Search

Abstract: We evaluated the strategies to tackle maternal and infant health problems developed by women''s groups in rural Malawi. Quantitative data were analyzed on strategies developed by 184 groups at two of the meetings in the community action cycle (attended by 3365 and 3047 women). Data on strategies implemented was collected through a survey of the 197 groups active in January 2010. Qualitative data on the identification and implementation of strategies was collected through 17 focus group discussions and 12 interviews with men and women. To address the maternal and child health problems identified the five most common strategies identified were: health education sessions, bicycle ambulances, training of traditional birth attendants, wetland vegetable garden (dimba garden) cultivation and distribution of insecticide treated bednets (ITNs). The five most common strategies actually implemented were: dimba garden cultivation, health education sessions, ITN distribution, health programme radio listening clubs and clearing house surroundings. The rationale behind the strategies and the factors facilitating and hindering implementation are presented. The potential impact of the strategies on health is discussed. Women''s groups help communities to take control of their health issues and have the potential to reduce neonatal, infant and maternal mortality and morbidity in the longer term. [Copyright &y& Elsevier]

Summary: The last few years have seen a welcome re-emphasis on the need to address the unmet health needs of pregnant women and children worldwide in an integrated manner. Although a number of high profile publications have synthesised the main challenges, scientific evidence and policy recommendations for improving maternal and child health, there are many uncertainties and even disagreements about how maternal, neonatal and child health (MNCH) services and interventions should be scaled up. This paper describes the existence of eight ‘tensions’ which underlie these uncertainties and disagreements. These are competition between maternal and child health needs for scarce resources; demands for investment across the full continuum of care; balancing the provision of community and facility-based services; bridging the selective-comprehensive divide; using evidence but recognising its limitations; managing both the public and the private; improving both supply and demand; and balancing short-term urgent demands with long-term needs. Based on a review of the literature and the experience of researchers belonging to the UK Department of International Development''s research programme consortium on maternal health, this paper discusses the implications of these tensions for MNCH advocates, policy makers and planners, and makes three sets of recommendations. Two key messages are the need for more harmonisation between the MNCH and health systems development agendas and greater recognition of the limitations of universal ‘gold standard’ evidence in informing policy development and implementation. [Copyright &y& Elsevier]