Of ZAMs & SMAGs in Zambia

Hello my fellow WDI interns!

Hope that all of you are thoroughly enjoying your experiences thus far, wherever you may be J     As some of you may or may not know, those of us in Eastern Africa have been dealing with quite the energy crisis and as the weeks go on it seems to just get worse and worse- there are points in the week when we are without electricity and water for far over 48 hours, and while it certainly makes things more difficult for us on the project, the strain and demands that it places on the local individuals can be certainly be seen and felt by all.

This summer I was given the opportunity to work with Africare Zambia. We began work on a three year project that aims to demonstrate high-quality entrepreneurial Zambian Maternity Homes (ZaMs) and evaluate if the model is operationally and financially sustainable, thereby improving equity of maternity access care for the most vulnerable and marginalized populations in the Lundazi and Mansa Districts in Eastern Zambia.

Phase I of the project was completed late last year and with additional funding from Merck and the Bill and Melinda Gates Foundation, phase II was able to build upon what research and data analysis was obtained from phase I.  Maternity homes, or residential dwellings located near health facilities where women in the late stages of pregnancy can stay to await delivery and receive postpartum services have been used previously in a variety of settings as a 'geographic bridge' to overcome distance and transportation barriers that prevent women from receiving obstetric care in a timely manner. Unfortunately, implementing maternity homes tend to be small-scale, unstandardized, and ultimately failed to be responsive to community needs.
 



Preparing food in a make-shift area outside a local birth clinic (a current establishment that will be upgraded) in the Lundazi area, Eastern Province of Zambia.

The initial weeks of my summer were spent gaining an insight into the organization of Africare itself and getting myself familiar with where the project currently stood, who I would be working alongside, and what tasks I would most dedicate myself to. Certainly before I came to Zambia I had ideas and visions about what this work would look like, but truthfully once you’re on the ground it almost feels like you are a part of it all because we’re such a close group of colleagues.  Rightfully so, the IT individual can easily be connected to our financial director, who’s then tied to all of us, on the ground or not.  So, it became clear to me that though I would have certain objectives and tasks, I would become very familiar with the logistics of everyone’s part on the project very quickly.

Recently we wrapped up solidifying what exactly our ZaMs accountability structure would look like- see below.  Ideally we wanted to construct it such that it is not only sustainable in the short-term with us on the ground, but that once we depart, the oversight and management of such facilities (ZaMs) continue to operate in efficient manner.

You’ll see in the red box where I most dedicated my last month of time to:  Maternity Home Committee, ZaMs Caretaker and ZaMs Coordinator. You’ll see that the community-supported ZaMs model is accountable to the community and to the government through the Ministry of Community Development and Mother and Child Health (MCDMCH).  Additionally, the Maternity Home Committee is made up of 6-10 community-elected representatives from Neighborhood Health Committees, health facility staff, Safe Motherhood Action Groups (SMAG) members, and traditional community leaders who will make up the governing structure of each ZaMs.  Our hope is that this structure promotes government recognition of ZaMs as an integral part of the health facility.  We believe that incorporating MCDMCH and local government throughout the implementation period will in turn lead to a seamless transition to full government oversight post-project.  Long-term operational and financial sustainability is essential to the success of the ZaMs model thus much of our time is devoted to these two topics!

Women waiting outside another clinic we are going to use as a foundation for another ZaM

3 women we spent quite a bit of time with discussing things like cultural acceptability to the ZaMs, the importance of local women involvement in the project and our ideas for financial sustainability and their thoughts

Next blog post I’ll share what we’ve accomplished thus far regarding the financial sustainability initiatives this project will employ.
 

Cheers!

Posted on behalf of Samantha Madden