Malawi and Zambia will shift control of maternal health research to local leaders, who will use real-time digital dashboards of death and near-miss data to drive improvements in hospital care. This matters because nearly all maternal deaths in Sub-Saharan Africa are preventable with good care, yet both countries are not making adequate progress. The programme tackles a critical gap: facility-level fixes often fail because root causes span the entire health system. By linking community and hospital data, and by training local managers in behaviour-change design, the work aims to close that gap. If successful, the project could reduce preventable deaths and stillbirths in dozens of hospitals across both countries. It will also produce a validated tool for measuring maternity users’ experience, and a model for annual national priority-setting meetings that could reshape how health ministries allocate resources. The first intervention—enhanced antenatal care targeting poor detection of sexually transmitted infections—will be field-tested and, if effective, rolled out across multiple sites.
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BACKGROUND: A majority of maternal deaths occur in Sub-Saharan Africa, and nearly all are preventable with good quality healthcare. Both Malawi and Zambia are committed to improve maternal and neonatal health outcomes, but are not making adequate progress. This new programme of work will build upon the collaboration formed by the NIHR DIPLOMATIC research group. AIM: Our aim is to improve maternal and neonatal health outcomes in Malawi and Zambia, by strengthening the quality of maternity care. TEAM: Senior leadership of the group are all based in Malawi and Zambia. They will partner with other leading international researchers and methodologists, but a decision has been made to shift the locus of control to Malawi. RESEARCH PLAN: The aim will be delivered through 4 themes: Theme 1. Data driving improvement High quality maternal and neonatal health data is key for quality improvement. We will provide real-time digital reporting of maternal deaths, near-miss cases, and quality of care data, accessible via online dashboards. This will be used to identify critical improvement needs and measure progress. We will link facility and community data to understand the gaps in facility data. Theme 2. Placing users at the centre of change We will use qualitative methods to understand the experience of users, in particular adolescents and women with mental health problems. Their narratives will identify how services can better support their needs and inform priority setting. We will optimise a brief tool to measure maternity users’ experience and evaluate its use in practice. Theme 3. Prioritisation and co-design Many changes to improve maternal health are identified at a facility level, yet the root causes span the whole system. We will conduct an annual maternal health needs prioritisation meeting, identifying and championing issues for sector wide focus. To target prioritised issues we will train managers and practitioners in intervention design using the Behaviour Change Wheel methodology and support them in the co-design process. Theme 4. Implementing and evaluating change Sites across Malawi and Zambia will implement behaviour change interventions and robustly evaluate the implementation process. The first intervention has been prioritised. This will evaluate a package of “Enhanced Antenatal Care”, seeking to improve compliance with evidence based antenatal care. We found identification of sexually transmitted infections is poor during antenatal care. We will address how services can be changed to improve this. Behavioural change interventions will be developed by site teams and field tested in their facility. The most effective of these pilots will be selected for a multi-site roll-out and evaluation. COMMUNITY ENGAGEMENT AND INVOLVEMENT (CEI): This is embedded across the work, with strong elements of user engagement and co-design throughout. A specific maternal and neonatal health CEI group will be established in Malawi and Zambia, and provided training. CAPACITY BUILDING: Plans include 3 PhD studentships and support for integrated MSc student projects. Ongoing research skills, policy engagement and management training will be provided at all levels of the team. COMMUNICATING FOR IMPACT: In addition to high quality scientific outputs we are superbly positioned to communicate the work and maximise impact. We will support this with “policy and impact committees” and policy briefs.
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