Improving healthcare in rural communities of Armenia through nurse training and community partnership: Results of Project NOVA evaluation

Background

Building a strong primary healthcare (PHC) system in Armenia is a key government priority. Rural Armenia's PHC is provided mostly at health posts (HPs) operated by community nurses, most of whom have few training or professional development opportunities after college; thus, they not performing to standard and contribute to the overall poor PHC quality, along with poor physical conditions at HPs and lack of medical equipment and supplies. USAID Project NOVA conducted Safe Motherhood Clinical Skills (SMCS) training of 186 nurses from northern regions and equipped their HPs with basic equipment and supplies. Also, 60 rural communities received the full package of NOVA interventions, including an additional component of community mobilization and education initiative called Community Partnership for Health (CPH). Changes in nurses' performance and HP utilization were evaluated six months after completion of NOVA interventions.

Methods

A survey of all HPs and nurses' performance was conducted at the baseline. The end-line assessment was conducted in a sample of facilities that received SMCS and full NOVA interventions. Checklists with routine antenatal, postpartum and infant care tasks measured community nurse performance. Registers and medical journals were audited to calculate average annual number of visits to HPs.

Results

Nurses who completed SMCS training and received equipment and supplies performed 82% more antenatal care tasks correctly as compared to baseline. Also, nurses engaged in the CPH initiative performed 29% more tasks correctly than nurses who received only SMCS training, equipment, and supplies.

Comparison of baseline and end-line data also suggests an increase in maternal and child health (MCH) service utilization at rural HPs: HP utilization for antenatal care increased six-fold in communities receiving full NOVA interventions and four-fold in communities where HP nurses received only SMCS training, equipment and supplies.

Conclusions

Following any NOVA interventions, HP utilization and nurse performance improved significantly. However, following the comprehensive set of NOVA interventions—including the CPH initiative—brought better results in both utilization of PHC services in rural areas and performance of community nurses in antenatal, postpartum and infant care. In time, these results will contribute to improved MCH health outcomes in rural Armenia.