||This project targets different levels: from community and community leaders to health workers in rural health centres towards staff in the district hospital. The project focuses on promotion of sexual and reproductive health, male involvement in maternal health and a better access to maternal and child health care.
The project has a big community involvement and there is good cooperation with the District Health Office of Mangochi run by the government. The project covers 5 health facilities and 255 villages.
The interventions can be summarized as follows:
- Training of community leaders (reproductive, maternal health)
- Setting up of a community-based referral system (bicycle ambulances)
- Focused Traditional Birth Attendant (TBA) training
- Community based birth/complication preparedness (awareness meetings)
- Male and youth involvement to reach Behavioural Change at community level (by awareness meetings, health education)
- Introduction of a system of action oriented community-based maternal death audits (verbal autopsies)
There is a research component to look into issues of patient satisfaction and effectiveness of interventions, after the implementation of these interventions.
||Long term objective:
- To reduce maternal mortality in the rural areas of Mangochi district in Malawi with 25% from 2004 till 2012.
Short term objectives:
- To improve reproductive health services (70%-80% of deliveries should be with skilled staff in 2012)
- To empower community members in reducing maternal and neonatal mortality and morbidity
- To improve data collection (for example mimimum of 70% of maternal death/morbidity registered at community level)
Direct target groups:
- Health centre staff (5 health centres)
- TBAs (60)
- Community leaders (20)
- Traditional healers (40)
- Community Based Distributing Agents (40)
- Community (awareness meetings)
- 30,000 pregnant women (amount of deliveries in the project period)
Indirect target group:
- The people living in the catchment areas of Kapire, Chilipa, Mtima, Phirilongwe and Katema (95000)
|Summary of Project Plan
||This project, implemented by the Centre for Reproductive Health of the College of Medicine, aims at reducing the maternal and neonatal mortality rates in a rural area (covering 5 health centres) in Mangochi district, Malawi. The project consists of training of health centre staff, community leaders and Traditional Birth Attendants, awareness meetings on reproductive health (including male involvement) and HIV prevention and the introduction of a referral system supported by bicycle ambulances.
||Malawi has one of the highest maternal mortality rates of the world: 984/100,000 live births (MDHS). 56% of the maternal deaths occur in the Southern Region, 26% in the Central and 17% in the Northern Region. A separate analysis of 81 maternal death audit reports (2005) from various districts in the country showed that 85% of the deaths took place in rural areas, compared to 15% in urban areas (2004 routine reports). This is due to the fact that there is a particularly significant mal-distribution of health personnel, which favours urban areas, and the secondary and tertiary levels of care. Half of Malawi's doctors work in its four central hospitals together with 25% of the nurses (MOHP 2003). While the majority of Malawians live in the rural areas, 97% of government -employed clinical officers and 82% of government-employed nurses are in urban areas (MOHP 2003).
Availability, quality of care, access and utilization of essential obstetric care are of paramount to prevention maternal mortality and obstetric complications. Additionally, skilled attendance during pregnancy, child birth and postnatal period are key to reducing maternal mortality (Assessment of Emergency Obstetric Care Services in Malawi, 2005).
Malawi has a high prevelance of HIV/ AIDS (12%) and sexual and reproductive health services are of poor quality.
This project focuses on quality, acces and utilization of maternal health care and also on reproductive health and male involvement. Mangochi district is situated in the South and the intervention areas are rural.
The project is an extension of an earlier project with the same kind of activities funded by Cordaid, implemented in some other rural areas in Mangochi district.
|Situation at start of project
||In the first year of this project, a lot of community activities have been conducted with the following results:
- No maternal death occurred in the three health centres of Kapile, Mtima bii and Phililongwe catchment areas in 2008
- There are increased antenatal referrals from trained TBAs to health facilities
- There is an increased rate of deliveries by skilled attendants both at the five health centres and district hospital (from 35% in 2007 to 46% in 2008)
- 42 initiation counselors and 10 local leaders were trained in reproductive health with focus on modifying risky cultural practices
- 60 TBAs got a refresher course
- 32 additional bicycle ambulances and mattresses were procured and donated to 32 villages in the zone, health education sessions in these 32 villages were done
- 34 bicycles for health workers in safe motherhood were donated
- An active male model group is established in the Mtima bii area
- Village headmen are recording maternal health information
- TBA supportive supervision including quarterly meetings were continued
- Successful community based maternal death audit (verbal autopsies) system was introduced
The project has been very successful and has been able to reduce maternal death (from 19 to 2 women/population 95,000), increase antenatal attendance (10 fold) and increase institutional deliveries from 33% to 59% between 2006 and 2009.
||Research is done on how to implement the activities of the projects also in other places in Malawi.
Sustainability is addressed in the design of the study: all people involved in maternal and reproductive issues at district level are involved in the project.