Sustainability
Sustainability means designing and developing a maternity waiting home (MWH) to support and maintain itself to meet the needs of future generations. Strong community involvement, governmental support, and local leadership support are essential to sustainable and successful homes. Community members should be involved in the major planning and establishment of MWHs (1). Community governance and financial planning, accountability and ownership contribute to a sustainable system. The use of several sources for revenue can aid in financial sustainability, such as revenue from local and national government sources, contributions, and fundraising activities chosen by the community (2). Successful MWHs must be integrated throughout an existing health system and incorporated with support from health facility staff (3).
Critical factors to consider with developing an MWH (click each factor below to read more):
-
Revenue-generating activities should come from multiple sources:
Health system via government budgets
Income-generating activities chosen by the community
Donation or monetary contributions
Fee for use
Financial training for community members has been shown to be helpful in financial sustainability and increase community involvement.
Challenge: Charging a fee for use or use of supplies may lead to a barrier and decrease the use of the MWH. If this is a consideration, it is important to include the women and understand:
What is a reasonable fee?
Would they still use the maternity waiting home if there was a fee?
-
Whether owned and managed by the community itself or by the government with community decision-making, community involvement is critical to sustainability. Ongoing commitment in times of political change must be maintained.
Staffing considerations:
Selected by community
Responsible for day-to-day operations
Involvement and oversight of health facility staff
-
It is important to periodically assess the women’s satisfaction and access to supplies while staying in the homes. Past areas of dissatisfaction with access to supplies have included:
Overcrowding
Safety and Quality of supplies
Lack of access to mosquito nets
Lack of private storage spaces
Lack of activities
-
The MWH must be located within easy access for community members and next to a health facility for emergency situations.
Challenges: Some women do not use the MWH due to distance or the expense of transportation. In some cases providing a transportation incentive could encourage women to travel to the MWHs.
-
There are many cultural considerations that must be addressed to ensure optimal use of the home, which include:
Visitation and attendance by family members
Providing traditional healing practices such as traditional teas, steam baths, etc.
Arranging child care
Male role
Role of traditional birth attendant
Challenges: Husbands are often the primary decision-makers and do not always allow the women to use the MWHs or leave the home for long periods during pregnancy. Community support early in the planning process could help address this challenge.
-
Education and communication between community members and health facilities are crucial to the successful use of the MWH, which should include:
Educational program for community members
Educational programs for pregnant women and their families
Educational programs for health facility staff
On-going outreach within the community
Continued feedback from community members
Challenges: Lack of knowledge from health facility staff and community members about how or when to use the MWH can cause a disconnect and decrease the overall use of MWH.
-
Referral System: referring women from the community to MWH and referring from MWH to appropriate level of care
Referral systems have been shown to improve the use of MWHs which include:
Increased community awareness and engagement
Women are more likely to use the MWH if referred by a friend or family member
Providing an incentive to refer
MWHs provide referrals for women in the community to higher levels of care in emergency situations or in high-risk pregnancies. This referral is essential to reducing the risk of maternal and neonatal morbidity and mortality. Access and referral to an appropriate level of care in the case of emergencies is essential.
MWH in Liberia (Photo: Jody R. Lori)
Welcome sign at MWH in Liberia (Photo: Jody R. Lori)
-
*denotes open access
(1) *Ruiz MJ, van Dijk MG, Berdichevsky K, Munguía A, Burks C, García SG. Barriers to the use of maternity waiting homes in indigenous regions of Guatemala: A study of users' and community members' perceptions. Culture, Health & Sexuality. 2013;15(2):205-18. doi:10.1080/13691058.2012.751128
(2) *García Prado A, Cortez R. Maternity waiting homes and institutional birth in Nicaragua: Policy options and strategic implications. The International Journal of Health Planning and Management. 2012;27(2):150-66. doi:10.1002/hpm.1107
(3) Kyokan M, Whitney-Long M, Kuteh M, Raven J. Community-based birth waiting homes in northern Sierra Leone: factors influencing women's use. Midwifery. 2016;39:49-56. doi:10.1016/j.midw.2016.04.013
Additional References
*Bongaarts J. WHO, UNICEF, UNFPA, World Bank Group, and United Nations Population Division trends in maternal mortality: 1990 to 2015. Population and Development Review. 2016;42(4):726-726. https://doi.org/10.1111/padr.12033
Campbell OM, Calvert C, Testa A, Strehlow M, Benova L, Keyes E, Donnay F, Macleod D, Gabrysch S, Rong L, Ronsmans C. The scale, scope, coverage, and capability of childbirth care. The Lancet. 2016;388(10056):2193-208. https://doi.org/10.1016/S0140-6736(16)31528-8
*Kaiser, J.L., Fong, R.M., Ngoma, T. et al. The effects of maternity waiting homes on the health workforce and maternal health service delivery in rural Zambia: a qualitative analysis. Hum Resour Health 17, 93 (2019). https://doi.org/10.1186/s12960-019-0436-7
*Lori JR, Boyd CJ, Munro-Kramer ML, Veliz PT, Henry EG, Kaiser J, Munsonda G, Scott N. Characteristics of maternity waiting homes and the women who use them: findings from a baseline cross-sectional household survey among SMGL-supported districts in Zambia. PloS One. 2018;13(12):e0209815. https://doi.org/10.1371/journal.pone.0209815
McIntosh N, Gruits P, Oppel E, Shao A. Built spaces and features associated with user satisfaction in maternity waiting homes in Malawi. Midwifery. 2018;62:96-103. doi:10.1016/j.midw.2018.03.020
*Satti, Hind, Megan M McLaughlin, and K.J. Seung. Rep. The Role of Maternity Waiting Homes as Part of a Comprehensive Maternal Mortality Reduction Strategy in Loesotho. Partners In Health Reports, 2013. Accessed 2022. https://www.pih.org/sites/default/files/2017-07/PIH_Report_Sept_IndividualPgs.pdf
-
Sustainability Table [download]