The impact of a multi-level maternal health programme on facility delivery and capacity for emergency obstetric care in Zambia

Elizabeth G Henry,Donald M Thea,Davidson H Hamer,William Dejong,Kebby Musokotwane,Kenneth Chibwe,Godfrey Biemba,Katherine Semrau

doi:10.1080/17441692.2017.1385824

Abstract

ABSTRACTIn 2012, Saving Mothers, Giving Life (SMGL), a multi-level health systems initiative, launched in Kalomo District, Zambia, to address persistent challenges in reducing maternal mortality. We assessed the impact of the programme from 2012 to 2013 using a quasi-experimental study with both household- and health facility-level data collected before and after implementation in both intervention and comparison areas. A total of 21,680 women and 75 non-hospital health centres were included in the study. Using the difference-in-differences method, multivariate logistic regression, and run charts, rates of facility-based birth (FBB) and delivery with a skilled birth provider were compared between intervention and comparison sites. Facility capacity to provide emergency obstetric and newborn care was also assessed before and during implementation in both study areas. There was a 45% increase in the odds of FBB after the programme was implemented in Kalomo relative to comparison districts, but there was a limited measurable change in supply-side indicators of intrapartum maternity care. Most facility-level changes related to an increase in capacity for newborn care. As SMGL and similar programmes are scaled-up and replicated, our results underscore the need to ensure that the health services supply is in balance with improved demand to achieve maximal reductions in maternal mortality.

Highlights

Maternal deaths are highly preventable and yet an estimated 289,000 women die annually worldwide from maternity-related causes (World Health Organization [WHO], 2014)
The rate of facility-based birth (FBB) increased from 54.8% in Kalomo before the intervention to 64.6% during the intervention, an absolute difference of 9.8 percentage points
There was 49% relative increase in the odds of FBB in the intervention district after SMGL compared to the comparison area, adjusting for confounders

Summary

Introduction

Maternal deaths are highly preventable and yet an estimated 289,000 women die annually worldwide from maternity-related causes (World Health Organization [WHO], 2014). Low-income countries (LIC) disproportionately bear the maternal mortality burden with 99% of all maternal deaths. Sub-Saharan Africa (SSA) alone accounts for more than 60% of the world’s maternal deaths (WHO, 2014). Despite steady improvement over the past two decades, Zambia continues to have one of the highest maternal mortality ratios in the world, estimated at 398 per 100,000 live births for 2013–2014 (Central Statistical Office [CSO] Zambia, Ministry of Health [MOH] Zambia, & ICF International, 2014).

Objectives

Methods

Results

Discussion

Conclusion