TABLE 1.

Saving Mothers, Giving Life Interventions to Reduce the First Delay, 2012–2017

SMGL Strategies and ApproachesCountry-Specific Interventions
UgandaZambia
Strategy 1: Promote community engagement and empowerment for improved maternal and newborn health
Approach 1.1: Implement community-based communication and education messages on safe motherhood via mass media and community events
  • 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”

Approach 1.2: Build stronger partnerships between communities and facilities
  • 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

Approach 1.3: Engage communities in monitoring and evaluation and accountability
  • 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)

Strategy 2: Increase birth preparedness, demand for facility delivery, and use of preventive health care services
Approach 2.1: Assist with community activities aimed to increase:
  • 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

Approach 2.2: Extend the delivery system of preventive services:
  • 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

Strategy 3: Decrease financial and logistic barriers to accessing facility delivery care
Approach 3.1: Market and distribute CDKs
  • 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

Approach 3.2: Market and distribute vouchers to subsidize access to facility delivery care services, ANC, and PNC
  • 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

Approach 3.3: Promote community-based loans to increase utilization of facility delivery care services
  • Established revolving funds for Village Saving Schemes (Phase 1 only)

  • Community revolving funds were not implemented in Zambia

  • Abbreviations: ANC, antenatal care; CDKs, clean delivery kits; PNC, postnatal care; RAMOS, Reproductive Age Mortality Study; SMAGs, Safe Motherhood Action Groups; SMGL, Saving Mothers, Giving Life; TBAs, traditional birth attendants; VHTs, Village Health Teams.