by dynes chinyama-kaluba senior programme officer, mamaz , zambia

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By Dynes Chinyama-KalubaSenior Programme Officer, MAMaZ, Zambia

Responding to Demand side barriers to MNH in Zambia

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What?• MAMaZ focuses on tackling demand side

barriers to accessing maternal and newborn health care

Why?• High MMR and newborn mortality rates• Limited evidence of what works in addressing

demand side barriersHow?• Support districts to implement community

activities to increase knowledge and resources• Compile evidence of change and “impact”Where?• 6 districts: Choma, Serenje, Mongu, Chama,

Kaoma, Mkushi

Mobilising Access to Maternal Health Services in Zambia (MAMaZ)

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BEOC Intervention Sites

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Intervention Communities

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Objective

To improve access to routine and emergency maternal and newborn care through community-

based interventions

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Three Delays model:– The delay in the decision to seek care– The delay in getting to a facility– The delay in receiving medical attention

Key demand-side barriers:•Knowledge and attitudes – limited awareness of danger signs; some conflicting beliefs and practices

•Physical – long distances to facilities; challenging terrain; lack of transport

•Financial – lack of savings for emergency and routine costs

Barriers to receiving MNH care

Community Facilitators

Country DirectorAbdul Badru

Quality Assurance

Group (QUAG)

HPI office UK: Programme and finance

management support

Senior Programme Officer Dynes Kaluba Finance & Admin Officer

District Medical Offices

Drivers

District Programme

Officer, Serenje

District Programme

Officer, Mongu

District Programme

Officer, Choma

MAMaZ PROGRAMME STRUCTURE

Community Facilitators

Community Facilitators

District Programme

Officer, Mkushi

District Programme

Officer, Kaoma

District Programme

Officer, Chama

Safe Motherhood Action Groups (SMAGs)

Community Facilitators

Community Facilitators

Community Facilitators

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Intervention components

2. Community

Systems

1. Community Mobilization

4. Community Monitoring

3. Facility Based

Emergency TransportScheme

5. Mentoring

and Support

Access to Maternal and Newborn Care

Community Mobilization: Participatory Methods

Whole Body Communication: Severe Headache

Community Mobilization: Danger Signs

Whole body communication: “Hand or foot comes first”

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Volunteers and other community members

follow-up on discussion group issues and visit pregnant women and newly delivered mothers

Community Mobilization: Follow-up Support

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Component 2: Community Systems

2. Community Savings scheme

1. Emergency Transport Scheme

3. Safe Pregnancy Plan

4. Mothers’ Helpers

6. ‘Food Bank’

5. Child Minding Scheme

Community

Systems

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Aim: To provide a reliable means of transport for patients from community to health facility

Several options, depending on terrain:

• Oxcarts and donkey-driven carts• Suitable for Mongu, Kaoma and Choma where

bicycle ambulances cannot work

Community Emergency Transport Scheme

Bicycle Ambulance and Ox Cart

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Once other community systems are in place, pregnant women are supported to develop safe delivery plans

Safe Pregnancy Plans

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Targeting mothers’ shelters

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Component 3: Facility based ETS: Motorcycle Ambulance

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• To generate information on community activities

• The system is participatory

• Strengthening communities’ capacity to document and reflect on changes

• Evidence from other contexts shows that community monitoring helps promote sustainability

Component 4: Community Monitoring System

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Thank You