Celebrate Solutions: Allowing Community-Driven Ideas to Improve Care

By: Rati Bishnoi, Special Projects Intern at Women Deliver

Over the last two years, thousands of people from all walks of life—from computer engineers to tribal women—in Malawi, Sierra Leone, and Orissa state in India have lent their voices and ideas to improve the quality of maternal and child health care in their communities.

These three areas have something in common – they house some of the worst maternal and child mortality rates in the world. But the barriers and challenges women face to quality care differ for many reasons. Recognizing that community members—including those not usually associated with maternal health care—have a valuable perspective to offer as well as a stake in improving the lives of women and girls, the Bill and Melinda Gates Foundation in 2009 funded a global partnership between UNICEF and Concern Worldwide to find bold, new ideas for addressing gaps in the delivery of quality care.

During the first phase of the Innovations for Maternal, Newborn, and Child Health (IMNCH) program, IMNCH worked with the community to identify key challenges. Next, they used radio and print media campaigns and meetings with key and diverse community groups to advertise a contest in which community members’ ideas would be judged by a panel of experts and potentially tested in an 18-month pilot implementation program.

The response was overwhelming.

Community members from across the three areas submitted nearly 13,000 ideas. Potential solutions poured in from all parts of the community—as it became apparent that better maternal health mattered not just to mothers and health care providers. People who entered the contest included individuals living in remote and medically underserved communities, mothers, high school and college students, entrepreneurs, engineers, frontline health workers, academics, members of civil society organizations, and religious leaders.

Out of thousands of entries emerged six winning ideas, which are currently about to be tested. If successful, they could save the lives of thousands of girls and women.

Malawi has a maternal mortality rate of 510 deaths for every 100,000 live births, an infant mortality rate of 86 deaths for every 1000 infant lives, and a life expectancy of only 52 years. Here, the two winning ideas focused on using technology to facilitate access to health care information and services.

• A health care hotline that sends personalized reminders and health tips to clients before complications occur and give patients an opportunity to speak directly to health care providers to get basic information before coming to a health care facility. Submitted by: Soyapi Mumba, a software development manager working with a Malawian nonprofit organization committed to finding technological solutions for health care challenges.
• An electronic booking system housed at the health care that allows women to book visits with providers and get reminders by SMS and allows health providers to send targeted text messages to communities about maternal and child health care. Submitted by: Clement Mwazambumba, who works at the Ministry of Local Government and Rural Development as the district AIDS coordinator.

Sierra Leone is a country struggling to rebuild its health care system and meet daunting health challenges after being ravaged by violent civil unrest. One in 21 women will die in pregnancy or childbirth, and more than one in every four children die before their fifth birthday. Here, the three winning ideas focused on supporting and improving the quality of care health workers provide.

• Provide psychosocial support to health workers—who themselves are recovering from emotional trauma experienced during Sierra Leone’s 11-year-long conflict. Help health providers manage stress in both their professional and personal lives so they can meet the needs of patients. Submitted by: Victor Makieu, a psychosocial counselor working with Médecins Sans Frontières.
• Foster peer-to-peer learning among health workers—forming “quality circles” of health workers working in similar fields so they may learn from and support each other in managing clinical challenges. Submitted by: Ishmael Rakeem Hemoh, who recently received his masters in rural development.
• Allow communities to grade health worker performance and tie ratings to rewards. Submitted by: Musa Kamara, who is training to be a community health officer.

Orissa lies on the east coast of India and is home to 36.7 million people. In Orissa, it is estimated that 303 maternal deaths occur for every 100,000 births and 69 infants die for every 1000 infant lives. Here, the winning idea focused on making providing care safer for women health workers.

• Incorporate male health workers in service delivery by pairing male health workers with female health workers to enable maternal, newborn, and child health delivery at night and in areas where the safety of women is a concern. Charge male health workers with engaging and interacting with men in households to raise awareness about the importance of proper maternal health. Submitted by: Daktar Majhi, who is currently studying to be a teacher.

IMNCH is currently creating implementation plans for piloting these six solutions in small communities in Malawi, Sierra Leone, and Orissa. As with all development ideas, there is a chance that some of these ideas may not work. However, IMNCH and these community members are willing to take risks, hear “unheard voices,” and try new approaches to find bold and inventive solutions to save the lives of women and children.