Coverage Of Maternal Health Services Research Articles

Pelaksanaan Permainan Ular Tangga dalam Kelas Ibu Hamil

The efforts to reduce maternal and infant mortality can be done by increasing the coverage and quality of maternal and child health services. One effort is made to bring health services closer to the community through the pregnant mothers class program. Pregnant woman class is a study group of pregnant women with gestational age between 4 weeks to 36 weeks with a maximum number of 10 participants. In this class, pregnant women will learn together, discuss and exchange experiences on overal maternal and child health, facilitated by midwives or health workers by using the class package for pregnant women, namely flip chart, guidelines for implementing classes of pregnant women, class facilitator’s handbook pregnant women, exercise books for pregnant women and books on maternal and child health (MCH). Based on the results of community service activities with participants of 40 pregnant women there was an increase in correct answers to all participants after participating in class activities for snakes ladderss of pregnant women. From the pre-test result it turns out that most of the results obtained were less than 60. This shows that the knowledge ability of pregnant women is still lacking. However, after holding the snakes ladder pregnant class, there was an increase in the knowledge of pregnant women with an increase in the post-test score point in the range between 21-30 (47.5%).

Avoiding indirect effects of COVID-19 on maternal and child health

Avoiding indirect effects of COVID-19 on maternal and child health

Children and Women's Health in South East Asia: Gap Analysis and Solutions.

In response to the Millennium Development Goals (MDGs) and Sustainable Development Goals (SDGs) commitment, eight selected countries in the South East Asia region have made a remarkable reduction in infant and child mortality, while a few have achieved an SDG 3.2 target of 25 and 12 for child and neonatal mortality rate, respectively, well before 2030. Across these eight countries, there is a large variation in the achievement of the nine dimensions of maternal, neonatal, and child health service coverage. The poorest wealth quintiles who reside in rural areas are the most vulnerable and left behind from access to service. The rich rural residents are better off than the poor counterparts as they have financial means for travel and access to health services in urban town. The recent 2019 global Universal Health Coverage (UHC) monitoring produced a UHC service coverage index and an incidence of catastrophic health spending, which classified countries into four quadrants using global average. Countries belonging to a high coverage index and a low incidence of catastrophic spending are good performers. Countries having high coverage but also a high incidence of catastrophic spending need to improve their financial risk protection. Countries having low coverage and a high incidence of catastrophic spending need to boost service provision capacity, as well as expand financial protection. Countries having low coverage and a low incidence of catastrophic spending are the poor performers where both coverage and financial protection need significant improvement. In these countries, poor households who cannot afford to pay for health services may forego required care and instead choose to die at home. This paper recommended countries to spend adequately in the health sector, strengthen primary health care (PHC) and safeguard the poor, mothers and children as a priority in pathways towards UHC.

Government Expenditure on Maternal Health and Family Planning Services for Adolescents in Mexico, 2003-2015.

The purpose of this study was to assess whether government policies to expand the coverage of maternal health and family planning (MHFP) services were benefiting the adolescents in need. To this end, we estimated government MHFP expenditure for 10- to 19-year-old adolescents without social security (SS) coverage between 2003 and 2015. We evaluated its evolution and distribution nationally and sub-nationally by level of marginalization, as well as its relationship with demand indicators. Using Jointpoint regressions, we estimated the average annual percent change (AAPC) nationally and among states. Expenditure for adolescents without SS coverage registered 15% for AAPC for the period 2003–2011 and was stable for the remaining years, with 88% of spending allocated to maternal health. Growth in MHFP expenditure reduced the ratio of spending by 13% among groups of states with greater/lesser marginalization; nonetheless, the poorest states continued to show the lowest levels of expenditure. Although adolescents without SS coverage benefited from greater MHFP expenditure as a consequence of health policies directed at achieving universal health coverage, gaps persisted in its distribution among states, since those with similar demand indicators exhibited different levels of expenditure. Further actions are required to improve resource allocation to disadvantaged states and to reinforce the use of FP services by adolescents.

Administrative effectiveness in the production of maternal health services in four Mexican states.

