Back in April, I joined a fact-finding mission to Zambia, where MSD for Mothers is supporting the construction of 12 maternity waiting homes (Click here to learn more about the amazing progress being made). Representatives from each of our Zambia partners were there: Africare and Boston University, the two NGOs overseeing the building projects, and the Bill & Melinda Gates Foundation and The ELMA Foundation, the two private donor organizations helping us fund the program.
Our purpose in coming together was to compare notes, align and discuss how to make the homes, which serve as temporary residences for women who are about to give birth, self-sustaining through income generating activities such as the sale of goods or locally grown produce. We are working to define how these facilities will be able to function long term, under local management, with local support.
Another reason for the trip was to visit one of the construction sites, located next to a rural health facility near the village of Mbabala in the Choma district, some 175 miles southwest of the capital city of Lusaka. Though only half way to completion, the walls of the maternity home were already up, forming the basic layout: one room with beds to accommodate up to eight women waiting to deliver; a second room to house up to four women post-birth; separate areas for cooking and doing laundry, plus a communal meeting space. There are plans to install toilets and showers as well, a luxury in this part of Africa.
After a tour, we met with community members and health workers under the shade of a tree as the clinic’s chief medical officer briefed us on how his facility meets the healthcare needs of the community. He told us that his facility, which serves a population of 11,000, sees about 200 out of the estimated 500 annual births. He estimated that about 90 babies are born at home every year, and data was not available for the remainder. The hope is that by providing a more comfortable, more welcoming, and better equipped place for women to stay during their final weeks of pregnancy, a place with easy access to intra-partum care and support from the clinic next door, and to community health workers who can assist with postpartum family planning and other services, more women will come, the number of facility births will increase, and overall maternal outcomes will improve.
In 2015, Zambia’s maternal mortality rate was 224 deaths per 100,000 live births, one of the highest in the world. One of the most persistent risk factors is the relative difficulty in accessing maternal care in remote areas. Half of Zambian rural households live at least three miles away from the nearest clinic, and with transportation limited, most women have to make the journey on foot.
Our project will assess whether the new buildings with all their amenities will prompt more women to make the trip, well in advance of their due date, and what kind of effect that will have on maternal mortality and morbidity.
At one point during our field visit to the Choma site, we received word that one of the clinic’s patients, a woman in labor, was not doing well. She needed to get to a higher-level facility about a half hour’s drive down the road, but the ambulance was at least two hours away.
We learned later that the woman gave birth to a healthy baby boy, and both mother and child survived. Yet what struck me was that the woman’s life had been in danger, even though she had made the “right move;” even though she had managed to get herself to a facility in time to have her baby. The situation was a stark reminder that there are many factors at work, and any one of them can mean the difference between life and death: a facility’s capacity and resources, a provider’s skills, or the availability of emergency transport. Strengthening health systems requires putting all of these pieces into place.
Despite the challenges, thanks to our efforts in the tiny village of Mbabala, mothers will have better access to healthcare than they did before. And that is progress we can be proud of.