Click to edit Master title style 29/10/20151 By Dynes Chinyama-Kaluba Senior Programme Officer, MAMaZ, Zambia Responding to Demand side barriers to MNH in Zambia

Click to edit Master title style 29/10/20152 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 barriers How? 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)

Click to edit Master title style 29/10/20153 BEOC Intervention Sites

Click to edit Master title style 29/10/20154 Intervention Communities

Click to edit Master title style 29/10/20155 Objective To improve access to routine and emergency maternal and newborn care through community- based interventions

Click to edit Master title style 29/10/20156 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 Director Abdul 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 District Programme Officer, Mkushi District Programme Officer, Kaoma District Programme Officer, Chama Safe Motherhood Action Groups (SMAGs) Community Facilitators

Click to edit Master title style 29/10/20158 Intervention components 2. Community Systems 1. Community Mobilization 4. Community Monitoring 3. Facility Based Emergency Transport Scheme 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”

Click to edit Master title style 29/10/ Volunteers and other community members follow-up on discussion group issues and visit pregnant women and newly delivered mothers Community Mobilization: Follow-up Support

Click to edit Master title style 29/10/ 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

Click to edit Master title style 29/10/ 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

Click to edit Master title style 29/10/ Once other community systems are in place, pregnant women are supported to develop safe delivery plans Safe Pregnancy Plans

Click to edit Master title style 29/10/ Social Fund Communities apply for grants to address barriers to accessing services. The Fund is ‘topping-up’ existing community savings schemes. Examples of community projects: Upgrading mothers’ shelters Tools for bicycle ambulance maintenance Construction of shelter for child care scheme Rewards for high performing volunteers

Click to edit Master title style 29/10/ Targeting mothers’ shelters

Click to edit Master title style 29/10/ Component 3: Facility based ETS: Motorcycle Ambulance

Click to edit Master title style 29/10/ 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

Click to edit Master title style 29/10/ Thank You