Closing the Gap Between Community and Formal Health Systems

Abstract

Every pregnant woman deserves the right to be treated with respect and dignity when visiting a health facility. Unfortunately, this is still not the case in many countries around the world. This creates an environment in which women decline antenatal care in facilities and/or prefer home births to giving birth in the attendance of skilled birth attendants. The possibility of complications during their pregnancy increases, which can put both the mother and child in danger and can even cause maternal mortality. To contribute to the elimination of preventable maternal deaths, the fully Amref sponsored Zambian program Closing the Gap Between Community and Formal Health Systems has been implemented and tackled a few factors associated with maternal mortality. The programs aim was to strengthen the relation between formal health systems and communities, but the novel and unique aspect of the program was the implementation of Respectful Maternity Care (RMC) and Customer Care (CC) (also informally known as the Smile Campaign). This could be understood as the root of the program, which had far reached influence on Maternal, Newborn and Child Health (MNCH) and its supporting system. This learning paper has examined the program and creates a RMC model, which shows the system in which all actors play its part, whereby providing knowledge and practice of RMC is seen as foundation and driving force. The aim is to have an optimized model, in which maternal mortality is diminished, by providing respectful care in a safe environment, and whereby formal and informal health systems work closely together.