Evaluating a Community Maternal Health Programme: Lessons Learnt

Abstract Using the example of a community-based health promotion intervention, this paper explores the important triangle between health promotion theory, intervention design, and evaluation research. This paper first outlines the intervention and then the mixed-method evaluation. In 2007, a non-governmental organisation (NGO) designed and implemented an intervention to improve the uptake of maternal health provision in rural Nepal. A community-based needs assessment preceded this novel health-promotion intervention that empowered women with information on the benefits of seeking care. The intervention had a flexible design and, at several points, the intervention’s progress was assessed and, where necessary, changes were made. The intervention targeted women of childbearing age and people (e.g. mothers-in-law and husbands) who influence these women’s ability to access health services. The intervention attempted to incorporate the diverse and changing needs of the local communities to make it more culturally appropriate (e.g. around traditions and beliefs linked to caste/ethnicity and socio-economic status) and to make the best of the existing resources whether these belong to the government or other NGOs. The research aimed to assess whether the planned health promotion activities improved maternal health service uptake. Greater access to maternal care should result in fewer women suffering from complications during childbirth, especially when complications are detected earlier and dealt with by skilled birth attendants. One key assumption was that health promotion would help improve knowledge, attitudes, and beliefs towards seeking care, especially during pregnancy complications. The programme ran for six years with the final evaluation in 2012.