Figures & Tables
Tables
- TABLE.
First Delay: Perception of Key Messages on Safe Motherhood to Increase Demand for and Use of Maternal and Newborn Health Services
Delay Defined in the Context of SMGL Initiative Strengths Challenges and Unintended Consequences Recommendations/Steps for Future Interventions First Delay:
Decision to seek careTraditional beliefs/cultural norms (belief that deliveries should be conducted in the presence of family elders if a problem was anticipated)
Lack of birth preparedness
Lack of male/spouse involvement in birth preparedness plans
Lack of community's understanding of danger signs during pregnancy and child birth
Perceived low quality of care at health facility
Challenges in deciding when to seek care
Increase community demand for MNH services Community sensitization using safe-motherhood health messages
Birth preparedness information given during ANC visits to encourage women and their families to financially plan for health facility use when needed
Involvement of men, chiefs, and headmen as “change champions”
Provision of pamphlets and education on “danger signs” during pregnancy and childbirth (e.g., postpartum hemorrhage, pre-eclampsia)
Engagement of community volunteers and SMAGs to assist with community mobilization to encourage health facility deliveries when needed
Health messages needed consistency and continuity to have full impact
Financial and resource challenges for families and program were reported
Overzealous chiefs enforced penalties on families not using health facilities for deliveries to put pressure on them
SMAGs needed sustained support systems to continue volunteering and assisting communities
MOH to increase funding for MNH programs to start with community engagement
Government stakeholders to continue collaborations to assist with collective funding for MNH programs
Engage Ministry of Chiefs and Traditional Affairs to assist with MNH agenda
Deliver health communication messages through radio and community drama programs to raise knowledge and awareness of danger signs and where to seek and use MNH care
Provide financial incentives for community volunteers
Second Delay:
Reaching the health facilitiesDistance to health facilities
Bad roads and difficulty of access, especially during rainy season
Lack of transportation
Lack of communication when transportation was needed
Increase access to high-impact MNH services Awareness to plan financially for communication and transportation to health facility
Government to improve road access and ambulances
SMGL program provided boats and ambulances
Community assistance from people with vehicles; reimbursements made for fuel
Health facility staff assisted with their mobile phones during emergencies
SMAGs provided with bicycles to assist women to go to the health facilities
Construction of MWHs
Impassable roads are still a challenge especially in the rainy season
Some roads through the game reserves were impassable
Vehicle breakdowns and maintenance needs were reported often
Mobile phone receptivity due to poor or unavailable network
Some SMAGs did not receive bicycles
MWHs used for other clinical services when empty
Continue to engage other government sectors, such as the Ministry of Transport and Communication
Program plans to include repair and maintenance of vehicles
Plan for training and reimbursement of drivers is imperative for programs
Delegate MWHs to SMAGs for maintenance through community cooperatives for sustained use
Third Delay:
Receiving care at the health facilityNot enough staff to handle number of patients
Lack of trained staff
Poor attitudes of staff
Lack of equipment and supplies
Improvements in quality of MNH services Improved staff capacity and attitudes through training and supportive supervision
Improved infrastructure of labor and operating rooms
Hired anesthetist and laboratory technicians
Obstetric/gynecologists reimbursed to provide mentoring and supportive supervision to new physicians
Nurse/midwives trained, mentored, and supervised in EmONC
Refresher courses in procurement/logistics of medicines and equipment
Improvement of referral policy and ambulance use
Provision of consumable supplies and equipment
Supported availability of blood and blood products within reach
Increased number of patients at health facilities
Failure of some equipment due to lack of maintenance and poor electricity supply
Supervision and placement of nurses and midwives not hired through the MOH became a challenge
Sustainability challenge to continue with staff salaries of hired midwives
Availability of policy and guidelines of MNH care
Adequate human resources
Improved infrastructure and maintenance as per demand
Training and supportive supervision for EmONC and mother-friendly services
Plan for continued procurement and repair of equipment
Referral monitoring and counter-referrals
Abbreviations: ANC, antenatal care; EmONC, emergency obstetric and newborn care; MNH, maternal and newborn health; MOH, Ministry of Health; MWH, maternity waiting home; SMAG, Safe Motherhood Action Group; SMGL, Saving Mothers, Giving Life.
Additional Files
Supplemental material
Files in this Data Supplement:
- Focus Group Discussion Guide: Community Volunteers (TBAs, SMAGs, CHAs) - Text s01, DOCX
- Focus Group Discussion Guide: Men Whose Wives/Partners Delivered at Home and Health Facility - Text s02, DOCX
- Focus Group Guide: Women Who Delivered at The Health Facility and at Home - Text s03, DOCX
- In-Depth Interview: Community Leaders/Influential People - Text s04, DOCX
- In-Depth Interview: Health Care Providers - Text s05, DOCX
- In-Depth Interview: Public Health Stakeholders - Text s06, DOCX
- Key Informant Interview Guide: Women Who Delivered at the Health Facility - Text s07, DOCX