St John International's Mother and Baby Programme
What's The Challenge?
Globally, maternal mortality remains unacceptably high. Efforts to reduce maternal and newborn mortality in Sub-Saharan Africa have been successful since 2000, with a continuous downward trend in most countries, but the rate is still almost double that of other regions.?About 287,000 women died during and following pregnancy and childbirth in 2020 with 95% occurring in low and lower middle-income countries. Most could have been prevented.??Sub-Saharan Africa?alone accounted for around?70% of maternal deaths?(202,000)
In 2019, 47% of all under-5 deaths occurred in the newborn period with about one third dying on the day of birth and close to three quarters dying within the first week of life.?Sub-Saharan Africa?had the?highest neonatal mortality rate?in?2019?at 27 deaths per 1,000 live births. A?child born?in sub-Saharan Africa is?15 times?more likely to die in the first 5 years than a child born in Europe or North America.
Where Do We Work?
Malawi has a high MMR currently estimated at 349 maternal deaths per 100,000 live births. According to the World Bank (2021), out of every 1,000 children born in Malawi, 31 of them will not reach their first birthday (UK and Canada infant mortality ratio is 4/1000).
Uganda is yet to achieve real progress in reducing neonatal and maternal deaths. MMR is currently estimated at 375 maternal deaths per 100,000 live births, with at least one in 4 girls aged 15 to 19 years already bearing children. Children born in rural areas, to the poorest families, and with uneducated mothers are most likely to die before the age of five.??
Zambia has made progress in reducing child mortality, but challenges remain in maternal and neonatal mortality. MMR is currently estimated at 213 maternal deaths per 100,000 live births. World Bank (2021) states that 40 of every 1,000 children will not reach their first birthday.?
Zimbabwe has high maternal mortality rates at 363 per 100,000 live births. World Bank (2021) states that 36 of every 1,000 children born in Zimbabwe will not reach their first birthday.
What Have We Achieved Thus Far?
Our Mother and Baby Programme began in 2015. St John currently have?26 staff?and?380 trained?St John volunteers?using the nationally recognised maternal and newborn health packages.
Having enrolled more than?146,000 primary beneficiaries?(pregnant women including single women and adolescents, new mothers with infants, expectant fathers, and new fathers- women). A further?570,000 community members?have been reached with health education. Clinical outreach services, in addition to serving maternal and child health needs, have provided over?425,000?people with primary health consultations in Malawi, Uganda and Zimbabwe.
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The project has resulted in increased local support for pregnant women and new mothers with infants, and stronger relationships between communities and local health providers. This has imbued a greater sense of partnership and mutual responsibility in solving the challenges in providing maternal and child health care and built a foundation for longevity that will ensure the improvements in MNCH are maintained.There is strong collaboration with community health coordinators, local health centres and District Health Offices with common understanding in maternal and child health.
Data from recent site surveys and other programme results show substantially improved outcomes when compared to provincial and national health MNCH. For example, our project sites in Zimbabwe show?68%?of women starting ANC in the first trimester while nationally only?39%?of women achieve this. In Zambia, women receiving 4 ANC consultations leapt from?64%?nationally to?82%?in our project sites.
In?2021?St John International published the?Mother and Baby Success Model (SuMo)?which pulls together the knowledge within St John developed from running the programme. It’s a recipe for success, detailing what has worked in projects so that it can be replicated in other locations. It goes far beyond a simple training curriculum. It tells a manager how to recruit volunteers, how to performance manage the project, and what could be done to improve it. The first version of the SuMo has been co-created by the four St John Associations who deliver the Mother and Baby Programme, (Malawi, Uganda, Zimbabwe, and Zambia) and St John International.
At the start of?2022, St John International rolled out a new performance monitoring system to all programme locations to allow establishments to collect and store impact data in one place. The system, called “Nurture”, allows for real time performance management by providing information on the adoption of healthy behaviour by participants on a monthly basis. Programme managers and volunteers can really see whether the advice they are giving is changing what pregnant mothers and their families do and can adapt their messaging if it is not working.
You can learn more about how we integrate St John's Mother and Baby Programme to the Three Delays Model here:
https://www.stjohninternational.org/Pages/Category/mother-baby
What's Next?
As the programme continues to save lives,?St John International will continue with the transitioning of the Mother and Baby programme towards establishment oversight while delivering current output. In?2023-24, the programme will enrol?46,000 direct beneficiaries?and?160,000 indirect beneficiaries?reached through community programmes.
We will use evidence-based approach for decision making within the programme to support learning, programme improvement and future programming.?The Success Model and Nurture database developed to deliver and manage the programme will serve as a template for the sustainable delivery of future multi-country programmes.
Discussions about longer term funding ongoing, with some of the solutions dependant on Middle East, Africa (EMEA) region uptake, and/or local fundraising capacity. Recently, St John International have had engagement with St John Canada, St John Wales, and St John Papua New Guinea about working together in expending or starting new initiative in country depending on new developments and strategic direction.