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ORIGINAL ARTICLE
Open Access

Community Perspectives of a 3-Delays Model Intervention: A Qualitative Evaluation of Saving Mothers, Giving Life in Zambia

Alice Ngoma-Hazemba, Leoda Hamomba, Adam Silumbwe, Margarate Nzala Munakampe and Fatma Soud on behalf of the Saving Mothers, Giving Life Working Group
Global Health: Science and Practice March 2019, 7(Supplement 1):S139-S150; https://doi.org/10.9745/GHSP-D-18-00287
Alice Ngoma-Hazemba
aDepartment of Community and Family Medicine, School of Public Health, University of Zambia, Lusaka, Zambia.
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  • For correspondence: alicengomah@gmail.com
Leoda Hamomba
bDivision of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Lusaka, Zambia.
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Adam Silumbwe
aDepartment of Community and Family Medicine, School of Public Health, University of Zambia, Lusaka, Zambia.
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Margarate Nzala Munakampe
aDepartment of Community and Family Medicine, School of Public Health, University of Zambia, Lusaka, Zambia.
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Fatma Soud
cCenters for Disease Control and Prevention, Lusaka, Zambia. Now an independent consultant, Gainesville, FL, USA.
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    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 InitiativeStrengthsChallenges and Unintended ConsequencesRecommendations/Steps for Future Interventions
    First Delay:
    Decision to seek care
    • Traditional 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 facilities
    • Distance 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 facility
    • Not 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

  • Tables
  • 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
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Global Health: Science and Practice: 7 (Supplement 1)
Global Health: Science and Practice
Vol. 7, No. Supplement 1
March 11, 2019
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Community Perspectives of a 3-Delays Model Intervention: A Qualitative Evaluation of Saving Mothers, Giving Life in Zambia
Alice Ngoma-Hazemba, Leoda Hamomba, Adam Silumbwe, Margarate Nzala Munakampe, Fatma Soud
Global Health: Science and Practice Mar 2019, 7 (Supplement 1) S139-S150; DOI: 10.9745/GHSP-D-18-00287

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Community Perspectives of a 3-Delays Model Intervention: A Qualitative Evaluation of Saving Mothers, Giving Life in Zambia
Alice Ngoma-Hazemba, Leoda Hamomba, Adam Silumbwe, Margarate Nzala Munakampe, Fatma Soud
Global Health: Science and Practice Mar 2019, 7 (Supplement 1) S139-S150; DOI: 10.9745/GHSP-D-18-00287
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