Adeodata Kekitiinwa | October 2015
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Presentation at the Global Maternal Newborn Health Conference, October 21, 2015

Background: SMGL undertook community-based activities in Uganda and Zambia to educate and engage families and community influentials, improve self-care, increase demand for services, and facilitate access to appropriate care. Two interventions focused on the most vulnerable: the provision of travel and service vouchers to poor women (Uganda) and building maternity waiting homes next to EmONC facilities for rural women (Zambia).

Methods: To address the first delay, SMGL focused on mobilizing, training, and deploying community health workers (CHWs) and leaders in both Uganda and Zambia as change agents in their catchment areas. To address the second delay, SMGL strengthened district transportation and communications networks, distributed means-tested travel and service vouchers, and refurbished/built maternity waiting homes.

Results: Over 5,000 CHWs were trained to conduct home visits to educate pregnant women, their families, and community leaders on the importance of facility delivery managed by a skilled birth attendant, and develop birth and savings plans. In Uganda, 15,655 clean birth kits containing a coveted receiving blanket were distributed at facilities to incentivize institutional deliveries. In Zambia, Chiefs were recruited and trained to become ‘Champions’ who would make facility deliveries normative in their chiefdoms. In remote areas, preexisting local transportation options were organized to transport women to facilities. Motorcycle operators—boda boda drivers—were enlisted in Uganda. Other transport innovations were utilized including motorcycle “Zambulances.” Distribution of means-tested travel and delivery-care vouchers contributed to a 62% increase in facility deliveries in Uganda. Maternity waiting homes were upgraded in Zambia to provide access to skilled care for women who live greater than two hours from an EmONC facility; facility deliveries increased by 35%. The met-need for EmONC services increased 25% in Uganda and 23% in Zambia.

Conclusion: SMGL successfully used community-based, equity-focused activities to increase demand and use of services by poor and rural women.