Community based strategies for reducing maternal mortality in Lusaka and Chongwe: A grounded theory approach

Abstract

Zambia is one of the countries with a very high maternal mortality rate. Since the focus on attaining the Millennium Development Goals begun, the Ministry of Health has been implementing a series of strategies and interventions aimed at reducing maternal mortality with varying success. The country recently recorded a reduction in maternal mortality from 591 in 2007 to 398 in 2014 (CSO-ZDHS, 2014). While this figure is still high, it is nonetheless a positive indication that the country is doing something right. Available data shows that most of the maternal deaths take place in the community: at home or while on the way to a health facility. While we are sure of the clinical based strategies, little has been done to understand what is working well in the communities and how the end-users perceive these interventions. This paper aimed to qualitatively explore the community based interventions and strategies that have contributed in reducing maternal mortality in Lusaka and Chongwe Districts, Zambia. Data was gathered through review of documents and Key Informant Interviews. A total of 29 interviews were conducted with Ministry of Health staff, community based health volunteers, mothers and pregnant women as well as maternal health specialists from selected NGOs. The results show that reducing maternal mortality is an inter play of many strategic interventions supported by policies focussed on empowering people in the community to take an active role in the management of maternal health. Strengthening of human capacity and systems; improving maternal health financing and service delivery at community level also helps to consolidate and sustain the maternal health activities. Community based maternal health groups have helped to address cultural barriers to good maternal health; helped increase male involvement in maternal health; as well as helped build a network of transporters who help transport pregnant women to the health facilities using different available local means. Community level prevention of haemorrhage has also greatly helped reduce death from excessive bleeding. This study also found that the active involvement of the local civic and traditional leadership helped to pool volunteers and eased communication processes. However, limited resources and tools were also identified as some hindrances to effective implementation of maternal health interventions. The most effective way to address maternal mortality is to have community focussed policies that support financing, capacity building and strengthening of systems at community level. This ensures that platforms are created for community members and the local traditional and civic leaders to participate in addressing their maternal health challenges. Key words: community level, maternal health,