To generate evidence on the influence of good management of resources in the delivery of maternal health services in Mexico. We studied the managerial processes involved in the provision of maternal health services in four states of Mexico exhibiting differences in maternal mortality, maternal health service coverage, and maternal health expenditure. Analysis was based on five analytical dimensions of the cyclic process model designed by the National Council for the Evaluation of Social Development Policy in Mexico. We describe the processes, identify areas of opportunity, and discuss opinions concerning the relevance, timeliness, and sufficiency of human and material resources employed in the delivery of maternal health services. Managerial performance in the four entities was very heterogeneous. In most of the analyzed entities, implementation of the processes was rated from "average" to "very good." In order to contribute to universal coverage of maternal health services, managerial processes at the state level need to ensure an adequate, timely, and sufficient supply of resources.

No effects of pilot performance-based intervention implementation and withdrawal on the coverage of maternal and child health services in the Koulikoro region, Mali: an interrupted time series analysis.

Performance-based financing (PBF) has been promoted and increasingly implemented across low- and middle-income countries to increase the utilization and quality of primary health care. However, the evidence of the impact of PBF is mixed and varies substantially across settings. Thus, further rigorous investigation is needed to be able to draw broader conclusions about the effects of this health financing reform. We examined the effects of the implementation and subsequent withdrawal of the PBF pilot programme in the Koulikoro region of Mali on a range of relevant maternal and child health indicators targeted by the programme. We relied on a control interrupted time series design to examine the trend in maternal and child health service utilization rates prior to the PBF intervention, during its implementation and after its withdrawal in 26 intervention health centres. The results for these 26 intervention centres were compared with those for 95 control health centres, with an observation window that covered 27 quarters. Using a mixed-effects negative binomial model combined with a linear spline regression model and covariates adjustment, we found that neither the introduction nor the withdrawal of the pilot PBF programme bore a significant impact in the trend of maternal and child health service use indicators in the Koulikoro region of Mali. The absence of significant effects in the health facilities could be explained by the context, by the weaknesses in the intervention design and by the causal hypothesis and implementation. Further inquiry is required in order to provide policymakers and practitioners with vital information about the lack of effects detected by our quantitative analysis.

Analyzing the disparities in the coverage of maternal and child health services: A district-level cross-sectional analysis of Jammu and Kashmir.

Improving overall coverage of maternal and child health (MCH) services is essentially required if India in general and Jammu and Kashmir state in particular have to attain the Sustainable Development Goals by the year 2030. Thus, the disparities in coverage of MCH services need to be assessed and addressed. The objective of this study was to examine the variation in coverage rates for a key set of interventions in MCH services and to assess the relationship between coverage gap and socioeconomic development across the districts of Jammu and Kashmir. Data from the National Family Health Survey-4 (NFHS-4), 2015-2016, Census of India 2011, and Digest of Statistics Jammu and Kashmir were used to construct two composite indexes of coverage gap and socioeconomic development at district level. Cronbach's alpha was used to assess the internal consistency of indicators used in the two indexes. The overall coverage gap in the state was 28.17%, and the size of coverage gap was largest for family planning interventions (55.8%), followed by treatment of sick children (26.95%) and maternal and newborn care (18.75%), and was smallest for immunization (10.5%). There is a moderate negative correlation between coverage gap and socioeconomic development (r = -0.63, P = 0.01). Coverage of MCH services and socioeconomic development has a significant disparity in the districts of Jammu and Kashmir. Resource-rich and more urbanized districts are much ahead of the poor and less urbanized districts in terms of the usage of MCH services.

The Indirect Impact of the COVID-19 Pandemic on Maternal and Child Mortality in Ethiopia: Modelling Study

