Table 1 Community-level strategy for controlling hypertensive disorders in pregnancy using existing VHWs equipped with the Microlife VSA device
Strategy | Engage government to take ownership and leadership of the initiative | Build local capacity to implement and scale up the BP intervention through existing community health programs | Monitor pregnant rural women’s blood pressure and refer cases to health facilities | Supportive supervision for VHWs |
|---|---|---|---|---|
Actors | Investigators, implementers, and leadership of GSPHCDA | Consultant from teaching hospital, implementers | Village health workers | CHEW supervisors |
Actions | Pre-implementation meetings on rationale Official notification of LGA PHC offices and community structures of governance via the leadership of GSPHCDA. Procurement of CRADLE Micro VSA BP device by SFH. Engagement of consultant for trainings | Training workshop for: - 22 master trainers - 15 CHEWs - 412 VHWs CHEWs further trained on supportive supervision On-the-field refresher trainings for VHWs 4 weeks after the first training | Identify pregnant women in the community Monitor their blood pressure during scheduled home visits Refer pregnant women with abnormal blood pressure to a health facility | Supportive supervision to VHWs 1st week post-training Meetings with VHWs at least once a month to assess progress with implementing the intervention and address data management issues |
Target | Government leadership and ownership of the intervention Readiness to use intervention’s result for decision-making | Pool of local experts with the capacity to scale up or the intervention in the state VHWs competent in assessing pregnant women’s BP and offering appropriate referral advice | Improve coverage and access to quality obstetric services in hard-to-reach communities | Continued delivery of quality community level obstetric services through VHWs |
Temporality | Step 1 | Step 2 | Step 3 | Step 4 |
Dose | As needed | Two-day 16-h training for 22 master trainers Two-day 12-h training for VHWs and CHEWs in clusters of 40 participants per class Two extra hours training for CHEWs Three hours on the field refresher training for VHWs in clusters of five to seven participants | At least two new home visits per week Revisits occur within 4 weeks of the first visit | 1st supportive supervision done in the 1st week post-training, then once for each VHW in the first month after the training Then once a week for VHWs identified as having challenges |
Implementation outcomes addressed/affected | Adoption Capacity of government lead implementation Readiness of government to scale up the intervention | Master trainers—availability of local resource persons for scale-up of the intervention Master trainers, CHEWs, and VHWs awareness and knowledge of hypertension in pregnancy and management, using the Microlife VSA device VHWs Capacity to assess pregnant women’s BP and refer abnormal cases to a health facility using the Microlife VSA device Capacity of CHEWs to ensure fidelity of the implementation strategy | Penetration and acceptability of the intervention Productivity of VHWs | Quality of services delivered Fidelity of the implementation strategy |
Theoretical framework | Replicating effective programs (REP) framework for healthcare interventions | |||