Addressing the First Delay in Saving Mothers, Giving Life Districts in Uganda and Zambia: Approaches and Results for Increasing Demand for Facility Delivery Services

Displayed posters with SMGL messages in public places to promote safe motherhood

Held talk shows on local radio stations with technical experts and local leaders (political and religious local leaders, local safe motherhood champions)

Supported local drama groups to perform skits and traditional songs on safe motherhood, raise awareness of danger signs in pregnancy, and promote facility delivery

Broadcasted targeted radio messages, including spots directed specifically to encourage men to actively support their pregnant partners in seeking care

Conducted drama performances to increase knowledge about and demand for delivery services and access to care

Created and screened a documentary film “Journey to Becoming a Parent”

Ensured that all SMGL-supported facilities have VHTs trained in accordance to the national training curriculum

Mobilized health facility staff, including district coordinators, to supervise the implementation of activities performed by VHTs

Ensured all SMGL-supported facilities had trained SMAGs

Mobilized health facility staff, including district coordinators, to supervise the implementation of activities performed by SMAGs

Trained VHTs to conduct RAMOS data collection in 2012, 2013, and 2017

Trained VHTs to conduct maternal and perinatal death surveillance in their communities

Ensured that SMAGs reported to health facilities on community events (pregnancies, home births, maternal deaths, and stillbirths)

Birth preparedness and knowledge of pregnancy danger signs

Use of ANC and PNC services

Awareness and use of facility-based delivery services

Trained VHTs in every village to provide health education on birth preparedness and pregnancy danger signs

Trained VHTs to encourage women to start ANC early, attend at least 4 ANC visits, deliver in a health facility, and use PNC services

Supported VHTs to escort women to deliver in a health facility

Trained health facility workers to conduct community dialogue meetings, including meetings that sensitized TBAs about danger signs of obstetric complications, and engaged them in emergency facility referrals

Trained SMAGs to provide health education on birth preparedness and pregnancy danger signs

Trained SMAGs to encourage women to start ANC early, attend at least 4 ANC visits, deliver in a health facility, and use postnatal care services

Supported SMAGs to escort women to delivery in a health facility

ANC visits

HIV counseling and testing

Postpartum home care for mothers and newborns

Postpartum family planning

Trained VHTs to perform follow-up postnatal visits for mothers and newborns, identify women and newborns with danger signs, and conduct referrals to health facilities when danger signs are identified

Organized clinic community outreach to provide ANC, health education, HIV counseling and testing, immunizations, and male involvement education sessions

Selected religious, political, and cultural leaders became champions for promoting utilization of maternal and newborn health services

Trained “Mama Ambassadors” to set up community dialogue meetings, give health education talks, distribute health commodities, and provide support to midwives

Trained SMAGs to conduct follow-up postnatal visits for mothers and newborns, identify women and newborns with danger signs, and conduct referrals to health facilities when danger signs are identified

Distributed birth plans to help pregnant women plan for social support, transport, nutrition, ANC, and PNC

Selected religious, political, and cultural leaders became champions for promoting utilization of maternal and newborn health services

Trained community “Change Champions” to promote safe motherhood and HIV prevention practices

VHTs marketed CDKs as part of the promotion of institutional deliveries

Facility health workers distributed “Mama Kits” to women who delivered in facilities

SMAGs and nurses in SMGL facilities marketed and distributed “Mama Packs” containing diapers, soap, and baby clothes to women who came to a facility for delivery

VHTs promoted and distributed transport vouchers; health facility workers from private facilities marketed and distributed private vouchers

The “Boda for mothers” voucher program to transport women by motorcycle for delivery or obstetric emergencies in 3 districts. During Phase 2, “Boda for mothers” was extended to cover transport for 4 ANC visits and 1 postpartum visit, in addition to transport for delivery care

Marie Stopes subsidized vouchers for care in private facilities in all districts (“private vouchers”) (Phase 1 only)

No vouchers or subsidies implemented in Zambia

Established revolving funds for Village Saving Schemes (Phase 1 only)

Community revolving funds were not implemented in Zambia