1. Increasing Utilization of Maternal Health Services through targeted Community Interventions in Malawi Anna Chinombo MSc. Nursing; Save the Children MCHIP Fannie Kachale MSc. Nursing; MoH Tambudzai Rashidi MSc. RH; MCHIP Aleisha Rozario MPH; MCHIP

2. Session Outline  Background information  Program Goal and objective  Community Level Results  The Community MNH model  Results and Lessons Learned 2

3. Malawi Country Indicators  Population=13 million  MMR=807/100,000 live births (4,624 / year; 13 / day  NMR=33/1,000 live births (18,900 / year; 52 every day)  CPR=38%  TFR=6.3  Skilled Birth Attendance = 54%  Women attending 4 ANC visits = 57%  Mother/infants receiving postnatal care within 2 days = 57% (Source MICS 2006) Source: MICS 2006 3

4. Contributing factors:  Delay in deciding to seek care  Delay in reaching a health facility  Delay in receiving care at health facility The first two delays occur at community level where cultural beliefs and harmful MNH practices are widespread 4

5. Program Goal  Accelerate the reduction of maternal and neonatal morbidity and mortality towards the achievements of the Millennium Development Goals (MDGs) Program Objective  Increased utilization of MNH services and practice of healthy maternal and neonatal behaviors 5

6. Community Level Results:  Increased adoption of household behaviors that positively impact the health of mothers and newborns  Increased availability of community-based MNH services through Health Surveillance Assistants 6

7. Program Coverage  4 of 28 Districts: 12 of 66 Health Centres  Population coverage: 232,326 (30% of total population for the 4 districts)  The program is also being piloted in 3 SNL supported 7

8. The Community MNH Model: Comprise 2 interventions:  Antenatal and postnatal home visits  Motivate and encourage focused antenatal care; health facility delivery, postnatal care, newborn care; and other facility services  Counseling / Health Education on PMTCT, nutrition, birth preparedness / complication readiness, essential newborn care  Screen for Danger Signs and Refer for health facility services 8 Intervention 1. The Community MNH package

9. Intervention 2: Community Mobilization  Health Surveillance Assistants are trained to establish “core groups” known as Community Action Groups of MNH champions in the community to lead in mobilizing their communities to practice healthy MNH behaviors using the Community Action Cycle 9

10. PREPARE THE COMMUNITY FOR ACTION EXPLORE MNH ISSUES & SET PRIORITIES PLAN TOGETHER ACT TOGETHER EVALUATE TOGETHER The Community Action Cycle PREPARE TO MOBILIZE

11. Achievements:  A total of 145 CAGs were established in 764 villages  60% taking a leading role in MNH.  Each CAG is different depending on the community and identified problems.  Some CAGs accomplishments include: - In one district, neighboring villages collaborated to raise some money, molded and burnt some bricks and assembled sand for construction of a maternity wing at the nearest health center. - Organized an open day and invited the District Assembly and District Health Management Team (DHMT). They used this podium to explain the problems they encounter at the HC and what they have done to help ease the problem and requested the invited guests for assistance 11

12. Cont. - CAGs are instrumental in sensitizing communities’ to deal with harmful cultural beliefs and practices (e.g. home deliveries) through dramas, community meetings, prescribing fines for harmful practices. CAGs conduct home-based follow up - 30% have written proposals for bicycle ambulances to solve transport problems for emergencies - 20% came up with IGAs and use the money to assist poor women to access facility based MNH services e.g. buying new wrappers. (Some women fail to go for MNH services if they have only one torn wrapper. They fear being laughed at by other women) - 10% Come up with vegetable gardens to encourage good nutrition - All CAGs keep data on pregnancies and pregnancy outcomes 12

13. Results:  Recorded 1,881 antenatal home visits  Recorded 1,042 postnatal home visits  From 1,881 ANC home visits, 9% conducted in first trimester, 47% and 18% in second and third trimester, respectively  73% counseled on PMTCT  45% got tested after HIV counseling 13

14. Pregnant women counseled on FP and Developed a Birth Plan 14

15. Percentage of mother identified with a danger sign 15

16. Percentage of deliveries with a SBA, mothers counseled on FP and postnatal checkups 16

17. Mothers and newborns identified with danger signs during postnatal 17

18. Lessons Learned  Involving community leaders as gate keepers is key to community MNH success  Many mothers and newborns can be saved and MNH status improve when communities know what to do  Involving males in MNH can save a lot of lives 18