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
Session Outline
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Background information
Program Goal and objective
Community Level Results
The Community MNH model
Results and Lessons Learned
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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)
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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
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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
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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
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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
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The Community MNH Model:
Comprise 2 interventions:
Intervention 1. The Community MNH package 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
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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
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The Community Action Cycle
PREPARE THE
COMMUNITY FOR
ACTION
PREPARE TO
MOBILIZE
EVALUATE
TOGETHER
ACT
TOGETHER
EXPLORE MNH
ISSUES &
SET
PRIORITIES
PLAN
TOGETHER
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
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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
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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
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Pregnant women counseled on FP and
Developed a Birth Plan
Pregnant women counselled on FP and developed a Birth Plan
80%
70%
73%
64%
65%
60%
50%
45%
40%
30%
20%
10%
0% n=1881
% counselled on FP
% developed a birth plan
% PMTCT counselled
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% HIV tested following counseling
Percentage of mother identified with a
danger sign
Identified Danger Signs Antenatally
2%
5%
6%
Dizziness
Fever/Malaria
High BP/heart palpitations
9%
Oedema
vaginal bleeding
Anaemia
19%
8%
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Percentage of deliveries with a SBA, mothers
counseled on FP and postnatal checkups
86%
79%
90%
80%
71%
70%
60%
50%
40%
30%
20%
10%
n=1042
0%
Total SBA Deliveries
Counselled on FP
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PNC Check-Up by Skilled Provider
Mothers and newborns identified with danger
signs during postnatal
9%
8%
8%
7%
6%
6%
5%
5%
4%
3%
2%
1%
0%
Mothers with danger sign
Newborns with danger sign
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Newborns identified LBW
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
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