Review
Strengthening implementation of the Maternal and Child Health Handbook for global maternal, newborn, and child health
2024 年 12 巻 1 号 p. 8-12
詳細
2024 年 12 巻 1 号 p. 8-12
The Maternal and Child Health (MCH) Handbook is an integrated home-based record format for maternal, newborn, and child health. “The WHO recommendations on home-based records for maternal, newborn, and child health (2018)” help country officers and experts to identify the value of home-based records including the MCH Handbook. It also indicates the importance of using home-based records effectively, as the benefits derived from them depend on the quality of their implementation.
In 2023, the World Health Organization, the United Nations Children’s Fund, and the Japan International Cooperation Agency published the implementation guide, “Strengthening implementation of home-based records for maternal, newborn, and child health”. The guide is designed around the key concepts of 1) the management cycle of a home-based record program and 2) a user-centered approach. Eight success factors for achieving optimal performance of home-based records are presented.
Researchers are expected to contribute to the effective implementation of the MCH Handbook by generating evidence for and conducting implementation research on the MCH Handbook. To ensure the effective implementation of the MCH Handbook in national health systems, professional associations should take a leadership role to involve health professionals.
In 2018, the World Health Organization (WHO) published “Recommendations on home-based records for maternal, newborn, and child health” (hereafter, “the guideline”).1) The guideline helps national health officials and professionals identify the value of home-based records for maternal, newborn, and child health and reminds them of the importance of using home-based records effectively, as the outcomes of using them depend on the quality of their implementation. The Maternal and Child Health (MCH) Handbook is an integrated home-based record format for maternal, newborn, and child health.2) When implemented effectively, the MCH Handbook is expected to benefit key users. In accordance with the guideline, the WHO, the United Nations Children’s Fund (UNICEF), and the Japan International Cooperation Agency (JICA) recently published the implementation guide, “Strengthening implementation of home-based records for maternal, newborn, and child health (2023)” (hereafter, “the guide”).3) This review briefly addresses the target population of the guide, how it is structured, and what it offers (Slide 1).
The guideline was launched at the official side event of the 2019 World Health Assembly as the first comprehensive guideline on home-based records for maternal, newborn, and child health (Slide 2). The WHO member states, namely Indonesia, Afghanistan, Kenya, Lao PDR, the Philippines, Myanmar, and others, jointly planned the side event. From Japan, JICA was involved, as were key partners such as UNICEF, and Save the Children.4) Why were the guideline developed and why did these countries have a voice?
A home-based record is a mobile written record of an individual’s health which is kept at home. It contains details regarding health and developmental status, care received, and vaccines administered, and comes in various forms, such as that for pregnancy, that for childhood vaccinations, or an integrated mother and child health record, such as the MCH Handbook. At least 163 countries have some kind of home-based record.
The continuum of care required for pregnancy, birth, and child health is to be provided in a variety of settings, including the home, primary health care facilities, and hospitals.5) The home-based record is a people-centered tool that ensures the continnum of care by enabling mothers and children to have their own data at hand (Slide 3). More countries than ever are interested in the examples of Japan and other countries that have long used the MCH Handbook as the national standard home-based record in their health systems, especially as a tool that can link care at this period of life.
In countries that wish to introduce the MCH Handbook, existing cards need to be integrated and replaced with the MCH Handbook. Indeed, many countries have immunization cards, and other cards as well, but often have difficulties in coordinating with stakeholders to integrate the cards and replace them with the MCH Handbook. One reason behind this is that different programs and stakeholders do not have the same perception of the value of home-based records. Therefore, it was considered important to first confirm the value of home-based records and share it among programs and stakeholders.
The guideline was developed by three relevant WHO departments relating to maternal and child health, immunization, and reproductive health, and provides two recommendations. The first recommendation is to encourage the use of home-based records for maternal and child health, namely to improve care-seeking behaviors, male involvement and support in the household, maternal and child home-care practices, infant and child feeding, and communication between health workers and women, parents, and caregivers (low-certainty evidence). The second is the remaining challenges to further promote home-based record use. The guideline notes the lack of information regarding which record format is better than others and highlights the importance of the effective implementation of home-based records.
