Abstract
The Cotopaxi, Ecuador, Essential Obstetric and Neonatal Care (EONC) project attempted to establish a comprehensive, sustainable provincial-level network, coordinating disparate EONC services, strengthening linkages between the levels of care (community, sub health post, health post, health center and hospital) and related services, focussed on the 21 poorest, most indigenous parishes in Cotopaxi with the specific objectives of: (1) improving access to and use of care; (2) improving knowledge and demand for evidence-based EONC; (3) improving the quality of maternal and newborn care and best practices; and (4) influencing the policy environment for coordination, expansion and sustaining project improvements. This final evaluation describes the project processes, their implementation and challenges, and their influence on improving EONC. It was tailored to address the interests and needs of the Ministry of Health (MOH), USAID and USAID child survival and health grants program stakeholders. The key accomplishments of the project are: (1) the project increased its principal outcome of postpartum and postnatal visits within 2 days of birth for the four vulnerable, marginalized intervention counties and Cotopaxi Province, thus improving equitable access to, utilization of, and availability of this critically important care, focused on a time during which most neonatal mortality occurs, through a continuum of high-impact community- and facility-based maternal newborn services through a coordinated network of TBAs, health facilities and social organizations; (2) the project also achieved its objective to improve numerous household maternal newborn best practices, including exclusive breastfeeding, recognition of postpartum and newborn MN danger signs, knowledge of newborn best practices, presentation of referral for complications from home to facility and satisfaction with services; (3) there was extensive and systematic improvement in adherence with maternal and newborn care evidence base standards and TBA knowledge and skills observed at the household and facility levels; and (4) the EONC network project was extremely successful in generating interest and promoting a favorable policy environment, ensuring that the project accomplishments will be sustained and scaled up. The Ministry of Public Health has created a national policy and dedicated budget, and assumed responsibility for the expansion, implementation and sustenance of the project's EONC Network model to the entire country, as specified in the MOH 2013 Norms). (Excerpt, modified)