Mobilizing Access to Maternal Health Services in Zambia (MAMaZ)

The strategic approach of MAMaZ was to focus on increasing demand and responding to supply-side barriers to care at household and community levels. A key strategy was engaging with the community to better understand and tackle barriers preventing timely access to maternal and newborn care. This included mobilising communities to creating widespread social approval for behaviour change, such as promoting routine clinic visits and acceptance of home-based care, as well as helping to establish sustainable community response systems.

Community mobilisation
The project used "a whole community approach," inclusive of men and women of different age groups. Working through existing structures where possible, such as the Safe Motherhood Action Groups, community health volunteers received training and mentoring to help them support mother and child health in their community. These volunteers led community discussion groups and made door-to-door home visits to pregnant women and their families. Communities participated in seven facilitated discussion sessions, equalling about 12 hours, which were guided by the Community Discussion Guide for Maternal and Newborn Health Care. These discussions begin with a focus on maternal health issues and maternal emergencies, and move on to more sensitive topics such as the impact of gender violence and social problems such as alcoholism.

Community response systems
"A set of interdependent community response systems was established by each community in response to the maternal and newborn health barriers that they faced." These systems varied among communities but included such initiatives as supporting families to develop safe pregnancy and delivery plans, implementing community emergency transport schemes (bicycle ambulances, oxcarts, donkey carts or boats), introducing savings schemes to save for medical expenses, and establishing food banks for women and their carers while using health facilities or in maternity waiting homes. Other initiatives included training mother's helpers to equip them with knowledge of what to do if there was an emergency, and establishing systems to care for other children while an expectant mother was in medical care. Many of these initiatives, as well as activities such as events to recognise volunteers, were funded through the application-based small grant making Social Fund.

Building district capacity
The project also supported district health teams to "create demand, reduce barriers to access, and improve referral to maternal health services along the household to hospital continuum of care." The training approach used a cascade system from national to community level, also based on the Community Discussion Guide for Maternal and Newborn Health Care.

Political advocacy
Another MAMaZ strategy was to advocate for greater political will to improve maternal and newborn health. "Following capacity assessment of selected national level partners, an advocacy strategy was developed which provides a framework for strategic, systematic and coordinated advocacy, capitalising on comparative advantages as well as the specific skills and experiences of each partner organization." The advocacy strategy linked with the Campaign for Accelerated Reduction of Maternal Mortality (CARMMA) which focuses on pushing for concrete action to reduce maternal mortality. "The strategy takes a two-pronged approach, complementing direct advocacy by MAMaZ and partner representatives at high-level with popular mobilisation activities at lower level in order to facilitate advocacy by affected individuals and groups themselves." The implementation plan included "activities such as engagement with political parties and members of parliament (MPs), training of community groups and journalists, and provision of technical support for the White Ribbon Alliance of Zambia."

Testing the approach
A main objective of MAMaZ was to "design and test innovative approaches to address the factors at household and community level that prevent timely access to emergency maternal health care services, utilisation of other essential maternal and newborn health services, and appropriate home-based care of pregnant women and their babies." Thus, MAMaZ emphasised generating evidence that would inform the process of scaling up the approach in selected districts and eventually across the country.

More MAMaZ
As a follow up to MAMaZ project, Health Partners International is scaling up the activities to more rural communities under the More MAMaZ project. "Five districts (Chama, Kaoma, Mkushi, Mongu, and Serenje) are being supported to take the MAMaZ intervention to scale by increasing the coverage of community engagement activities to a target 100% over the programme’s lifetime (from a current average of 25% population coverage)."

Maternal Health, Children

According to HPI, "the community engagement approach was implemented in 289 intervention sites in six rural districts. The total population coverage was 250,000, which equates to between 18 and 31% of the district populations. " The end of project evaluation showed that "the programme generated sufficient evidence of its effectiveness, which informed scaling up plans at district level. Skilled birth attendance rates increased by 27 percent over a period of less than two years. Scaling up the approach to cover the entire country would likely result in a dramatic fall in maternal and neonatal death rates."