SMGL Strategies and Interventions Implemented in Uganda and Zambia to Reduce the 3 Delays, 2012–2017

StrategyApproach/InterventionPrimary DelayAddresseda
Promote community engagement and empowerment for improved maternal and newborn health
  • Implement community-based communication and education messages on safe motherhood via mass media and community events, which includes displaying SMGL messages in public places to promote safe motherhood, broadcasting radio messages and programs, developing a documentary in Zambia, and supporting local drama groups in performing skits and traditional songs

  • Build stronger partnerships between communities and facilities, which includes supervision and support provided by facility health workers to community volunteers

  • Engage communities in monitoring and evaluation, which includes participation of VHTs in the SMGL baseline and endline evaluation of population maternal mortality ratio and MDSR (Uganda)

Increase birth preparedness, demand for facility delivery, and use of preventive health care services
  • Assist with community activities aimed to increase birth preparedness, knowledge of pregnancy danger signs, and use of antenatal care, facility-based delivery, and postnatal care services

  • Extend the delivery system of preventive services by using mobile and community outreach clinics to provide antenatal care, HIV counseling and testing, immunization, and postpartum family planning; ensuring provision of postpartum home care for mothers and newborns; distributing commodities through Mama Ambassadors (Uganda); and distributing birth plans through community volunteers and change champions (Zambia)

Decrease financial and logistic barriers to accessing facility delivery care
  • Market and distribute clean delivery kits

  • Market and distribute transport vouchers to subsidize access to facility delivery, antenatal, and postnatal care services

  • Promote community-based loans to increase use of facility delivery care services

1 and 2
Decrease distance to facility-based delivery services by increasing the number of EmONC facilities
  • Establish additional EmONC facilities and strengthen existing ones to provide: clean and safe basic delivery services; quality HIV counseling and testing; management of routine and complicated deliveries; essential and specialized newborn care; and timely referrals

  • Implement interventions to improve facility renovations, including building operation theaters and maternity waiting homes; expanding/upgrading maternity wards, neonatal special care units, and laboratories and pharmacies; purchasing equipment, supplies, and essential medicines; and hiring and training nurses, midwives, doctors, and anesthetists in EmONC

2 and 3
Improve the accessibility of EmONC facilities
  • Create a 24 hour a day/7 day a week communication/transportation system that is consultative, protocol-driven, quality-assured, and integrated (public and private) to ensure that women with complications reach emergency services within 2 hours

  • Implement interventions such as purchasing ambulances and other motorized vehicles; supporting operating costs of transport, such as maintenance, insurance, and petrol; setting up district transportation committees to improve coordination of ambulances; and renovating and building maternity waiting homes

Ensure facilities providing delivery care have adequate infrastructure
  • Support uninterrupted access to electricity and water

  • Implement interventions such as procuring solar panels and generators and ensuring safe water systems in maternity wards (water tanks and provision of piped water)

  • Support expansions, renovations, and facility enhancements to accommodate additional deliveries (including renovating and building operation theaters, expanding labor rooms, and adding postpartum wards)

  • Support facility enhancements to improve neonatal survival, including renovating infrastructure to provide space for KMC and neonatal special care units and procuring special equipment (incubators, infant warmers, and phototherapy lamps)

Ensure sufficient medical supplies, equipment, and essential medicines
  • Strengthen supply chains for essential supplies and medicines

  • Strengthen availability of blood supplies and surgical equipment, including the opening of new blood banks

Ensure sufficient well-trained health care providers at facilities
  • Recruit new medical doctors and nurse-midwives through a joint hiring process with the districts

  • Conduct trainings and refresher courses including: basic EmONC trainings, surgical skills course for medical officers, management of postpartum hemorrhage using uterine balloon tamponade, essential newborn care and neonatal resuscitation, and KMC

  • Provide mentoring and supportive supervision to newly hired and existing personnel

Improve quality of care and ensure care is evidence-based
  • Implement quality effective interventions, such as partograph use, active management of the third stage of labor, KMC, improved infection control practices, and management of obstetric complications protocols to prevent and treat obstetric and newborn complications

  • Ensure reliable delivery of quality essential and emergency maternal and newborn care, which includes interventions such as the training of midwives in respectful maternity care and the use of facility-generated data to review quality of care and implement practice changes

  • Develop guidelines and policies, and ensure protocol adherence through activities such as the introduction of clinical guidelines and protocols for diagnosing and managing most common obstetric emergencies, delivery checklists, and a tool to prevent perinatal deaths by using data to guide actions (BABIES matrix)

Ensure referral capacity exists to support transfers to higher level of care
  • Improve referral communication systems through increased communication capacity and introduction of referral protocols and forms

  • Ensure timely referrals through purchase of motorized vehicles, support of operating costs of transport, and promotion of district-level coordination

Strengthen health management information system and maternal and perinatal death surveillance
  • Set up pregnancy outcomes monitoring surveillance in health facilities and train health providers and health monitoring officers in data recording, data abstraction, data entry, and data file management

  • Strengthen maternal and perinatal death surveillance in health facilities, including the development of national standards for MDSR

  • Train medical doctors in assigning causes of maternal death using ICD-MM

  • Train health personnel in conducting maternal and perinatal death reviews at facility and district levels

  • Introduce a community MDSR system using the VHTs and other district personnel and develop protocols and tools, including an electronic data monitoring system

  • Abbreviations: BABIES, birthweight group age-at-death boxes for an intervention and evaluation system; EmONC, emergency obstetric and newborn care; ICD-MM, International Classification of Diseases–Maternal Mortality; KMC, kangaroo mother care; MDSR, maternal death surveillance and response; SMGL, Saving Mothers, Giving Life; VHTs, village health teams.

  • Note: Detailed information about SMGL country-specific interventions targeting each of the 3 delays are included elsewhere in this supplement.

  • a Primary delay addressed refers to which of the 3 delays the interventions are assumed to primarily address, since some of the interventions may address more than one delay. 1=First Delay; 2=Second Delay; 3=Third Delay.