Implementation of Mother Support Group Programs in Sri Lanka Público

Abstract

Background: Child undernutrition is a public health problem in Sri Lanka. Despite numerous nutrition interventions, the prevalence of stunting, wasting and underweight remains high. In 2015, UNICEF funded a community based health promotion approach to address undernutrition. In this program, mother support groups were formed where the community played an active role in identifying and addressing the causes of undernutrition.

Project Goal: The overall aim of this study was to understand the implementation of mother support group (MSG) programs in Sri Lanka with specific focus on understanding facilitators and barriers, and health workers' attitudes and motivation towards such programs.

Methods: A cross-sectional qualitative study was conducted in Anuradhapura, Kandy, Badulla and Moneragala districts of Sri Lanka. In-depth interviews with UNICEF and government program staff, and focus group discussions with Public Health Midwives' (PHMs) were done to understand their experiences and perspective regarding MSG programs.

Results: A conceptual framework was developed to show the key personnel and the relationship between various factors that may influence the success or failure of mother support group programs in Sri Lanka. The framework consists of four main parts: cycle of motivation, external support, contextual influences and the intervention. Some facilitators are mothers' interest in MSG topics, and PHMs' openness to new approaches, while some barriers are lack of support from estate managers and local companies. Health workers, MOHs and PHMs, were motivated to participate when they felt the program improved a child's weight gain, understood that MSGs could reduce their workload, or they felt appreciated for their work.

Conclusions/Recommendations: There are several situations and factors, ranging from individual choices to health worker training to contextual limitations, that influence the implementation of MSG programs. Information gained from this study may help inform the implementation of future MSG programs.

Table of Contents

Table of Contents:

Chapter 1: Introduction............................................................................................................. 1

Chapter 2: Literature Review...................................................................................................... 3

Sri Lanka - Country Profile......................................................................................................... 3

Sri Lanka's Health System.......................................................................................................... 4

Background to Under-nutrition.................................................................................................... 6

Prevalence of Child Malnutrition in Sri Lanka................................................................................. 8

Determinants of Child Malnutrition in Sri Lanka............................................................................. 9

Nutrition Interventions in Sri Lanka............................................................................................ 12

Mother Support Group Programs - Global Evidence....................................................................... 14

Sri Lankan Government: Mother Support Group program............................................................... 16

UNICEF funded Community Empowerment Program: Mother Support Groups.................................... 17

Chapter 3: Methods................................................................................................................... 20

Study Site................................................................................................................................ 20

Data Collection Methods............................................................................................................. 21

Recruitment............................................................................................................................. 21

Data Collection Preparation........................................................................................................ 22

Focus Group Discussions............................................................................................................ 23

In-depth Interviews.................................................................................................................. 23

Data Processing....................................................................................................................... 23

Ethical consideration................................................................................................................. 24

Data Analysis........................................................................................................................... 24

Chapter 4: Results.................................................................................................................... 26

Cycle of Motivation.................................................................................................................... 27

Public Health Midwives' Support.................................................................................................. 27

Mothers' Enthusiasm..................................................................................................................33

External support....................................................................................................................... 40

MOH Support............................................................................................................................41

Institutional Support..................................................................................................................45

Husbands' support.....................................................................................................................52

Intervention............................................................................................................................. 54

Contextual Influences................................................................................................................ 57

Perceived Impacts of MSGs........................................................................................................ 61

Summary of results.................................................................................................................. 66

Chapter 5: Discussion................................................................................................................70

Cycle of Motivation................................................................................................................... 71

Public Health Midwives' Support................................................................................................. 71

Mothers' Enthusiasm.................................................................................................................76

Impact....................................................................................................................................79

External support...................................................................................................................... 81

Contextual Influences............................................................................................................... 84

Strengths and Weaknesses of Study........................................................................................... 85

Future Recommendations for MSG programs............................................................................... 86

References.............................................................................................................................. 89

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Nutrition Health Sciences, Public Health
Palavra-chave	Mother Support Group South Asia
Committee Chair / Thesis Advisor	Young, Melissa Fox, Emory University
Partnering Agencies	Non-US governmental agency (e.g., Minister of Health in Haiti) International Non-governmental organization (e.g., CARE, Inc.)

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