Evidence brief: Scaling up Safe Motherhood Action Groups in Zambia

The Mobilising Access to Maternal Health Services in Zambia programme (MAMaZ) and its successor programme, MORE MAMaZ, supported the scaling up of the national Safe Motherhood Action Groups (SMAG) initiative between 2010 and 2016. Government efforts to roll SMAG activities out to new areas (horizontal scale-up) and to build institutional ownership, thereby placing the initiative on a sustainable footing (vertical scale-up) were supported. These scaling up experiences are highly relevant in a context where current global health policy gives high priority to accelerated implementation of evidence-based initiatives to ensure the survival of every newborn, mother and child.

This brief sets out to capture the changes that have occurred in communities where Safe Motherhood Action Groups (SMAGs) are operational.

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Tips for Engaging Communities during COVID-19 in Low-Resource Settings, Remotely and In-Person – April 2020

This brief provides key considerations for engaging communities on COVID-19 and tips for how to engage where there are movement restrictions and physical distancing measures in place, particularly in low-resource settings. It is designed for non-governmental organizations (NGOs), UN agencies, government agencies, and other humanitarian and implementing actors working on health promotion, risk communication, and community engagement for COVID-19.

This document is an initiative of the GOARN Risk Communication and Community Engagement (RCCE) Coordination Working Group co-led by UNICEF, the International Federation of the Red Cross (IFRC), and the World Health Organization (WHO). It was developed jointly by the READY initiative [funded by USAID’s Office of Foreign Disaster Assistance (OFDA), Johns Hopkins Center for Communication Programs (CCP), Save the Children, UNICEF, UNICEF’s Social Science Analysis Cell (CASS), IFRC, WHO, CORE Group, Social Science in Humanitarian Action (SSHAP), Anthrologica, United National High Commissioner for Refugees (UNHCR), CARE International, Internews, DAI, Community Health Impact Coalition, BBC Media Action, Emergency Telecommunications Cluster (ETC), World Food Programme, and Catholic Relief Services, with additional input from public health consultant Sanchika Gupta. This document will be updated periodically as new guidance and practices are developed.

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Emergency Transport Scheme (ETS) Training Guide for Trainers of Bicycle Ambulance (April 2019)

Emergency Transport Schemes (ETS) offer an affordable means of transportation for health emergencies and patient referrals to health facilities, in communities where no formal transport services exist, or where affordable means of transportation lack.

This training manual is intended for trainers who are conducting training on ETS, and introducing bicycles as a solution for community based transport to help expecting mothers and under 5 children with severe malaria in accessing health care when in labour and six weeks after child birth. The topics in this manual have been logically arranged to help guide the trainer follow an approach which aims to maximise the impact of the ETS introduction through clear messaging and instruction.

 The purpose of the ETS training is to develop the knowledge and skills of the community volunteer ETS riders so that they can professionally, safely, actively and effectively contribute to reducing the delay on maternal emergencies and children with severe malaria faced in accessing transportation. This manual acts as a learning tool and reference to be used in conducting training geared towards achieving this. It contains the course layout, proposed timings and gives the trainer comprehensive guidance on critical issues relating to the successful operation of a community managed ETS. It is not meant as a document for general distribution among all ETS volunteer riders, rather for trainers.

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Emergency Transport Scheme (ETS) in Nasarawa State, Nigeria – Technical Brief

According to the World Bank (2017), Nigeria has the fourth worst estimated maternal mortality rate (MMR) in the world of 917 deaths per 100,000 live births. Nasarawa State, located in North Central Nigeria, has been estimated to have a maternal mortality rate (MMR) of 1,000 deaths per 100,000 live births. Among the many factors contributing to the alarming MMR figures, transport availability and affordability are some of the key barriers to safe motherhood in Nasarawa. To address these constraints, Transaid established an Emergency Transport Scheme (ETS) in two Local Government Authorities (LGA) in 2016-2017 that aimed to bridge the gap in available and affordable transport solutions for women seeking institutional deliveries.

Programmatic operations involved the training of ETS volunteer drivers, equipping them with the skills to safely transport women in need to a health facility in the six Local Government Authorities (LGA). Building on the learnings from this pilot intervention, in partnership with the National Union of Road Transport Workers (NURTW), the Ministry of Women Affairs and the Ministry of Health in Nasarawa State, ETS activities were expanded into four new LGAs in November 2017.


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Emergency Transport Scheme (ETS) in Adamawa State, Nigeria – Technical Brief

In July 2013, Transaid, in partnership with Nigerian NGO, Society for Family Health (SFH), received funding from Comic Relief to deliver a five-year programme aimed at improving access to maternal health services for rural communities in Adamawa State. Nigeria had a Maternal Mortality Ratio (MMR) of 576 deaths per 100,000[1] live births in 2013, one of the highest in sub-Saharan Africa.

Based on lessons learned from previous programmes including PRRINN-MNCH and the Emergency Transport Scheme (ETS) programme in Gombe State, Transaid implemented an ETS in Adamawa State in collaboration with the National Union of Road Transport Workers (NURTW). This programme targeted communities living in 16 Local Government Areas (LGAs), constituting almost 3.1 million people[2], utilising the NURTW’s influence and capacity in coordinating the activities of taxi drivers nationwide.


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Health Facility Study Report – Adamawa State Emergency Transport Scheme (ETS) Programme

The Comic Relief funded Emergency Transport Scheme (ETS) programme ran in Adamawa State, North East Nigeria, for a five-year period between 2013 and 2018. It focused on reducing the health care access gap for pregnant women in rural communities during delivery or maternal complications, through safe and affordable transport.

Given the limited evidence-based guidance for practitioners and policy-makers in both the health and transport sectors on how best to reduce the negative impact of lack of transport on Africa’s high maternal mortality rates, there is scope for this report to add to global learning and inform decision-makers.

The Adamawa State ETS programme Health Facility Study Report outlines the findings from an investigation to determine if and how the use of ETS correlates to a woman’s health condition upon arrival at a health facility during delivery or a maternal complication.

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Emergency Transport Scheme (ETS) User Survey Report – Adamawa State ETS programme

The Emergency Transport Scheme programme ran in Adamawa State, North East Nigeria, for a five-year period between 2013 and 2018 and was funded by Comic Relief. This focused on bridging the gap in access to health care for pregnant women in rural communities during delivery or maternal complications through providing safe, affordable transport. The programme was implemented by Transaid and Society for Family Health (SFH) in collaboration with the National Union of Road Transport Workers (NURTW), the Adamawa State Government and local communities.

The ETS User Survey Report presents the findings from the Adamawa State ETS programme and gathered both qualitative and quantitative data, which are invaluable in building understanding of the reasons behind ETS users’ choices to make use of the emergency transport scheme. The survey was conducted in March 2017 and gathered data from 150 women on their health and transport seeking behaviour.

To read this report, please click below.