MaiKhanda's unique approach blends quality improvement in health facilities with community mobilization centering on women’s groups and Maternal and Neonatal Health (MNH) Task Forces.
We focus on the United Nations Population Fund (UNFPA) “Three Delays” model:
- Delay in deciding to seek care
- Delay in reaching the appropriate health facility
- Delay in being cared for promptly and effectively on arrival at the health facility
Women's group meeting in Lilongwe
To achieve our aims, MaiKhanda focuses on five main intervention areas:
- Community mobilization, women’s empowerment, and targeted education through women’s groups and Maternal and Neonatal Health Task Forces.
- Improvement of care in health facilities within their resource constraints.
- Support of maternal and neonatal death audits, both within health facilities and in communities.
- Improvement in data collection, management, and utilization to inform decisions and drive change.
- MaiKhanda developed a low-cost surveillance system, providing prospective data on maternal and neonatal births and deaths using government Health Surveillance Assistants linked with village-based volunteer key informants. The system has potential to provide African governments with relatively inexpensive and reliable sentinel sites to monitor maternal and infant mortality.
Peter Maseko, Safe Motherhood Coordinator,
cares for a premature child in Salima District Hospital
Working in Community: Creating Demand for Maternal and Neonatal Health Services
MaiKhanda helps women in communities through establishing women's groups to identify potential maternal and newborn health problems, prioritize the health problems, and design and implement low-cost sustainable strategies to address their prioritized problems. Examples of strategies selected include cultivating vegetable gardens to increase diet diversity and to generate money to pay for transport costs to health centers, thus specifically addressing delay 1 (delay in decision making to seek medical care) and delay 2 (delay in identifying and reaching the appropriate health facility). Women's group members conduct self-evaluations to determine what was done well and what could be improved.
Women’s group in action
MaiKhanda also works with communities through the establishment of safe motherhood task forces that are mainly responsible for:
- Village registration of all pregnant women, community mobilization, and dissemination of MNH messages
- Encouragement of pregnant women to attend antenatal classes (ANC) early (first trimester)
- Identifying blood donors for pregnant women to take to the health facility for delivery
- Identifying high-risk pregnant women (HRPW) and counseling all HRPW to deliver at the right facility
- Following up with all new mothers to encourage them to attend postnatal classes (PNC) within seven days of birth
Working in Health Facilities: Supply to Meet Demand Created at the Community Level
This intervention mainly is aimed at reducing deaths caused due to delay 3 (delay in receiving the appropriate care when at a health facility). MaiKhanda is helping staff in health facilities identify key drivers of maternal and neonatal mortality and apply quality improvement approaches to address them systematically. We are in 13 Comprehensive Emergency Obstetric and Newborn Care facilities (CEmONCs) and 42 health centers in the three districts (9 CEmONCs and 21 health centers in Lilongwe, 3 CEmONCs and 12 health centers in Kasungu, and 1 CEmONC and 9 health centers in Salima District).
MaiKhanda Facility Intervention uses collaborative learning methods for quality improvement, including: testing and adapting changes before implementation using the Model for Improvement and Plan-Do-Study-Act (PDSA) cycles; collecting data each month on a set of measures used for decision making and to demonstrate improvement; and accelerating learning by sharing experiences during Learning Sessions and Action Periods.
Learning Sessions emphasize collaboration to accelerate and spread change. MaiKhanda has supported the establishment of Quality Improvement Teams in all target health facilities and, through these teams, has focused on the following interventions:
- Local clinical skills building and adherence to protocols
- Leadership development
- Continued adaptation of the system according to need
- Data improvement and use of data for decision making
Participants in a Learning Session