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By Dynes Chinyama-KalubaSenior Programme Officer, MAMaZ, Zambia
Responding to Demand side barriers to MNH in Zambia
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What?• MAMaZ focuses on tackling demand side
barriers to accessing maternal and newborn health care
Why?• High MMR and newborn mortality rates• Limited evidence of what works in addressing
demand side barriersHow?• Support districts to implement community
activities to increase knowledge and resources• Compile evidence of change and “impact”Where?• 6 districts: Choma, Serenje, Mongu, Chama,
Kaoma, Mkushi
Mobilising Access to Maternal Health Services in Zambia (MAMaZ)
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BEOC Intervention Sites
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Intervention Communities
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Objective
To improve access to routine and emergency maternal and newborn care through community-
based interventions
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Three Delays model:– The delay in the decision to seek care– The delay in getting to a facility– The delay in receiving medical attention
Key demand-side barriers:•Knowledge and attitudes – limited awareness of danger signs; some conflicting beliefs and practices
•Physical – long distances to facilities; challenging terrain; lack of transport
•Financial – lack of savings for emergency and routine costs
Barriers to receiving MNH care
Community Facilitators
Country DirectorAbdul Badru
Quality Assurance
Group (QUAG)
HPI office UK: Programme and finance
management support
Senior Programme Officer Dynes Kaluba Finance & Admin Officer
District Medical Offices
Drivers
District Programme
Officer, Serenje
District Programme
Officer, Mongu
District Programme
Officer, Choma
MAMaZ PROGRAMME STRUCTURE
Community Facilitators
Community Facilitators
District Programme
Officer, Mkushi
District Programme
Officer, Kaoma
District Programme
Officer, Chama
Safe Motherhood Action Groups (SMAGs)
Community Facilitators
Community Facilitators
Community Facilitators
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Intervention components
2. Community
Systems
1. Community Mobilization
4. Community Monitoring
3. Facility Based
Emergency TransportScheme
5. Mentoring
and Support
Access to Maternal and Newborn Care
Community Mobilization: Participatory Methods
Whole Body Communication: Severe Headache
Community Mobilization: Danger Signs
Whole body communication: “Hand or foot comes first”
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Volunteers and other community members
follow-up on discussion group issues and visit pregnant women and newly delivered mothers
Community Mobilization: Follow-up Support
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Component 2: Community Systems
2. Community Savings scheme
1. Emergency Transport Scheme
3. Safe Pregnancy Plan
4. Mothers’ Helpers
6. ‘Food Bank’
5. Child Minding Scheme
Community
Systems
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Aim: To provide a reliable means of transport for patients from community to health facility
Several options, depending on terrain:
• Oxcarts and donkey-driven carts• Suitable for Mongu, Kaoma and Choma where
bicycle ambulances cannot work
Community Emergency Transport Scheme
Bicycle Ambulance and Ox Cart
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Once other community systems are in place, pregnant women are supported to develop safe delivery plans
Safe Pregnancy Plans
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Targeting mothers’ shelters
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Component 3: Facility based ETS: Motorcycle Ambulance
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• To generate information on community activities
• The system is participatory
• Strengthening communities’ capacity to document and reflect on changes
• Evidence from other contexts shows that community monitoring helps promote sustainability
Component 4: Community Monitoring System
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Thank You
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