Figures & Tables
Figures
- FIGURE 1
SMGL Theory of Change Model
Abbreviations: EmONC, emergency obstetric and newborn care; MCH, maternal and child health; MDSR, maternal death surveillance and response; MMR, maternal mortality rate; NMR, neonatal mortality rate; SMGL, Saving Mothers, Giving Life; USG, U.S. government.
- FIGURE 2
Scale-Up of SMGL Approach in Zambia, 2016–2021
Abbreviations: COC, continuum of care; RMNCAH/N, reproductive, maternal, newborn, child, adolescent health and nutrition; SMGL, Saving Mothers, Giving Life.
- FIGURE 3
Scale-Up of SMGL Approach in Uganda Through World Bank Support, 2016–2021
Abbreviation: SMGL, Saving Mothers, Giving Life
- FIGURE 4
Scale-Up of SMGL Approach in Uganda Through Regional Health Integration to Enhance Services, 2012–2022
Abbreviations: UBOS, Uganda Bureau of Statistics; URMNCAH, Uganda reproductive, maternal, newborn, child, and adolescent health.
Mothers wait with Safe Motherhood Action Group member at Lundazi Urban Health Centre, Zambia. © Amy Fowler/USAID
A service provider examines a client at the SMGL-supported Kakumiro Health Center in Uganda. © Amy Fowler/USAID
Tables
Domains Prompts/Questions for Ministry of Health Staff, Leadership, and Decision Makers at National, Provincial, and District Levels 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?
Abbreviations: CEmONC, comprehensive emergency obstetric and newborn care; EmONC, emergency obstetric and newborn care; SMAG, Safe Motherhood Action Group; SMGL, Saving Mothers, Giving Life; VHT, village health team.
Stakeholders KIIs on Sustainability of SMGL
(No.)Participants in Group Interviews on Sustainability
(No.)U.S. Government, field Uganda 4 0 Zambia 6 0 Host government, national Uganda 4 3 Zambia 2 0 Host government, subnational Uganda 7 0 Zambia 4 38 In-country partner Uganda 7 8 Zambia 5 0 Total 39 49 Abbreviations: KIIs, key informant interviews; SMGL, Saving Mothers, Giving Life.
Uganda Zambia % change in institutional delivery rate (2012–2016) 47% increase
(from 45.5% to 67%)44% increase
(from 63% to 90%)# trained SMAGs/VHTs reporting to health center (cumulative individuals trained from baseline) 11,189 13,658 # of change champions N/A 35023 % of all institutional deliveries in SMGL-supported original districts supported by transport vouchers (2012–2016) 24% N/A % change in number of facilities with a maternal waiting shelter from 2012 to 2016 N/A 69% increase Abbreviations: HFA, health facility assessment; N/A, not available; SMGL, Saving Mothers, Giving Life; VHT, village health team.
aData from HFAs unless otherwise noted.
- TABLE 4.
HFA Data on Health Systems and Service Delivery in Original 8 SMGL Districts, 2012–2016
Uganda Zambia Baseline Endline Baseline Endline Infrastructure – facilities with electricity 56% 96% 57% 93% Infrastructure – facilities with running water 75% 100% 90% 97% No stock-out of medicines – oxytocin 56% 82% 75% 75% No stock-out of medicines – magnesium sulfate 48% 64% 20% 43% Population-based cesarean delivery rate 5.3% 9.0% 2.7% 4.8% 24 hours a day/7 days a week services at facilities 78% 89% (NS) 65% 96% Facilities with available transportation (vehicle or motorcycle) 61% 59% (NS) 55% 73% Facilities with communications equipment 93% 99% 45% 100% Abbreviations: HFA, health facility assessment; NS, not significant; SMGL, Saving Mothers, Giving Life.
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