Working with local resources to ensure sustainability; lessons from a maternal and newborn study in Eastern Uganda
How sustainable is that? If someone wanted to replicate your intervention, how easy would it be? What happens when the study ends? Will the communities be able to continue with this initiative?
If you are involved in research or some kind of programme implementation you will agree with me that these and similar questions are increasingly becoming common in light of life beyond research interventions. And these, are indeed genuine questions especially in a context where we have had so many pilot studies that never go beyond their intervention areas, let alone being sustained in these sites.
Well, there are no straight answers to solving this, but working with the Maternal and Neonatal Implementation for Equitable Systems (MANIFEST) Study of Makerere University School of Public Health which was conducted in Kamuli, Kibuku and Pallisa Districts, I learnt a couple of ways of going about this.
With an aim of improving maternal and newborn outcomes, MANIFEST employed a participatory action research approach, which ensured that community and district teams played a big role in implementation of the project, unlike its predecessor the safe deliveries study where university staff were heavily involved.
MANIFEST had three components of community mobilisation and sensitisation, savings and transport, and health systems strengthening. In order to sustain most of what was implemented during the project intervention period of 2013-2015, MANIFEST activities were strategically planned to secure community and district buy in, as explained thus under each component.
Community Mobilisation and Sensitisation
In order to promote birth preparedness and safe motherhood in general at community level, it was conceived during the design phase that existing community health workers â€“ also known as Village Health Teams- carry out the mobilisation and sensitisation. This was done through home visits to health educate families. The VHTs also facilitated community dialogues which discussed a range of safe motherhood issues. They also complimented the HMIS by providing maternal and newborn mortality data from outside health facility settings.
Savings and Transport
To avoid delays occasioned by the lack of funds for routine and referral transport or safe birth essentials, communities were mobilised to start saving groups or incorporate a maternal and newborn health fund within existing self-help saving groups which had interests varying from raising money to buy meat for festive seasons to funding funerals. Again, the use of VHTs in mobilising the communities and the involvement of community development officers as well as district commercial officers for technical support (which is actually part of their work) was strategically aimed at ensuring sustainability. Promoting community development is ideally the work of these stakeholders.
Some members of the Luzinga Parish VHT Savings Group in Kamuli District during a meeting early this year.
This was an already existing group that adapted the MANIFEST model following training.
Health Systems Strengthening
In one of the activities under this component, MANIFEST paired up national level mentors with district based ones to ensure capacity building of the latter in terms of conducting supportive supervision and mentorship. This was aimed at ensuring that district staff continued with supportive supervision and mentorship even after the study. Refresher trainings for health workers to improve on their knowledge and skills in basic and emergency obstetric care, training of health managers in health services management, and recognition of best performing health workers and facilities at public symposia were the other activities under this component of the study.
So did the MANIFEST concept of using locally available resources work?
This is how Kibuku District Health Officer Dr Ahmed Bumba summed it up last December: â€œFor me as a district health officer, it is obvious, this has worked. The MANIFEST project and people in academia, you can go ahead and do the tests. Be it Z test, T test, multiple regression, removing possible confounders; I really donâ€™t care about the tests. For us, this has worked.â€
Well, to Dr Bumba and colleagues, hope the story script will read the same come December 2016 – one year after the official end of the MANIFEST Project.
A summary of MANIFEST study findings can be found in this Research Brief.
Blog by Kakaire Ayub Kirunda, a communication for development specialist with Makerere University School of Public Health