Background: According to the Ethiopian Federal Ministry of Health daily pandemic report, COVID-19 has caused considerable morbidity and mortality directly due to the virus. The occurrence of COVID-19 has caused serious interruption to high impact essential health services in Ethiopia like in many other countries. However, the indirect impact of the pandemic due to the interruption of other essential health services on maternal and child mortality has not been examined. Therefore, this study aimed to estimate the indirect impact of COVID-19 pandemic on maternal and child mortality in Ethiopia. Methods: We used the Lives Saved Tool (LiST) to estimate the impact of COVID-19. By varying the coverage of essential Maternal and Child Health (MCH) services from the baseline, we build four plausible scenarios that represent possible service interruptions possibilities. Scenario-1 represents a 25% average decrement in MCH service for a year, scenario-2 represents a 35% average service coverage decrement for a year, scenario-3 represents a 50% average service coverage decrement for a year, and the scenario-4 represent a 35% service coverage decrement for a half year duration. Ethiopian Demographic and Health Survey 2016 (EDHS 2016), Ethiopia Mini Demographic and Health Survey 2019 (EMDHS 2019) and for those variable which were not included in EDHS 2016 and EMHDS 2019, multivariate analysis estimates conducted on population-level coverage were used to estimate the baseline coverage and the impact of MCH interventions. Results: Based on scenario-1, additional 10,252 child deaths, 379 maternal deaths, and 1,673 stillbirths would occur per year. Based on scenario-2, over a year, additional 26,307 child deaths, 2,197 maternal deaths and 7,876 stillbirths would occur. Based on scenario-3, additional 41,945 under-5 deaths, 4,038 maternal deaths, and 13,294 stillbirths would result in a year. Wasting was the most predominant factor contributing about 16% to 30% of the additional under-5 deaths.Conclusion: A significant number of additional maternal and child deaths would occur in Ethiopia if the essential health service interruption persists, as seen in the first few months of the pandemic. This is more than the mortality caused by the pandemic itself.

Closing the inequality gaps in reproductive, maternal, newborn and child health coverage: slow and fast progressors

IntroductionUniversal Health Coverage (UHC) is a critical goal under the Sustainable Development Goals (SDGs) for health. Achieving this goal for reproductive, maternal, newborn and child health (RMNCH) service coverage will...

MHealth intervention "ImTeCHO" to improve delivery of maternal, neonatal, and child care services-A cluster-randomized trial in tribal areas of Gujarat, India.

BackgroundThe coverage of community-based maternal, neonatal, and child health (MNCH) services remains low, especially in hard-to-reach areas. We evaluated the effectiveness of a mobile-phone–and web-based application, Innovative Mobile-phone Technology for Community Health Operations (ImTeCHO), as a job aid to the government’s Accredited Social Health Activists (ASHAs) and Primary Health Center (PHC) staff to improve coverage of MNCH services in rural tribal communities of Gujarat, India.Methods and findingsThis open cluster-randomized trial was conducted in 22 PHCs in six tribal blocks of Bharuch and Narmada districts in India. The ImTeCHO mobile-phone–and web-based application included various technology-based job aids to facilitate scheduling of home visits, screening for complications, counseling during home visits, and supportive supervision by PHC staff. Primary outcome indicators were a composite index calculated based on coverage of important MNCH services and coverage of at least two home visitations by ASHA within the first week of birth. Primary analysis was intention to treat (ITT). Generalized Estimating Equation (GEE) was used to account for clustering. Eleven PHCs each were randomly allocated to the intervention (280 ASHAs, population: 234,134) and control (281 ASHAs, population: 242,809) arms. The intervention was implemented from February, 2016 to January, 2017. At the end of the implementation, 6,493 mothers were surveyed. Most of the surveyed women were tribal (5,571, 85.8%), and reported having a government-issued certificate for living below poverty line (4,916, 75.7%). The coverage of at least two home visits within first week of birth was 32.4% in the intervention clusters compared to 22.9% in the control clusters (adjusted effect size 10.2 [95% CI: 6.4, 14.0], p < 0.001). Mean number of home visits within first week of birth was 1.11 and 0.80 for intervention and control clusters, respectively (adjusted effect size 0.34 [95% CI: 0.23, 0.45], p < 0.001). The composite coverage index was 43.0% in the intervention clusters compared to 38.5% (adjusted effect size 4.9 [95% CI: 0.2, 9.5], p = 0.03) in the control clusters. There were substantial improvements in coverage home visits by ASHAs during antenatal period (adjusted effect size 15.7 [95% CI: 11.0, 20.4], p < 0.001), postnatal period (adjusted effect size 6.4, [95% CI: 3.2, 9.6], p <0.001), early initiation of breastfeeding (adjusted effect size 7.8 [95% CI: 4.2, 11.4], p < 0.001), and exclusive breastfeeding (adjusted effect size 13.4 [95% CI: 8.9, 17.9], p < 0.001). Number of infant and neonatal deaths was similar in the two arms in the ITT analysis. The limitations of the study include potential risk of inaccuracies in reporting events that occurred during pregnancy by the mothers and the duration of intervention being 12 months, which might be considered short.ConclusionsIn this study, we found that use of ImTeCHO mobile- and web-based application as a job aid by government ASHAs and PHC staff improved coverage and quality of MNCH services in hard-to-reach areas. Supportive supervision, change management, and timely resolution of technology-related issues were critical implementation considerations to ensure adherence to the intervention.Trial registrationStudy was registered at the Clinical Trial Registry of India (www.ctri.nic.in). Trial number: CTRI/2015/06/005847. The trial was registered (prospective) on 3 June, 2015. First enrollment was done on 26 August, 2015.

