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.