Online Program

Combined community and health system strategies to increase institutional deliveries: An emerging practice in Mozambique

Monday, November 4, 2013 : 10:30 a.m. - 10:45 a.m.

Alicia Mehl, MSc, Pathfinder International Mozambique, Nampula, Mozambique
Maria Teresa Vitorino, MPH, Pathfinder International Mozambique, Nampula, Mozambique
Adalgisa Viola, MD, Pathfinder International Mozambique, Nampula, Mozambique
Claire Cole, MPH, Technical and Program Strengthening Department, Pathfinder International, Watertown, MA
Low institutional delivery rates are associated with increased risk for maternal mortality. In Mozambique's Nampula province in 2011, only 63% of deliveries occurred in a facility. Strengthening Communities through Integrated Programming (SCIP) developed a practice to mitigate barriers to institutional delivery in the Nampula district of Mogovolas. This emerging practice may offer lessons regarding community access to services.

The two-part emerging practice combines community and health systems strengthening. One: a facility nurse conducts discussions in the community to improve knowledge and demand for safe delivery practices. Two: a facility nurse trains traditional birth attendants (TBAs) in safe delivery, risk identification, and referral to facilities, and provides supervision to TBAs to support skills application in the community. Monitoring data on institutional deliveries from January 2011 to March 2012 was analyzed across 34 communities in the Muatua health facility's catchment area. Due to constraints, the practice described above was implemented in varying completeness across these communities, allowing for a comparison of effect. Seven communities implemented both practice components, 10 implemented one, and 17 implemented none.

Institutional deliveries increased across the communities, possibly explained by other SCIP efforts. Where the practice was fully implemented, the highest increase was observed, at 247% (from 46 deliveries to 160). In communities where no component was implemented, there was an increase of 134% (from 26 deliveries to 61).

Preliminary data suggest the practice positively contributes to increased institutional deliveries. Analysis of the comparative advantages of practices combining community and health system strengthening is recommended.

Learning Areas:

Implementation of health education strategies, interventions and programs
Program planning
Provision of health care to the public

Learning Objectives:
Explain the two-part community and health system strengthening emerging practice used to increase institutional deliveries in Mogovolas district, Mozambique. Analyze monitoring data to evaluate the preliminary evidence of effect for this emerging practice. Describe steps that implementers and policymakers can take to advance evidence of the effectiveness of emerging community and health system strengthening practices for improved health service uptake.

Keyword(s): Maternal Well-Being

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I led the capacity building efforts of key staff in Mozambique to identify this emerging practice, and generate and analyze the preliminary evidence of its performance.
Any relevant financial relationships? Yes

Name of Organization Clinical/Research Area Type of relationship
Pathfinder International Technical Services Unit, Technical Documentation Employment (includes retainer)

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.