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Can simulations prepare providers for real-life scenarios? What does partnership with the community look like? How does a team address health challenges that are bigger than any one facility? Experiences from a maternal and child health initiative provide insights in response to these questions.
USAID’s Alcançar Project aims to improve maternal and child health in Mozambique. A 2019 analysis identified cultural and institutional barriers to quality care. The project team has implemented changes to enhance respect and dignity in care, increase patient confidence, and reduce maternal mortality.
Simulations and Real Life
The majority of maternal deaths in the region are preventable. Common causes of maternal mortality are related to post-partum hemorrhage, high blood pressure, and sepsis. Other deaths are related to unsafe abortions; supply chain management (e.g., lack of medicine); travel, accessibility, and referrals; and incorrect completion of partographs (forms used to track labor).
The Alcançar Project has tested different changes to improve care, including conducting simulations involving the delivery or resusciation of a newborn. Participants took on the roles of both the patient and provider. Many nurses admitted that, prior to taking part in the simulations, they would speak to the patient only briefly and may not have communicated clearly. While going through the simulation as a patient, they felt what it is like to have concerns and fears ignored or not taken seriously. The experience compelled the nurses to start introducing themselves to patients and their birth companions to make them feel welcomed, relaxed, and in good hands. They also began to provide information during the delivery process, including giving specific guidance to birth companions to help the patient feel calm and confident. In two cases — one involving asphyxia and another involving post-partum hemorrhage — nurses successfully applied what they had learned soon after facing the same situations in simulation.
Working in Partnership
The project coordinates with the Provincial Health Directorate (DPS) as well with the District Health, Women and Social Welfare Services (SDMAS) Focal Points by designing and sharing joint activities. Some of these efforts include:
- Planning and implementation of the mobile brigades of health care workers who provide vaccinations, family planning, and youth services
- Conducting trainings in maternal newborn and child health topics, including referral, demystifying myths and taboos, women’s empowerment and men’s engagement, and danger signs
- Offering technical assistance to local groups that include community health workers, traditional leaders, and traditional birth attendants
- Providing support for field officers who identify potential project beneficiaries and participate in community dialogues
Coordination helps build connections between project activities and communities and helps ensure key messages are heard. It creates safe and trusting environments for project staff to work in communities.
During community dialogues, we show respect for social norms and traditions. For instance, when we explain the importance of healthy food and supplements, we provide examples using the food available locally.
The project refers young people to youth friendly sexual and reproductive health services. It includes community health committees that foster discussions among peers and empowers young people to advocate for better sexual and reproductive health care.
Though Nampula Province in Mozambique has a matrilineal system, we observed that many men have more power than women when it comes to following recommendations from health professionals regarding maternal and child health. These include taking medicine, going for antenatal care, or delivering at a health facility. In other words, if the husband does not allow it, the wife will not follow medical recommendations. Therefore, engagement and advocacy is crucial to provide more inclusive care, encourage behavior change, and ensure safe and healthy pregnancies.
Many of the principles used in this work can be applied to other settings:
- Enhance current learning opportunities. To increase commitment from health care providers, facilities embedded quality improvement and respectful care activities into existing trainings and technical assistance.
- Act outside the facility walls. Team members are active in local and national advocacy. This includes tackling prohibitions on opening antenatal health records without a man present and spreading awareness about coming to a health facility to deliver safely.
- Adapt to changing circumstances. Due to the COVID-19 pandemic, the project switched to virtual learning for some training. When in-person sessions were possible, we delivered more sessions with fewer participants per session.
- Build political will and work together. Strong coordination with the government allows innovative activities to succeed. Using a mobile platform allows many community members to have access to information. Including community members in the identification and discussion of their problems helps to find locally suitable and sustainable solutions.
Ester Sumbana is a Gender and Youth Advisor for the Alcançar Project.
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