Slide 1

Increasing Utilization of Maternal HealthServices through targeted CommunityInterventions in Malawi

Anna Chinombo MSc. Nursing; Save the Children MCHIP

Fannie Kachale MSc. Nursing; MoH

Tambudzai Rashidi MSc. RH; MCHIP

Aleisha Rozario MPH; MCHIP

Session Outline

Background information

Program Goal and objective

Community Level Results

The Community MNH model

Results and Lessons Learned

Malawi Country Indicators

Population=13 million

MMR=807/100,000 live births (4,624 / year; 13 / day

NMR=33/1,000 live births (18,900 / year; 52 every day)

CPR=38%

TFR=6.3

Skilled Birth Attendance = 54%

Women attending 4 ANC visits = 57%

Mother/infants receiving postnatal care within 2 days =57%

(Source MICS 2006)

Source: MICS 2006

Contributing factors:

Delay in deciding to seek care

Delay in reaching a health facility

Delay in receiving care at health facility

The first two delays occur at community level wherecultural beliefs and harmful MNH practices arewidespread

Program Goal

Accelerate the reduction of maternal and neonatalmorbidity and mortality towards the achievements of theMillennium Development Goals (MDGs)

Program Objective

Increased utilization of MNH services and practice ofhealthy maternal and neonatal behaviors

Community Level Results:

Increased adoption of household behaviors thatpositively impact the health of mothers andnewborns

Increased availability of community-based MNHservices through Health Surveillance Assistants

Program Coverage

4 of 28 Districts: 12 of66 Health Centres

Population coverage:232,326 (30% of totalpopulation for the 4districts)

The program is alsobeing piloted in 3 SNLsupported

The Community MNH Model:Comprise 2 interventions:

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Antenatal and postnatal homevisits

Motivate and encouragefocused antenatal care; healthfacility delivery, postnatal care,newborn care; and otherfacility services

Counseling / Health Educationon PMTCT , nutrition, birthpreparedness / complicationreadiness, essential newborncare

Screen for Danger Signs andRefer for health facilityservices

Intervention 1. The Community MNH package

Intervention 2: Community Mobilization

Health SurveillanceAssistants are trained toestablish “core groups”known as CommunityAction Groups of MNHchampions in thecommunity to lead inmobilizing theircommunities to practicehealthy MNH behaviorsusing the CommunityAction Cycle

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PREPARE THE

COMMUNITY FOR

ACTION

EXPLORE MNH

ISSUES &

SET

PRIORITIES

PLAN

TOGETHER

ACT

TOGETHER

EVALUATE

TOGETHER

The Community Action CycleThe Community Action Cycle

PREPARE TO

MOBILIZE

Achievements:

A total of 145 CAGs were established in 764 villages

60% taking a leading role in MNH.

Each CAG is different depending on the community and identifiedproblems.

Some CAGs accomplishments include:

- In one district, neighboring villages collaborated to raise some money,molded and burnt some bricks and assembled sand for constructionof a maternity wing at the nearest health center.

- Organized an open day and invited the District Assembly and DistrictHealth Management Team (DHMT). They used this podium toexplain the problems they encounter at the HC and what they havedone to help ease the problem and requested the invited guests forassistance

Cont.

- CAGs are instrumental in sensitizing communities’ to deal withharmful cultural beliefs and practices (e.g. home deliveries)through dramas, community meetings, prescribing fines forharmful practices. CAGs conduct home-based follow up

- 30% have written proposals for bicycle ambulances to solvetransport problems for emergencies

- 20% came up with IGAs and use the money to assist poorwomen to access facility based MNH services e.g. buyingnew wrappers. (Some women fail to go for MNH services ifthey have only one torn wrapper. They fear being laughed atby other women)

- 10% Come up with vegetable gardens to encourage goodnutrition

- All CAGs keep data on pregnancies and pregnancy outcomes