Introduction
In the world, health of mothers remains an issue that is confronting health systems, policy makers and communities. In every year hundreds of thousands of women experience the complications or even die because of those reasons which can be avoided during prayer, delivery and puts. It is argued that even though international bodies and national governments have been pouring money into top-down approaches, namely the development of clinical guidelines, global targets, and national maternal health policies, still gaps exist. Inequality exists not only between nations but also within countries, and it impacts more on the marginalized and the rural areas.
More and more, there has been evidence that there cannot be lasting solutions through the top alone enforced. Instead, the substantial steps are made when the communities are involved as equal partners by the governments and health agencies where the local actors apply ingenuity, experience, and social resources. Maternal health activities carried out as grass roots all over the world have innovated approaches which are effective, culturally appropriate, and sustainable. These are localized success and can be of paramount interest in developing policies that really work its way on ground.
This paper will claim that top-down policy is not enough to address maternal health issues and this is where governments can learn valuable lessons by examining what grassroots organizations achieve. It also offers realistic policy explanations of ways to make the wisdom of the community a part of the national maternal health policy towards making sure that every woman has the right to safe and dignified provision of care.
The Limits of Top Down Policy Approaches
One Size Doesn’t Fit All
Nationwide strategies to advance maternal health are usually focused on clinical practice requirements, construction of infrastructure or planning the workforce. Even though necessary, these plans tend to overlook the following:
- Health-seeking behavioural norms Cultural norms play a role in determining the health-seeking behaviour.
- Gender dynamics on decision-making
- Domestic suspicion of organized health services
- The practical barriers such as distance, cost and transportation
To illustrate, policies that encourage facility-based births can fail to take into consideration that women in certain communities perceive hospitals as a foreign or hostile place, thus, voluntarily giving birth to their children in their homes, which is more likely to be unsafe.
The Consequences of Policy Blind Spots
There are certain unintended consequences encountered even in top-down maternal health interventions and they include:
- Women fearing to receive care because of mistreatment in facilities
- Disrespectful health campaigns Community opposition to health campaigns that people consider disrespectful
- Continue to use out-of-control measure of relying on non-trained traditional birth attendants
Such blind spots can be explained by the fact that policies developed in capital cities do not always take into account the lives of the communities that need most of all.
The Power of Grassroots Maternal Health Initiatives
Community Led Innovation
On continents, through grassroots maternal health programs have been innovating models to suit the local contexts. Practicing traditional birth attendants in rural Bangladesh to small communities in Nigeria, local leadership, women and other community organizations:
- Invented maternal health teaching programs in native languages
- Put up community savings groups to help in emergency transportation
- Joined hands with health establishments to develop referrals mechanisms
- Promotion of decent maternity care services
Such solutions are not externally mandated but are ones made by communities tackling their own problems that know best.
Case Study: Bangladesh’s Community Based Midwives
In Bangladesh it was a joint effort between government and NGOs in training community-based skilled birth attendants who were frequently women within the same villages they were working in. These midwives:
- Give culturally fragile care
- Make home visits during pregnancy and after birth stages
- Promote birth in the facility among the high-risk cases
The number of maternal deaths was reduced substantially in regions where such midwives rendered services. The effectiveness attributes to the strength of technological training coupled with community confidence- a dynamic that can never be achieved by the national policies.
Case Study: Lagos State’s Integration of TBAs
In Nigeria, a state in the Lagos region the initial effort to prohibit the activities of traditional birth attendants was unsuccessful because women persisted in embracing traditional birth attendants. Lagos instead switched to the collaborative model:
- Registration and training of TBAs on practices of safe delivery
- Referring TBAs to health facilities to work as partners
- Regulation of practices monitoring
The outcomes of this unification were the increased facility-based births and decreased maternal death rates, which show that the collaboration, not isolation, can produce better health outcomes.
Why Governments Must Embrace Community Voices
Cultural Relevance and Trust
Community health activities are effective in cases where communities believe in those offering workers. Grassroots initiatives are based on the works of local actors, trusted by the much needed community health workers, midwives, TBAs, who feel free to use local dialects, comprehension of local cultural processes, and community standards. Such cultural competence promotes:
- Better relationships provided to patients
- Greater compliance with medication recommendation
- Increased readiness to get care on time
Practical Knowledge of Barriers
Members of the community are aware of the exact reasons why women do not seek or postpone maternal care, e.g.:
- Fear of getting mistreated in hospitals
- Unavailability of cheap transport
- Social stigma on pregnancy complications
- Financial drawbacks that inhibit the delivery of facilities
Solutions provided by grassroots efforts are quite innovative and are things that are not captured in policy documents at great heights.
Cost Effective Solutions
The approaches, which are community-driven, tend to be cheaper compared to big-scale infrastructure development. For example:
- Transport emergency can be funded by community savings schemes, mitigating death due to transport delays on the part of the maternal.
- Clean delivery kits can be locally produced and provide alternatives to the costly imports.
- TBAs are much cheaper to train than it is to grow the formal health workforce into each and every rural village.
Governments that aim at gaining long term or sustainable effects ought to be aware of the economic efficiencies of the grassroots models.
Policy Recommendations: Integrating Community Wisdom into Maternal Health Strategies
Successful case studies in grassroots initiatives provide a chance to governments to reshape their maternal health policy. The gap between policy and practice can be filled through the following recommendations.
- Establish Community Health Councils
Here governments ought to institutionalize the channels of community participation through establishment of local health councils that constitute:
- Females grouping
- Native birth attendants
- