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Responding to
Demand side barriers
to MNH in Zambia
By Dynes Chinyama-Kaluba
Senior Programme Officer, MAMaZ, Zambia
13/04/2015
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Mobilising Access to Maternal Health
Services in Zambia (MAMaZ)
What?
• MAMaZ focuses on tackling demand side
barriers to accessing maternal and newborn
health care
Why?
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• 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
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BEOC Intervention Sites
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Intervention Communities
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Objective
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To improve access to routine and emergency
maternal and newborn care through communitybased interventions
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Barriers to receiving MNH care
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 Click
demand-side
barriers:
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• Knowledge
attitudes
– limited
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
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MAMaZ PROGRAMME STRUCTURE
Quality
Assurance
Group (QUAG)
District Medical
Offices
HPI office UK:
Programme and finance
management support
Country Director
Abdul Badru
Senior Programme Officer
Dynes Kaluba
Finance & Admin Officer
Drivers
District
Programme
Officer, Serenje
Community
Facilitators
District
Programme
Officer, Mongu
Community
Facilitators
District
Programme
Officer, Choma
District
Programme
Officer,
Mkushi
Community
Facilitators
Community
Facilitators
District
Programme
Officer, Kaoma
District
Programme
Officer, Chama
Community
Facilitators
Community
Facilitators
Safe Motherhood Action Groups (SMAGs)
Intervention components
2.
Community
Systems
1.
Community
Mobilization
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3. Facility
Based
Emergency
Transport
Scheme
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Access to
Maternal and
Newborn Care
5. Mentoring
and Support
4.
Community
Monitoring
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Community Mobilization: Participatory Methods
Whole Body Communication: Severe Headache
Community Mobilization: Danger Signs
Whole body
communication:
“Hand or foot
comes first”
Community Mobilization: Follow-up Support
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Volunteers and other community members
follow-up on discussion group issues and visit
pregnant women and newly delivered mothers
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Component 2: Community Systems
2.
Community
Savings
scheme
1.
Emergency
Transport
Scheme
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3. Safe
Pregnancy
Plan
Community
Systems 4. Mothers’
5. Child
Minding
Scheme
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Helpers
6. ‘Food
Bank’
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Community Emergency Transport Scheme
Aim: To provide a reliable means of transport for
patients from community to health facility
Several options, depending on terrain:
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• Oxcarts and donkey-driven carts
• Suitable for Mongu, Kaoma and Choma where
bicycle ambulances cannot work
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Bicycle Ambulance and Ox Cart
Safe Pregnancy Plans
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Once other community systems are in place, pregnant
women are supported to develop safe delivery plans
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Targeting
mothers’
shelters
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Component 3: Facility based ETS:
Motorcycle Ambulance
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Component 4: Community Monitoring System
• To generate information on community
activities
• The system is participatory
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• Strengthening communities’ capacity to
document and reflect on changes
• Evidence from other contexts shows that
community monitoring helps promote
sustainability
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Thank You
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