Written by Women’s groups using PLA and focusing on MNH can dramatically reduce maternal and newborn deaths and catalyse improvements in the demand, delivery and quality of maternity services. Based on the three delays model (delays in i. deciding to seek care, ii. reaching the place of care and iii. receiving adequate care once there) we will use a three pronged approach – PCP’s community based demand side intervention will reduce the first and second delays and health system strengthening and advocacy will address the third delay.
Prong 1 – Women’s groups: The main approach focuses on the establishment of 194 women’s groupsthrough which we willmobilise communities for better MNH care. The women’s groups will be led by facilitators who are local WRA with at least high school level education, recruited and trained by PCP. These facilitators will convene a cycle of around eight monthly meetings on MNH and each facilitator will be responsible for four women’s groups. She will guide the women’s groups through a four-phased community action cycle, in which she will activate and support the groups to identify and prioritise MNH problems (phase 1), plan strategies to address these problems (phase 2), and implement (phase 3) and self-evaluate (phase 4) these strategies. At the end of phase 2 and the start of phase 3 community meetings will be held to engage the wider community in the development and implementation of the strategies. The facilitators will use picture cards and flip charts to stimulate discussion and will receive training in participatory communication methods and in basic MNH. Coverage is an important element of a successful PLA approach. From our own previous project experience in Bangladesh with one women’s group per 1414 population, newborn mortality fell by just 7% (Azad et al, 2010), but when scaled to one women’s group per 300 population, mortality reduced by 38% (Fottrell et al, 2013). Based on this, and learning from other projects in South Asia and Africa, we have opted for coverage of one women’s group per 500 population(Prost et al, 2013; Fottrell et al, 2013). The women’s groups develop the strategies, which vary between groups and settings depending on local priorities. Examples of popular strategies include MNH awareness raising, emergency funds and transportation.
Prong 2 – Health system strengthening: PCP will build links between the women’s groups and community health committees and clinics to strengthen the referral system. PCP will do this by encouraging women’s groups’ facilitators and members to participate in government mandated health committee meetings at the union, upazila and district levels to ensure optimum utilization of existing health facilities and to ensure that health committee members are aware of and address the MNH issues facing women in the community.Prong 3 – Advocacy: We will advocate for improved quality services and for increased participation of rural women in the health committees (above). We will also focus on sharing local MNH information, data and case studies with government staff, NGOs, CBOs, Imams and teachers.