Too Good, and True: Ensuring Rights-Based, Quality Maternal Health Care in Mozambique

BY Claire B. Cole Alicia Mehl April 8, 2015

Last week, a team of Pathfinders and partners working in Nampula province, Mozambique, convened to investigate a significant change observed in the districts where we are working. The discoveries made during last week’s implementation learning meetings made us leap with joy.

Skilled birth attendance in intervention areas of Nampula Province, Mozambique has increased from 63% to 75% over the past four years.

We wanted to understand why.

First, we had to ask ourselves, "could this be right?" But we triple checked, and the numbers held up. After more than four years of meticulously designed activities by the USAID-funded Strengthening Communities through Integrated Programming (SCIP) project and the tireless efforts of the maternal and child health teams across Mozambique's Nampula Province, the coverage by skilled birth attendants has increased dramatically.

For months now, as part of a final evaluation of the project, we’ve visited district after district and village after village—speaking with health facility staff, community leadership council members, and combing through record books. Time and again, we offered our truck as a means to transport women (often as young as 14 or 15) in need of emergency care to the health facility.

We experienced firsthand the challenge of fording flooded rivers just to reach the health post from the rural village of Muatua (located in Mogovolas, Nampula). And, we listened with mixed emotions as nurses like Telma Francisco of Muatua told us what she’s seen over the years.

“It’s like this. When I first began working this facility, no one came to deliver," she said. "I knew women were delivering in the community, and I knew I needed to go to them, to earn their trust. But I had no support, no way to do that. Then SCIP came. They trained me, gave me the tools, partnered with me, and made it possible. Now I work actively in the community.”

Telma’s efforts haven’t been in vain.

Today, nearly every community in Muatua has a community leader participating in decision-making about their community’s health, with nurse Telma as a partner in the process. SCIP has helped to set up the co-management committees that make this possible. SCIP also supports nurse Telma to become a mentor to traditional birth attendants so that they work together to improve safe motherhood practices and encourage women to come to the facility for birth.

More than that, traditional birth attendants (previously operating with no formal link to the health system) are now reporting data directly to their own community leaders. As part of the community system SCIP has supported, communities are now organized and actively tracking their own accomplishments toward safe motherhood and institutional deliveries.

And the results are evident: The increase in skilled attendance in Nurse Telma’s coverage area is among the largest in Nampula—the percentage rose from a mere 19% in 2009 to 72% in 2013!

To understand just how important these numbers are, consider three things:

Ensuring that women deliver with skilled birth attendants is the most important aspect of preventing maternal deaths and disability;
Pregnancy and childbirth is the second leading cause of death among adolescent girls in developing countries, and
In Mozambique, more than 70% of all women have begun bearing children by the time they turn 20.

But change this powerful doesn’t happen magically.

In many parts of the world (Nampula included), a lack of skilled attendance at birth is due to several complex factors such as shortfalls in health care providers, equipment, and essential medications; and a pervasive distrust of—or outright distaste for—the care women receive if they do make it to a facility.

Pathfinder has long understood that it is essential to jointly implement efforts to improve the delivery and availability of quality maternal health care (so women will actually receive respectful, high-quality care) while simultaneously supporting health systems and communities to overcome beliefs, social norms, and behaviors which perpetuate disrespectful care of women and which foster distrust of the health facilities. This is exactly what we’ve been doing through SCIP.

The health and well-being of the world’s women and girls relies on ensuring they have access to and utilize high-quality, skilled care during pregnancy and delivery.

In Nampula, at least, communities are much closer to meeting that need.