Implementation of a community-based intervention in the most rural and remote districts of Zambia: a process evaluation of safe motherhood action groups
Abstract Background A community-based intervention known as Safe Motherhood Action Groups (SMAGs) was implemented to increase coverage of maternal and neonatal health (MNH) services among the poorest and most remote populations in Zambia. While the outcome evaluation demonstrated statistically signi...
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| Format: | Article |
| Language: | English |
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BMC
2018-05-01
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| Series: | Implementation Science |
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| Online Access: | http://link.springer.com/article/10.1186/s13012-018-0766-1 |
| _version_ | 1818478394599276544 |
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| author | Choolwe Jacobs Charles Michelo Mosa Moshabela |
| author_facet | Choolwe Jacobs Charles Michelo Mosa Moshabela |
| author_sort | Choolwe Jacobs |
| collection | DOAJ |
| description | Abstract Background A community-based intervention known as Safe Motherhood Action Groups (SMAGs) was implemented to increase coverage of maternal and neonatal health (MNH) services among the poorest and most remote populations in Zambia. While the outcome evaluation demonstrated statistically significant improvement in the MNH indicators, targets for key indicators were not achieved, and reasons for this shortfall were not known. This study was aimed at understanding why the targeted key indicators for MNH services were not achieved. Methods A process evaluation, in accordance with the Medical Research Council (MRC) framework, was conducted in two selected rural districts of Zambia using qualitative approaches. Focus group discussions were conducted with SMAGs, volunteer community health workers, and mothers and in-depth interviews with healthcare providers. Content analysis was done. Results We found that SMAGs implemented much of the intervention as was intended, particularly in the area of women’s education and referral to health facilities for skilled MNH services. The SMAGs went beyond their prescribed roles to assist women with household chores and personal problems and used their own resources to enhance the success of the intervention. Deficiencies in the intervention were reported and included poor ongoing support, inadequate supplies and lack of effective transportation such as bicycles needed for the SMAGs to facilitate their work. Factors external to the intervention, such as inadequacy of health services and skilled healthcare providers in facilities where SMAGs referred mothers and poor geographical access, may have led SMAGs to engage in the unintended role of conducting deliveries, thus compromising the outcome of the intervention. Conclusion We found evidence suggesting that although SMAGs continue to play pivotal roles in contribution towards accelerated coverage of MNH services among hard-to-reach populations, they are unable to meet some of the critical sets of MNH service-targeted indicators. The complexities of the implementation mechanisms coupled with the presence of setting specific socio-cultural and geographical contextual factors could partially explain this failure. This suggests a need for innovating existing implementation strategies so as to help SMAGs and any other community health system champions to effectively respond to MNH needs of most-at-risk women and promote universal health coverage targeting hard-to-reach groups. |
| first_indexed | 2024-12-10T09:47:32Z |
| format | Article |
| id | doaj.art-f40e3dfcf32a4f4c816a3a2323682cc7 |
| institution | Directory Open Access Journal |
| issn | 1748-5908 |
| language | English |
| last_indexed | 2024-12-10T09:47:32Z |
| publishDate | 2018-05-01 |
| publisher | BMC |
| record_format | Article |
| series | Implementation Science |
| spelling | doaj.art-f40e3dfcf32a4f4c816a3a2323682cc72022-12-22T01:53:45ZengBMCImplementation Science1748-59082018-05-0113111010.1186/s13012-018-0766-1Implementation of a community-based intervention in the most rural and remote districts of Zambia: a process evaluation of safe motherhood action groupsChoolwe Jacobs0Charles Michelo1Mosa Moshabela2School of Nursing and Public Health, University of KwaZulu-NatalSchool of Public Health, Department of Epidemiology and Biostatistics, University of ZambiaSchool of Nursing and Public Health, University of KwaZulu-NatalAbstract Background A community-based intervention known as Safe Motherhood Action Groups (SMAGs) was implemented to increase coverage of maternal and neonatal health (MNH) services among the poorest and most remote populations in Zambia. While the outcome evaluation demonstrated statistically significant improvement in the MNH indicators, targets for key indicators were not achieved, and reasons for this shortfall were not known. This study was aimed at understanding why the targeted key indicators for MNH services were not achieved. Methods A process evaluation, in accordance with the Medical Research Council (MRC) framework, was conducted in two selected rural districts of Zambia using qualitative approaches. Focus group discussions were conducted with SMAGs, volunteer community health workers, and mothers and in-depth interviews with healthcare providers. Content analysis was done. Results We found that SMAGs implemented much of the intervention as was intended, particularly in the area of women’s education and referral to health facilities for skilled MNH services. The SMAGs went beyond their prescribed roles to assist women with household chores and personal problems and used their own resources to enhance the success of the intervention. Deficiencies in the intervention were reported and included poor ongoing support, inadequate supplies and lack of effective transportation such as bicycles needed for the SMAGs to facilitate their work. Factors external to the intervention, such as inadequacy of health services and skilled healthcare providers in facilities where SMAGs referred mothers and poor geographical access, may have led SMAGs to engage in the unintended role of conducting deliveries, thus compromising the outcome of the intervention. Conclusion We found evidence suggesting that although SMAGs continue to play pivotal roles in contribution towards accelerated coverage of MNH services among hard-to-reach populations, they are unable to meet some of the critical sets of MNH service-targeted indicators. The complexities of the implementation mechanisms coupled with the presence of setting specific socio-cultural and geographical contextual factors could partially explain this failure. This suggests a need for innovating existing implementation strategies so as to help SMAGs and any other community health system champions to effectively respond to MNH needs of most-at-risk women and promote universal health coverage targeting hard-to-reach groups.http://link.springer.com/article/10.1186/s13012-018-0766-1Access to healthcareProcess evaluationMaternal healthNeonatal healthRemote and rural areasLay health workers |
| spellingShingle | Choolwe Jacobs Charles Michelo Mosa Moshabela Implementation of a community-based intervention in the most rural and remote districts of Zambia: a process evaluation of safe motherhood action groups Implementation Science Access to healthcare Process evaluation Maternal health Neonatal health Remote and rural areas Lay health workers |
| title | Implementation of a community-based intervention in the most rural and remote districts of Zambia: a process evaluation of safe motherhood action groups |
| title_full | Implementation of a community-based intervention in the most rural and remote districts of Zambia: a process evaluation of safe motherhood action groups |
| title_fullStr | Implementation of a community-based intervention in the most rural and remote districts of Zambia: a process evaluation of safe motherhood action groups |
| title_full_unstemmed | Implementation of a community-based intervention in the most rural and remote districts of Zambia: a process evaluation of safe motherhood action groups |
| title_short | Implementation of a community-based intervention in the most rural and remote districts of Zambia: a process evaluation of safe motherhood action groups |
| title_sort | implementation of a community based intervention in the most rural and remote districts of zambia a process evaluation of safe motherhood action groups |
| topic | Access to healthcare Process evaluation Maternal health Neonatal health Remote and rural areas Lay health workers |
| url | http://link.springer.com/article/10.1186/s13012-018-0766-1 |
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