Sustainability and Scale of the Saving Mothers, Giving Life Approach in Uganda and Zambia

Community normative change

Behaviors

Demand for quality services

Social norms

How has the % of deliveries in health facilities changed?

Is there a change in proper use of and demand for waiting shelters?

What % of women/families had a birth preparedness plan, saved money, and pre-arranged for transportation?

How has the use of vouchers in Uganda changed and been institutionalized?

What is the evidence of local customs/norms changing?

How has male engagement in birth planning and maternal health changed?

What is the sustained level of engagement of community health cadres for normative change (SMAGs in Zambia, VHTs in Uganda)?

Is there evidence of prolonged leadership of “change champions” in the community?

Governance, leadership and accountability

Willingness to champion change

Planning/coordination

Policies and governance

Civil society engagement

Private-sector engagement

Public access to information

Are there national or local champions that emerged from SMGL who successfully advocate for improved maternity services?

How has SMGL influenced changes in government policies and guidelines that are critical to long-term improvements in maternal and newborn survival?

At the national level, which guidelines, policies, or tools were updated? Has the implementation of policies been institutionalized at the lower level to sustain the benefits to maternal and newborn health?

Has the role of the community workers/VHTs in ensuring women are linked to appropriate care been institutionalized?

Will the role of the private sector in providing maternal and newborn health services continue after SMGL? Has the government established public–private partnerships?

What evidence exists of change in public access to information on maternal and newborn health at the district level or below?

Has the role of the community workers/VHTs in ensuring women are linked to appropriate care continued after SML?

Health system and service delivery

Service delivery

Human resources for health

Commodity security

Quality management

Have signal functions—such as newborn resuscitation, administration of anticonvulsants and oxytocics, cesarean section, and manual removal of placenta for EmONC and CEmONC—been institutionalized?

Has the government scaled up the district systems strengthening approach/key components of SMGL? Which components has the government picked up?

Has there been a transition of SMGL-supported human resources to government positions or has the government at the district level started to fund the SMGL-contracted positions? To what extent?

Has the government picked up the funding of lifesaving drugs such as oxytocin and commodities such as balloon tamponades or anti-shock garments to prevent and or treat postpartum hemorrhage and eclampsia?

Has the government institutionalized some type of district/health facility assessments/quality assurance approach to use as the basis of planning and budgeting?

Is the blood supply for transfusion adequate? Is fresh frozen plasma available?

Strategic investments, efficiency, and sustainable financing

Domestic resource mobilization (capital investments and recurring costs)

Technical and allocative efficiencies

Has there been an increase in domestic financial resources for maternal and newborn health in SMGL-supported districts to continue the quality of services?

Has the government budgeted and allocated funding for the scale-up of the SGML approach in other districts? Have they included funding considerations for both capital investments and recurring costs?

What key components were taken to scale by the government?

What components of SMGL were eliminated or reduced as they were not affordable or cost-effective? Was there any study on efficiency or cost-effectiveness?

Did SMGL influence planning of Ministry of Health resources or improve technical/allocative efficiencies?

Strategic information

Epidemiological and health data

Financial/expenditure data

Performance data

Were maternal death audits institutionalized?

Were data reviews institutionalized?

After SMGL, how are districts/facilities continuing to use data to improve maternal and newborn outcomes?