Understanding variation in health service coverage and maternal health outcomes among districts in Rwanda - A qualitative study of local health workers' perceptions.

To obtain the perspectives of health professionals and community health workers on factors that determine health service coverage and maternal health outcomes so as to understand variations between districts. 16 Focus group discussions involving four different groups of participants were conducted in May 2015 in four purposively selected districts, complemented by three key informant interviews in one of the districts. The solidarity support for poor people and the interconnectedness between local leaders and heads of health facilities were identified as enablers of health service utilization. Geographical factors, in particular location close to borders with mobile populations and migrants, and large populations with sparsely distributed health infrastructure, exacerbated by hilly topography and muddy roads were identified as barriers. Shortages of skilled health providers at the level of district hospitals were cited as contributing to poor maternal health outcomes. There is a need to take into account disparities between districts when allocating staff and financial resources in order to achieve universal coverage for high-quality maternal health services and better outcomes. Local innovations such as the use of SMS and WhatsApp text messages by health workers and financial protection schemes for poor patients improve solidarity and are worth to be scaled up.

Review of Policy-Oriented Research on Maternal Mortality

&lt;p&gt;Maternal mortality remains an unresolved critical issue. This condition indicates that women’s reproductive health rights has not yet been fulfilled. Maternal mortality occurs due to medical and non-medical factors. Even though a small amount of those deaths still happens due to unpreventable causes, however, most of those deaths could have been prevented and avoided. Government efforts to address the problem of maternal mortality are carried out through various policies that focus on medical factors and through programs aimed at increasing the coverage and quality of maternal health services. On the other hand, other factors such as social economic and cultural are being neglected. A review of researches on the theme of maternal mortality found various factors that contributed to the causes of maternal mortality such as socio-cultural barriers that limit women’s access to health, ranging from poverty, geography and local culture. Unmet need for contraception in family planning program, adolescence reproductive health issue that still hasn’t been addressed in a serious and comprehensive manner, as well as unsafe abortion are the key underlying causes of maternal mortality.&lt;/p&gt;

The Egyptian health map: a guide for evidence-based decisionmaking.

The Egyptian health system is characterized by the multiple entities in charge of service regulation, financing and provision. Moreover, health outcomes in Egypt mirror epidemiologic transition; increasing prevalence of non-communicable diseases (NCDs) and persistent high levels of selected communicable diseases (CDs) place a huge financial burden on the health system's limited resources. This together with financial inefficiencies aggravate inequality in health services coverage and health outcomes. We aimed to map and link health services with key health outcomes to support efficient utilization of scarce resources and achieving Universal Health Coverage (UHC). Data on health services and health outcomes were obtained from the Ministry of Health and Population and key national surveys for the year 2014. Data on health services' availability and coverage were compared in different geographical regions. Correlation analysis was used to test the relation between selected service availability indicators and mortality rates from key NCDs. There was a high coverage of key maternal and child health services. However, there was in general low achievement of national targets for service availability as well as wide geographical disparities. Cardiovascular diseases were the leading cause of death and there was a marked reduction in the incidence of major CDs in Egypt, particularly vaccine preventable diseases. Wide geographical disparities and increased burden of NCDs and their risk factors are identified as key challenges facing the healthcare system in Egypt. Priority setting in the light of these findings is crucial to support national efforts to attain health equity and UHC.

