TABLE 1.

SMGL Interventions to Reduce the Third Delay, 2011–2016

Strategies and Approaches	Country-Specific Interventions^a
Strategies and Approaches	Uganda	Zambia
Strategy 1. Ensure facilities have adequate infrastructure to provide EmONC
Approach 1.1: Support expansion and renovation of operating theaters and facility enhancements to accommodate additional deliveries	Renovated and upgraded operating theaters Increased the size of labor rooms Provided additional delivery beds to allow more women to deliver in facilities and stay longer postpartum	Supported renovation of birthing centers, delivery rooms, and maternity annexes Provided additional delivery beds to allow more women to deliver in facilities and stay longer postpartum
Approach 1.2: Support facility enhancements to improve neonatal survival	Procured incubators, infant warmers, and phototherapy lamps Renovated infrastructure to have designated space for KMC and to create NICUs	Refurbished dedicated KMC rooms at hospitals
Approach 1.3: Support improved access to electricity and water	Provided safe water systems at health facilities Provided solar panels at facilities to improve continuity of access to electricity and light	Improved lighting systems for delivery rooms Improved piped water to maternity annexes
Strategy 2. Ensure sufficient medical supplies, equipment, and medications
Approach 2.1: Strengthen supply chains for essential supplies and medicines	Procured essential medication and backup supply of commodities for all sites on the SMGL project Redistributed supplies between health facilities to reduce stock-outs Implemented SMS reminder system to ensure timely drug ordering Equipped health centers with BEmONC equipment and supplies	Procured essential emergency medications and supplies with backup Trained staff in eLMIS Equipped health centers with BEmONC equipment and supplies Assembled and distributed uterine balloon tamponade kits, and CPAP machines
Approach 2.2: Strengthen availability of blood supplies and surgical equipment	Strengthened and maintained the blood supply system in CEmONC sites and supported new regional blood bank Provided new blood refrigerators Procured and distributed new surgical equipment to facilities	Procured and distributed centrifuges, refrigerators, and freezers to support blood bank Procured and distributed new surgical equipment to facilities
Strategy 3. Ensure sufficient trained health care providers at facilities
Approach 3.1: Recruited staff	Recruited new medical doctors and nurse/midwives through a joint hiring process with the districts	Recruited new nurse/midwives
Approach 3.2: Trained health professionals in emergency obstetric care, including obstetric surgeries	Trained medical officers, anesthetic officers, and midwives/nurses in CEmONC Conducted surgical skills course for medical officers, including decision making and caesarean section Trained providers on neonatal resuscitation/HBB and used drills to reinforce lessons	Trained doctors, nurses, midwives, and anesthetists in EmONC, clinical decision making, obstetric complications, hemorrhage management with uterine balloon tamponade, early HBB, and CPAP Limited rotation of trained providers to different wards Supported capacity building of laboratory staff for blood services
Approach 3.3: Provided mentoring and supportive supervision to newly hired and existing personnel	Conducted individual clinical mentorship sessions Provided selected nurses with intensive hands-on clinical skills placement to expand NICU skills	Trained district mentorship teams who then held monthly on site health facility staff training and mentorship visits on normal delivery and partograph use, EmONC, and HBB
Strategy 4. Improve quality of care and ensure care is evidence-based
Approach 4.1: Implemented quality, effective interventions to prevent and treat obstetric and newborn complications	Provided quality improvement practice to increase partograph use Implemented KMC	Introduced emergency kits and logs/registers to facilitate quick access to emergency supplies Implemented partograph use by facility staff Enhanced infection prevention practices
Approach 4.2: Introduced sound managerial practices using ‘short-loop' data feedback and response to ensure reliable delivery of quality essential and emergency maternal and newborn care	Incorporated concepts related to respectful maternity care into customer care training of midwives Used facility-generated data to review quality of care and implement practice changes	Incorporated respectful maternity care into EmONC and early newborn care and supported it through mentorship
Approach 4.3: Developed guidelines and policies, and ensured protocol adherence	Developed national standards for MDSR that were informed by SMGL processes Implemented BABIES matrix to prevent perinatal deaths by using data to guide actions	Developed clinical guidelines and protocols for diagnosing and managing most common obstetric emergencies Contributed to the development of the newborn health framework and guidelines Created standardized clinical forms to guide providers in recognizing danger signs and diagnosing the most common obstetric emergencies Introduced laminated checklists for quick reference in delivery rooms
Strategy 5. Ensure referral capacity exists to support transfers to higher-level care
Approach 5.1: Improved referral communication systems	Introduced ambulance referral forms to better track referrals Set up and supported district ambulance committees to work on referral-related issues Procured and maintained landline phones for facilities and mobile phones for village health workers	Used referral forms to improve communication between health centers and hospitals Set up and supported district ambulance committees to work on referral-related issues. Repaired and maintained 2-way radios at health facilities. Improved communications through the SMS and Remind-mi mHealth program (local communication programs)
Approach 5.2: Support increased transportation between facilities with motor vehicles or ambulances	Procured ambulances (vehicle and tricycle)	Procured ambulances (vehicle and motorcycle)
Strategy 6. Support effective maternal and perinatal health surveillance
Approach 6.1: Strengthen maternal and perinatal mortality surveillance in facilities and communities	Trained providers on MPDSR Set up MPDSR system, including committees to identify and understand maternal and newborn mortality at facilities and in communities Strengthened prospective health facility surveillance through the MOH DHIS2 Set up POMS and RAPID to understand facility maternal and perinatal mortality Developed national standards for MDSR that were informed by SMGL processes	Established MDSR including verbal autopsies at facilities with a community component Conducted MDR trainings for the district medical officer and health facility staff Supported MDR at facilities
Approach 6.2: Promote a government-owned HMIS data-gathering system to accurately record every birth outcome, obstetric and newborn complication, and treatment at facilities	Trained providers and implemented BABIES matrix Strengthened prospective health facility surveillance through the MOH DHIS2 Set up POMS	Supported national MDSR processes and expansion of MDSR to SMGL districts

↵a This list is not exhaustive and activities noted may apply to more than one approach.
Abbreviations: BABIES, birth weight and age-at-death boxes for an intervention and evaluation system; BEmONC, basic emergency obstetric and newborn care; CEmONC, comprehensive emergency obstetric and newborn care; CPAP, continuous positive airway pressure; DHIS2, District Health Information System 2; eLMIS, Electronic Logistic Management Information System; EmONC, emergency obstetric and newborn care; HBB, Helping Babies Breathe; HMIS, Health Management Information System; KMC, kangaroo mother care; MDR, maternal death review; MDSR, maternal death surveillance and response; MOH, ministry of health; MPDSR, maternal and perinatal death surveillance and response; NICU, neonatal intensive care unit; NSCU, neonatal special care units; POMS, pregnancy outcome monitoring surveillance; RAPID, Rapid Ascertainment Process for Institutional Deaths; SMGL, Saving Mothers, Giving Life; SMS, short message service.