite effective in stopping potentially harmful traditional practices, such as giving infants herbal teas, use of crystallised sugar to treat jaundice and use of bitter substances for weaning off breastmilk. There was a very high satisfaction rate among participating mothers, who reported increased self-esteem and confidence.

Midwives had also gained new insights in their training as home visitors, especially on nutrition, breastfeeding and hygiene practices, but also on early childhood development (an area that had been recently included in their role). Moreover, health providers and key informants cited key successes where they saved lives or detected complications for referral in timely fashion, although these had not been measured in the evaluation.

Addressing challenges and lessons learned

The evaluation also highlighted a number of ways to enhance the quality of postnatal care and to better integrate such care into maternal and child health services. Recommendations include standardisation of postnatal guidelines, harmonisation of services provided by all stakeholders, and building a centralised information system to document and monitor programme implementation. Due to financial constraints, the programme has had to focus on women with high-risk pregnancies/deliveries and first-time mothers, rather than covering all households. However, the PNHV programme needs to address concerns about the absence of a holistic postnatal care approach and lack of an updated protocol in order to ensure sustainability of continued external funding. Furthermore, there was no specific strategy to engage fathers and extended family members, such as grandparents.

Home visits facilitated a more personalised approach and allowed a deeper understanding of problems that women in the programme were facing. The mothers realised that they need postnatal care for themselves and not only for their infants. In addition, home visitors were able to provide enhanced services through building stronger relationships with beneficiaries, and postnatal care was perceived as a routine aspect of their role. Providing high-quality PNHV services, including better targeting and criteria for selection of high-risk pregnant and lactating women, is extremely important for successful outcomes. However, documenting and evidence-based programming should be considered from the beginning until the end of an intervention.

Read more...

Footnotes

1UNRWA Report. www.unrwa.org/activity/health-gaza-strip

2Palestinian Central Bureau of Statistics (2015); Palestinian Multiple Indicator Cluster Survey (2014) Final Report, Ramallah, Palestine.

3Ministry of Health (2016) Nutrition Surveillance.

4UNICEF. Health and Nutrition Profile, Palestine. www.unicef.org/sop/what-we-do/health-and-nutrition

More like this

Resource: Group Urges Disaster Planning for Pregnant Women, Babies, News article

Group Urges Disaster Planning for Pregnant Women, Babies By Rama Lakshmi Special to The Washington Post Thursday, August 17, 2006; Page A09 In the days after Hurricane...

FEX: The Paediatric Development Clinic: A model to improve medical, nutritional and developmental outcomes for high-risk children aged under-five in rural Rwanda

By Kathryn Beck, Catherine M Kirk, Jessica Bradford, Christine Mutaganzwa, Evrard Nahimana and Olivier Bigirumwami View this article as a pdf Kathryn Beck is the Nutrition...

Delivering care to address a double burden of maternal malnutrition in Sri Lanka

View this article as a pdf Dr Irosha Nilaweera is a Consultant Community Physician for the National Programme for Maternal Care, Family Health Bureau, Ministry of Health, Sri...

NEX: Renforcement des soins postnatals à Gaza : un programme de visite à domicile pour les mères et les nouveau-nés

Read an English version of this article here Amani Jouda est responsable de la petite enfance et du développement au bureau de l'UNICEF à Gaza. Selena...

FEX: Experiences in addressing malnutrition and anaemia in Gaza

By Dr Bassam Abu Hamad and Erik Johnson Dr Hamad is Palestinian Public Health Professional with a PhD in health management, and works at the School of Public Health, Al Quds...

Creating an enabling environment for delivering maternal nutrition interventions in Bhutan

Creating an enabling environment for delivering maternal nutrition interventions in Bhutan View this article as a pdf Laigden Dzed is a Senior Programme Officer in the...

Resource: Helping moms, babies when disaster strikes, news article relating to Hurricane Katrina

www.baltimoresun.com/news/opinion/oped/bal-op.mothers14may14,0,3362192.story?coll=bal-oped-headlines From the Baltimore Sun Helping moms, babies when disaster strikes By...

FEX: Assessing the intervention on infant feeding in Gaza 2008

By Susan Thurstans and Vicky Sibson Susan Thurstans has been part of the emergency response team for nutrition with Save the Children UK since January 2009 and previously...

Providing maternal nutrition services at sub-national level in Punjab Province, Pakistan

View this article as a pdf Dr Khawaja Masuood Ahmed is the National Coordinator for Nutrition and for the National Fortification Alliance in the Ministry of Health, Pakistan....

FEX: Breastfeeding support in the refugee camps of North Western Tanzania

By Lucas Kulwa Machibya Lucas Machibya has been working for UNHCR since June 1994 in the north-western Tanzania refugee operation as National Public Health Nutrition Officer....

FEX: Cash voucher programme and rabbit raising intervention in Gaza

By Elena Qleibo, Ena’am Abu Nada, Wassem Mushtaha and Julie Campbell Elena Qleibo is the Oxfam Food Security Coordinator for the Gaza programme. She has been working in...

Addressing maternal nutrition service delivery gaps in Afghanistan: Policy and programming opportunities

View this article as a pdf Dr Zakia Maroof is a Nutrition Specialist working with UNICEF Afghanistan. Dr Homayoun Ludin is an Afghan doctor working with the Ministry of...

FEX: Adolescent inclusion in the Care Group approach: the Nigeria experience

By Shiromi Michelle Perera Shiromi Michelle Perera is a Technical Officer with the Nutrition, Food Security and Livelihoods Unit at International Medical Corps, Washington...

FEX: Border Closures and Nutrition in Gaza

By Dr. Adnan Al-Wahaid Dr. Al-Wahaidi is a paediatrician based in the Gaza Strip. Originally working for Terre des hommes since 1987, he is now Medical Director of Programming...

FEX: Counselling on infant feeding choice: Some practical realities from South Africa

By Tanya Doherty (pictured), Mickey Chopra and Mike Colvin Tanya is currently a senior scientist at the Health Systems Trust and Medical Research Council in Capetown, South...

FEX: Effects of performance payments to health workers in Rwanda

Summary of published research1 A study just published in the Lancet set out to assess the effect of performance-based payment of healthcare providers on the use and quality of...

FEX: Integrating nutrition and antenatal care: a reproductive health perspective

Sarah Neusy is an Obstetrician-Gynecologist and Reproductive Health Advisor with Save the Children UK. I read with a great interest Mike Golden's article.1 His view makes a...

FEX: The Gaza context

The prolonged stalemate in the Middle East peace process, on-going conflict, continued access restrictions and internal Palestinian divisions have resulted in a...

Nepal’s success story: What helped to improve maternal anaemia?

View this article as a pdf Dr Ram Padarath Bichha is Director of the Family Welfare Division, Department of Health Services, Ministry of Health and Population, Nepal. Kedar...

FEX: Risk factors for vitamin A and D deficiencies among children under five years old in Palestine

Research snapshot1 The Palestinian Ministry of Health (MoH) and UNICEF conducted a national cross-sectional survey in 2013 to ascertain the prevalence of and risk factors for...

Close

Reference this page

Amani Jouda, Selena Bajraktarevic, Younis AwadAllah and Shereen Obaid (2019). Strengthening postnatal care in Gaza: A home-visiting programme for mothers and newborns. Nutrition Exchange 12, July 2019. p20. www.ennonline.net/nex/12/postnatalcaregaza

(ENN_6390)

Close

Download to a citation manager

The below files can be imported into your preferred reference management tool, most tools will allow you to manually import the RIS file. Endnote may required a specific filter file to be used.