Implementation and effectiveness of free health insurance for the poor pregnant women in Tanzania: A mixed methods evaluation

Demand side financing strategies have been a popular means of increasing coverage and availability of effective maternal and child health services in low and middle income countries (LMIC). However, most research to date has focused on the effects of demand side financing on the use and costs of care with less attention being paid to how they work to achieve outcomes. This study used a mixed methods evaluation to determine the effect of a targeted health insurance scheme on access to affordable quality maternal and child care, and assess implementation fidelity and how this affected programme outcomes.Programme effects on service access, affordability and quality were evaluated using difference in difference regression analysis, with outcomes being measured through facility, patient and household surveys and observations of care before the intervention started and eighteen months later. A simultaneous process evaluation was designed as a case study of the implementation experience. A total of 90 in-depth interviews (IDIs) and five focus group discussions were conducted during three rounds of data collection among respondents from management, facility and community. The scheme achieved high coverage among the target population and reduced the amount paid for antenatal and delivery care; however, there was no effect on service coverage and limited effects on quality of care. The lack of programme effects was partly due to the late timing of first antenatal care visits and registration for the scheme together with limited understanding of entitlements among beneficiaries and providers.Better communication of programme benefits is needed to enhance effects together with integration of such schemes within existing purchasing mechanisms and in financially decentralised health systems.

Geographic Inequities in Coverage of Maternal and Child health Services in Haryana State of India

Introduction India aims to achieve universal health coverage, with a focus on equitable delivery of services. There is significant evidence on extent of inequities by income status, gender and caste. In this paper, we report geographic inequities in coverage of reproductive, maternal and child health (MCH) services in Haryana state of India. Methods Cross-sectional data on utilization of maternal, child health and family planning services were collected from 12,191 women who had delivered a child in the last one year, 10314 women with 12-23months old child, and 45864 eligible couples across all districts in Haryana state. Service coverage was assessed based on eight indicators - 6 for maternal health, one for child health and one for family planning. Inter- and intra-district inequalities were compared based on four and three indicators respectively. Results Difference in coverage of full ante-natal care, full immunization and contraceptive prevalence rate between districts performing best and worst was found to be 54%, 65% and 63% respectively. More than one-thirds of the sub-centres (SCs) in Panchkula, Ambala, Gurgaon and Mewat districts had their ante-natal care coverage less than 50% of the respective district average. Similarly, a significant proportion of SCs in Mewat, Panipat and Hisar districts had full immunization rate below 50% of the district average. Conclusion Widespread inter- and intra-district inequities in utilization of MCH services exist. A comprehensive geographical targeting to identify poor performing districts, community development blocks and SCs could result in significant equity gains, besides contributing to quick achievement of sustainable development goals.

High uptake of an innovative mobile phone application among community health workers in rural India: An implementation study.

We assessed the uptake, feasibility and effectiveness of an mHealth intervention in improving the performance of village-based frontline workers, called accredited social health activists (ASHAs), to increase the coverage of maternal, newborn and child health services in rural India. A new mobile phone application-Innovative Mobile-phone Technology for Community Health Operations (ImTeCHO)-was implemented in all the 45 villages of two primary health centres in Jhagadia, Gujarat (population ~45 000), between August 2013 and February 2014 after training 45 ASHAs. After 9 months of implementation, 99 mothers of young infants between the ages of 1 and 4 months and 187 mothers of infants between the ages of 6 and 9 months were interviewed during the household survey to assess the coverage of maternal, newborn and child health services in the project and similar control villages. Fifteen ASHAs were purposively selected and interviewed. The coverage of home-based newborn care (56% v. 10%), exclusive breastfeeding (44% v. 23%), care-seeking for maternal (77% v. 57%) and neonatal complications (78% v. 27%) and pneumonia (41% v. 24%) improved in the interventional area compared to the control area. The ASHAs logged into the mobile phone application on 88% of working days. Of a total of 10 774 forms required to be completed, the ASHAs completed 7710 forms. During the interviews, all ASHAs demonstrated sufficient competency to use ImTeCHO and expressed a high level of acceptability and utility of all components of the intervention. A high degree of acceptability, feasibility and effectiveness for the mHealth intervention among ASHAs was supported by its widespread use.

