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Table 1 CBIO+ explained

From: Reducing inequities in maternal and child health in rural Guatemala through the CBIO+ Approach of Curamericas: 8. Impact on women’s empowerment

The CBIO+ Approach is an expansion of CBIO. It is composed of three components: (1) the Census-Based, Impact-Oriented (CBIO) Approach, (2) the Care Group Approach, and (3) the Community Birthing Center Approach. CBIO consists of conducting with the community a census, registering all households, identifying local epidemiological priorities and the health priorities according to the local people, developing and executing a plan to address these priorities, and assessing over time whether the health of the population has improved [33]. All of this is accomplished through partnerships with the community, collection of local data, and routine systematic home visitation guided by census registers to collect data, including vital events, and to deliver services. Further descriptions of the CBIO approach and its effectiveness are available [34,35,36,37,38].

The Care Group Approach is, in a sense, an extension of CBIO that involves the selection of one female Care Group Volunteer for every 10–15 households with a mother of young child. Then, 5–12 Care Group Volunteers meet with a Care Group Promoter every 2–4 weeks to learn 1–2 educational messages to share with the mothers in the catchment area for each Care Group Volunteer, either by visiting each home separately or meeting as a group. At the subsequent meeting, the Promoter teaches them a new message and the Care Group Volunteers report pregnancies, births and deaths to the Promoter [28]. Further descriptions of the Care Group Approach and its effectiveness are available [39,40,41,42].

The Community Birthing Center Approach, as developed by Curamericas/Guatemala, is a participatory approach that involves working with communities to construct, staff and operate a readily available local facility where mothers can give birth in a way that respects traditional customs and enables the traditional midwife (called a comadrona in the Project Area) to perform her traditional role. These centers are staffed 24/7 by auxiliary nurses with special additional training in midwifery and supervised by an experienced obstetrical graduate nurse who is based at one of the birthing centers and is available by phone to support the other birthing centers. Connected to each birthing center is an emergency transport system to provide prompt referral to a hospital should the need arise. Also associated with the birthing center is an insurance system that pregnant women and their families can contribute to during the pregnancy to offset to cost of transport if a referral is needed. Further descriptions of the Community Birthing Center Approach are available [23].