Encouraging Positive Practices for Improving Child Survival (EPPICS) Project

Photo by Michael Stulman/CRS

The four-year Encouraging Positive Practices for Improving Child Survival (EPPICS) project, funded by USAID, fosters high levels of community involvement to contribute to improved maternal and neonatal health outcomes in Ghana’s East Mamprusi District.

PROJECT DETAILS

Official name of project: Encouraging Positive Practices for Improving Child Survival (EPPICS) Project

Project years: 2011-2015

Country: Ghana

Value of project: $2,188,069

Names of donors and partners: USAID

GOALS OF THE PROJECT

The goal of the EPPICS project is to reduce maternal and newborn deaths in the East Mamprusi District of Ghana. The project combines both facility and community-based approaches to reach a target of 51,000 (27,000 women of reproductive age and 24,000 children under five) direct beneficiaries. CRS, the Ghana Health Service and the University for Development Studies are collaborating partners for the implementation of the EPPICS project.

NEED FOR THE PROJECT

In Ghana, despite national strides to strengthen health services, maternal and infant mortality and illness remain higher in the Northern Region than the rest of the country. The Ghana Health Service and their health partners are working to implement high-impact, evidence-based interventions to address these concerns.  Most of their previous efforts have focused on health services at the facility level.

Despite these efforts by the Ghana Health Service, there are still gaps at the community and household levels in accessing health services due to challenges such as overcoming harmful cultural practices, poor transportation system and late referral for emergencies.

HOW WE DO IT

THE EPPICS project has both facility-based and community-based components. The project implements maternal and child health care in 11 health facilities and 240 communities with a current total population of 129,000.

The program centers around maternal and newborn care (60%), nutrition (30%) and malaria in pregnancy (10%). For EPPICS to achieve its goal of reducing maternal and infant deaths, three key strategies are being deployed:

  • Engaging community through mobilization and awareness raising 
  • Empowering the health staff and community-based agents through quality improvement capacity strengthening 
  • Monitoring and facilitative supervision plus using data in the decision-making process

CRS is responsible for grant management and administration, capacity strengthening, monitoring supervision and learning.

The Ghana Health Service is responsible for mobilization, formation of community structures, and training and monitoring of community-based activities.

The communities are responsible for encouraging healthy practices by facilitating referral of pregnant women and children to facilities and setting up platforms for communities to engage in maternal and child health discussions.

The University for Development Studies provides technical guidance to the Council of Champions innovations, the operations research arm of the EPICCS project. Council of Champions are opinion leaders who serve as advocates against traditional and cultural practices that may hinder uptake of health service for women and children in the communities.

One of the project’s greatest hurdles is persuading decision makers within households and communities to encourage women to give birth in health centers for safer deliveries. Traditionally, Ghanaian women have little say regarding their pregnancies and child rearing. Husbands and their mothers make most family related decisions, including if and when to use health services. As a result, many women living in East Mamprusi still opt to give birth outside of formal health facilities. To help change this, community health volunteers receive training to persuade community members—particularly husbands and mothers-in-law— to include wives/women in household decision making and to choose healthier birthing practices. These volunteers also reach out to key leaders with the power to sway public opinion, including village chiefs, religious leaders, elders and queen mothers (magazias) who are respected leaders in the various communities.

In addition, the project encourages traditional birth attendants to refer pregnant women to health facilities so mothers can benefit from prenatal and other services. The project also supports the formation of mother-to-mother support groups to promote antenatal services, health center deliveries and exclusive breastfeeding.

The EPPICS project reaches additional community members through use of giant community scoreboards. These large signs serve as visual tools (like a “donation thermometer”) that rally residents by publicly tracking community performance against key maternal and child health indicators. The scoreboards are updated monthly using green or red sticks to indicate positive and negative outcomes. Scoreboards are a highly effective way to help communities track their progress and to promote healthy competition between communities. They also serve as an educational tool by presenting images of desirable and undesirable health practices.

BY THE NUMBERS

  • A comparison of survey results from October 2011 to December 2014 showed the number of mothers who registered for antenatal care increased from 80% to 99%.
  • Those who attended at least four antenatal care visits increased from 48% to 63%.
  • Skilled assisted deliveries increased from 43% to 97%.
  • Exclusive breastfeeding increased from 43% to 94%.
  • Early postnatal care (within first week of life) improved from 32% to 69%.
  • The maternal mortality rate decreased from 275/100,000 live births to 57/100,000 live births.
  • The still birth rate declined from 2.8/1,000 live births to 1.7/1,000 live births.
  • The infant mortality rate declined form 62/1,000 live births to 14/1,000 live births. 

ACHIEVEMENTS & MILESTONES

  • Project officers stationed within the Ghana Health Service participate in the day-to-date decisions with the health department staff and monitor and share feedback to improve the project.
  • The project also helped to improve the health information system of the Ghana Health Service through training health officers in the use of iPads to ensure accurate and timely submission of data.
  • Community and government ownership of the project was established from the project onset through effective mobilization, dialogue and awareness raising sensitization. The project’s quarterly reflection meetings between the three main partners and project focal persons created improved learning and trust, thus helping to address project implementation challenges.
  • The Ghana Health Service relied on very few volunteers to carry out community mobilization activities for them. The EPPICS project has created a wide volunteer base for project implementation. The EPPICS project added : 1) the healthy mothers and newborn care committees to document and report on key maternal/newborn and child health performance indicators using the giant scoreboard; 2) traditional birth attendants to serve as referral point persons (link providers) for women in labor to health facilities and; 3) Council of Champions (opinion leaders) who served as advocates against traditional and cultural practices that may hinder uptake of health service for women and children in the communities. 

SUCCESS STORY

The EPPICS Project uses Community Pregnancy Surveillance and Newborn Education Sessions (C-PrES), with groups of 15-25 pregnant or breastfeeding women. Most of those women have not received any formal education so are unable to use educational materials written in English. To address this problem, C-PrES facilitators and individuals within the community composed educational songs in the local languages based on health topics from existing health educational materials which were all in English.  The facilitators and group members sing these songs during meetings. After three years of using these songs for educational and entertainment (edutainment) purposes , CRS has found this to be an effective way to communicate health information especially in communities where use of existing formal health services by expectant and lactating mothers is low.

“Sometimes, it is very difficult to communicate certain information about health, but that’s not the case with a song,” said Adisa Yaakurugu, a traditional birth attendant. “You just sing and it engages their attention to whatever issues that are being emphasized. It also encourages some women who are reluctant in attending meetings to come out and participate in the meetings.”

 Zima Adam has benefited from this activity. Zima attended seven sessions when she was pregnant. She was confident to say, “From the sessions, I was motivated to attend ANC [antenatal care] regularly. I took all my medications and I made all preparations to ensure I deliver at the facility. I now have a healthy baby girl.”

OTHER CRS RESOURCES

1. Ghana Country Page