By Nazeem Muhajarine, Jessie Forsyth, Denise Kouri and Don Kossick

After seven successful years of project implementation, the Mozambique-Canada Maternal Health Project is ending on June 30. Last week we submitted our final report, describing our activities and outcomes, and reflecting on our success. We are proud of our efforts.

Together, strengthened communities are working alongside a strengthened health system to make pregnancy and delivery safer in 20 partner communities in Inhambane province, as a result of our project.

We have increased women’s participation in their communities’ leadership and contributed to the empowerment of, and respect for, women. We have contributed to their social and economic wellbeing through microprojects and community discussion about the role of women. And we have supported pregnant women through education and facilitating their access to health services.

These two women’s comments are illustrative of the range of interventions that took place:

 “[I appreciated the] help going to the prenatal consults. And to be taught how to use the mosquito net to prevent malaria … And to wait for delivery in the Maternal Waiting Home… I was happy to have a [flour] grinder, because I no longer had to do heavy work, and the motorized ambulance, to transport people who are sick, especially pregnant women.”

“[Participating in the project] helped me a lot, there were things that even though I knew they were wrong, I could be afraid to tell my daughter but today with the conversations we had I feel that I must have the courage to speak because it is the right way. I have to talk to other mothers so that they too know what to talk to their daughters about.”

Stories from the field indicate that our contribution is making an important difference in women’s lives. At the community level, the work of the health committee members successfully guiding and supporting women and family members to seek pre-natal care and deliver at health facilities becomes clear from the following story: 

A 29-year-old woman was expecting her third child, alone, and fearful of delivering at a health centre in the false belief of being forced to undergo a caesarean. Her previous two children had been born at home, and the social exclusion she experienced created barriers to seeking trained health assistance. But through discussion with health committee members, she decided to travel to the nearest health facility where her baby was born without complication. She continued to receive post-partum care there, creating new confidence in the health system and its benefits.

We have trained and supported health workers to improve their skills and attitudes. Midway through the project, the Inhambane Provincial Directorate of Health reported that maternal deaths due to hemorrhaging had decreased as a result of training and materials provided by the project. We also received reports from health facility managers that more health workers were successfully performing newborn resuscitation as a result of practical, on-site continuing education provided by the project, and reports from community health committees indicated throughout that increasing numbers of women were seeking out timely pre-natal care and having hospital deliveries as a result of community engagement activities. The described changes are significant achievements in support of improved sexual, reproductive, maternal, and neonatal health and attest to the quality of our clinical and behavioural/attitudinal continuing education, the willingness of health workers to improve their practice and deepen gender-sensitive, humanized approaches to care – particularly in dealing with obstetrical complications and providing emergency newborn care – and the growing commitment of community members to promote and seek out institutional care.

New health facilities have been successfully constructed, equipped and operationalized at seven different sites in a timely and cost-efficient manner, including the completion of a range of additional components, that strengthen provision of SRMNH care. In conjunction, 40 strong community health and youth committees lead gender-sensitive community building work that situate the new health infrastructure within community contexts alert to the social determinants of health and the need for gender-sensitive, humanized care.

We take satisfaction in knowing that improvements will continue beyond the life of the project and take a variety of forms. The project influenced a comprehensive range of activities that set the foundation for improved sexual, reproductive, maternal and newborn health with far-reaching impacts: from community-engaged health practice to skills training and systems building to women’s and girls’ empowerment and the wider promotion of sexual and reproductive health and rights within and beyond health care.

In conjunction, health planners experience increased access to gender-responsive information generated by the project that supports reflection on and planning for improved interventions at community, district and provincial levels.

Intervention research was carried out alongside the community and health system strengthening work, focusing on women’s maternal experiences, maternal near-miss, and maternity waiting homes, all of which have generated rich insights and are ongoing. Research findings have been fed back into the activities further driving evidence-based interventions, while they have also led to more than a dozen peer-reviewed publications, presentations and policy dialogues. 

REFLECTING ON OUR PRACTICE

In our report, we identified some key practices that contributed to the project’s success.

Women’s empowerment

This project’s main premise was that women’s empowerment is key to improved sexual, reproductive, maternal and newborn health. Therefore, feminist practices were important in implementing the project. We identified the following elements in the project’s feminist approach:

  • Attention to women’s participation at all levels of the project
  • Integrating the ideas about women’s equality into all activities
  • Listening to women, seeking input from women about issues impacting their lives
  • Rights-based approach to sexual health education

Collaborative practice

Another key value in our project’s approach was collaboration. We identified the following elements:

  • Building trust and credibility
  • Management engagement in quality improvement and policy dialogues
  • Supporting healthcare practitioner and infrastructure needs

Community engagement

At the community level, we identified the following elements of community engagement:

  • Supporting community leadership, including women’s leadership
  • Integrating economic development
  • Increasing the participation of young adults

Flexibility in meeting training needs

In developing skills, we tried to remain flexible. For example, by:

  • Adapting our continuing education training methodology; doing more onsite training
  • Combining training with infrastructure support

Mozambican team skills and dedication

This project’s success is due to the dedication and skills of our Mozambican team, led by Ruta Massunguine, Argentina Munguambe, Horácio Mandevo and António Tanda. Our team has knowledge, experience and abilities in continuing education, maternal and reproductive health, community engagement and development, construction of health facilities, health system training and management and management of microprojects. Their commitment to the values of the project build trust and positive relationships with both institutional and community partners. This includes our team of community support workers and drivers whose work in reaching remote areas was invaluable.

PROJECT TIME MAP

The figures below provide an overview of the project’s time map over the seven years, with the bottom figure showing how overlapping multisectoral activities complemented each other toward achieving project outcomes that ultimately lead to healthier women, families and communities.

Project time map

Project time map showing overlapping functions