Skip to main content

Table 1 Detail of Intervention Components

From: Toward communities as systems: a sequential mixed methods study to understand factors enabling implementation of a skilled birth attendance intervention in Nampula Province, Mozambique

Intervention Component Description
Engagement with community leaders for reflection on drivers of poor health, and solutions SCIP facilitated discussions with community leaders and their community members regarding their self-identified health priorities. Community leaders were then supported to apply the results of these discussions to inform health action plans with their community, including actions to address adverse maternal and child health outcomes, among other priorities.
Revitalization of CLCs and creation of health facility co-management committees Both CLCs and co-management committees are part of government strategies for community engagement, but their implementation is non-uniform. Revitalization efforts focused on ensuring their creation and operational capacity. After this, SCIP provided direct support to council and committee members to structure their meetings, and basic remunerations for transportation.
CLCs are village level committees composed of traditional leaders recognized by their community. CLC members help troubleshoot any issues in the community and set agendas for community health and stability. Related to maternal health, CLCs could, for example, provide leadership in building maternal waiting homes, or organize resources for maintenance of bicycle ambulances.
Health facility co-management committees bring together facility staff with CLC members, community volunteers, and TBAs to jointly set agendas for health service delivery in response to community needs. Co-management committees met on a monthly to quarterly basis to review and apply data in health service delivery planning. For example, committees could identify the need for improvement in MCH service delivery quality, or to address low ANC attendance by pregnant women in the community.
Educational community dialogue meetings Communities were supported to begin dialogue meetings regarding their prioritized health topics. Facility staff received training from SCIP as facilitators, and in turn trained CLC members to facilitate these discussions. Sometimes referred to as “Hot Topics” discussions, content ranged from maternal health to agriculture to hygiene. These sessions ensured community access to information regarding effective practices, and the opportunity to consider how these practices might be applied for community benefit.
MCH nurse and TBA collaboration SCIP supported monthly mentorship meetings between MCH nurses and TBAs. Meetings were held on the facility grounds, and agendas were set by MCH nurses. The content of the meetings focused on building TBAs’ safe delivery, ANC, and PNC knowledge, and community-facility referral skills. TBAs were also supported to track their beneficiaries from ANC through institutional delivery and postpartum follow-up. Meetings provided an ongoing channel for direct communication between MCH nurses and TBAs. Nurses kept attendance sheets and schedules of these meetings, and received follow-up from SCIP coordinators to support their implementation.
TBA escort and non-medical attendance of pregnant women for institutional delivery TBAs served as liaison for pregnant beneficiaries, coordinating transport for women to the facility and often attending to their needs along the way. Escort typically included negotiating barriers to access such as distance, poor or limited road access and means of transportation, and flooding. Once at the facility, TBAs were to provide non-medical support in line with the Model Maternity Initiative’s focus on humanization of the birth process. For example, TBAs might coordinate family members to be present at the facility during the birth, prepare meals or attend to the comfort of laboring and postpartum women, or support mothers to initiate breastfeeding. MCH nurses retained responsibility for clinical procedures. Under the Model Maternity Initiative guidelines, TBAs were not supported to provide skilled birth attendance [10].