Countries often face common problems that hinder the effective implementation of home-based records. These include frequent stockouts, inadequate use by health workers, low retention rates by women, parents, and caregivers, and content and design not meeting users’ needs. For example, according to the immunization program, 77 countries reported stockouts of vaccination forms, including the MCH Handbooks, during the period spanning 2014–2020, with 48 of these countries experiencing stockouts over multiple years.7)
A guide for strengthening implementation was therefore developed to support decision-making and efforts to strengthen the implementation of home-based records through planning, design, implementation, and monitoring processes. The targeted audience is program managers and stakeholders in each country and region (Slide 4).
The guide was created based on tools used in each country and feedback from country representatives. JICA shared hundreds of tools and feedback, resulting in the current version of the form.
1. Key conceptsFirst, the guide is structured around the management cycle of home-based record implementation and consists of seven chapters. It is designed to enable readers to select the sections needed. Second, the guide takes a user-centered approach. For home-based records to achieve their purpose, they should respond to the needs of three main user groups: i) women, parents, and caregivers, ii) health workers, and iii) program managers. The guide shows how to learn more about these three user groups, engage them effectively, use information at each stage of the program management cycle, and make decisions that address their needs.
2. Factors for achieving optimal use and performanceWhile home-based records help minimize missed opportunities for service provision, such as child vaccination, they have not necessarily been used optimally.8) Based on a scoping review of the guideline, eight success factors were identified for achieving optimal use and performance of home-based records: i) high-level support; ii) coordination mechanisms; iii) home-based record content; iv) printing and distribution; v) budget and funding; vi) being valued by health workers; vii) being valued by women, parents, and caregivers; and viii) monitoring. These factors help ensure that efforts to strengthen home-based records achieve their intended impact. Attention to these factors throughout the program management cycle will help track progress in home-based record implementation, leading to their optimal use and performance.
3. Examples of using the guideAs a reference, the necessary sections can be taken from the guide. Boxes are provided to elaborate on key topics with national examples. Activities and works are also provided to support necessary decisions. Alongside the activities and works, templates for working with stakeholders are provided. For example, the template for assessing the performance of operational support processes (p37) can be used to review the MCH Handbook implementation process; it is expected to be used to discuss the current state with stakeholders and to promote the analysis of facilitators, inhibitors, responsibilities, and initiatives needed for the future.
As a case of Burundi, the Ministry of Health used this template in a review of the operational process of the MCH Handbook. Several departments then came together at a workshop to analyze the operational process of the MCH Handbook, and noted that the guide helped them discuss operational challenges with different departments and programs.9)
Home-based records are an integral part of interventions to support the health and well-being of women and children, are supportive of a life-course approach for programming, and are records of valuable information for different users. In connection with the release of the guideline, several WHO guidelines suggest the use of home-based records for positive experiences and family involvement in antenatal care, postnatal care, care for preterm or low-birth-weight infants, and self-care. There may be further opportunities to use home-based records to support early childhood development.
To strengthen the implementation of the MCH Handbook for the health and well-being of mothers, newborns, and children, researchers can contribute by generating evidence regarding the value of the MCH Handbook and conducting research on its implementation. In most countries which use the MCH Handbook, health professionals in hospitals and private practitioners are expected to be more involved in the implementation of the MCH Handbook. Professional organizations are expected to take a leadership role in promoting the effective implementation of the MCH Handbook.
The abstract of this manuscript was presented at the Workshop of the 22nd Congress of the Federation of Asia and Oceania Perinatal Societies. I would like to thank Professor Mamoru Tanaka for giving me the opportunity to present this research, and Drs. Yasuhide Nakamura and Satoru Takeda for their efforts as chairpersons of the workshop at the Congress.
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