Process evaluation of a social franchising model to improve maternal health: evidence from a multi-methods study in Uttar Pradesh, India

BackgroundA prominent strategy to engage private sector health providers in low- and middle-income countries is clinical social franchising, an organisational model that applies the principles of commercial franchising for socially beneficial goals. The Matrika programme, a multi-faceted social franchise model to improve maternal health, was implemented in three districts of Uttar Pradesh, India, between 2013 and 2016. Previous research indicates that the intervention was not effective in improving the quality and coverage of maternal health services at the population level. This paper reports findings from an independent external process evaluation, conducted alongside the impact evaluation, with the aim of explaining the impact findings. It focuses on the main component of the programme, the “Sky” social franchise.MethodsWe first developed a theory of change, mapping the key mechanisms through which the programme was hypothesised to have impact. We then undertook a multi-methods study, drawing on both quantitative and qualitative primary data from a wide range of sources to assess the extent of implementation and to understand mechanisms of impact and the role of contextual factors. We analysed the quantitative data descriptively to generate indicators of implementation. We undertook a thematic analysis of the qualitative data before holding reflective meetings to triangulate across data sources, synthesise evidence, and identify the main findings. Finally, we used the framework provided by the theory of change to organise and interpret our findings.ResultsWe report six key findings. First, despite the franchisor achieving its recruitment targets, the competitive nature of the market for antenatal care meant social franchise providers achieved very low market share. Second, all Sky health providers were branded but community awareness of the franchise remained low. Third, using lower-level providers and community health volunteers to encourage women to attend franchised antenatal care services was ineffective. Fourth, referral linkages were not sufficiently strong between antenatal care providers in the franchise network and delivery care providers. Fifth, Sky health providers had better knowledge and self-reported practice than comparable health providers, but overall, the evidence pointed to poor quality of care across the board. Finally, telemedicine was perceived by clients as an attractive feature, but problems in the implementation of the technology meant its effect on quality of antenatal care was likely limited.ConclusionsThese findings point towards the importance of designing programmes based on a strong theory of change, understanding market conditions and what patients value, and rigorously testing new technologies. The design of future social franchising programmes should take account of the challenges documented in this and other evaluations.

Cost-effectiveness of results-based financing, Zambia: a cluster randomized trial.

ObjectiveTo evaluate the cost–effectiveness of results-based financing and input-based financing to increase use and quality of maternal and child health services in rural areas of Zambia.MethodsIn a cluster-randomized trial from April 2012 to June 2014, 30 districts were allocated to three groups: results-based financing (increased funding tied to performance on pre-agreed indicators), input-based financing (increased funding not tied to performance) or control (no additional funding), serving populations of 1.33, 1.26 and 1.40 million people, respectively. We assessed incremental financial costs for programme implementation and verification, consumables and supervision. We evaluated coverage and quality effectiveness of maternal and child health services before and after the trial, using data from household and facility surveys, and converted these to quality-adjusted life years (QALYs) gained.FindingsCoverage and quality of care increased significantly more in results-based financing than control districts: difference in differences for coverage were 12.8% for institutional deliveries, 8.2% postnatal care, 19.5% injectable contraceptives, 3.0% intermittent preventive treatment in pregnancy and 6.1% to 29.4% vaccinations. In input-based financing districts, coverage increased significantly more versus the control for institutional deliveries (17.5%) and postnatal care (13.2%). Compared with control districts, 641 more lives were saved (lower–upper bounds: 580–700) in results-based financing districts and 362 lives (lower–upper bounds: 293–430) in input-based financing districts. The corresponding incremental cost–effectiveness ratios were 809 United States dollars (US$) and US$ 413 per QALY gained, respectively.ConclusionCompared with the control, both results-based financing and input-based financing were cost–effective in Zambia.

Correction: Evaluation of a community-based intervention to improve maternal and neonatal health service coverage in the most rural and remote districts of Zambia.

[This corrects the article DOI: 10.1371/journal.pone.0190145.].

Implementation of a community-based intervention in the most rural and remote districts of Zambia: a process evaluation of safe motherhood action groups

BackgroundA 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.MethodsA 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.ResultsWe 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.ConclusionWe 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.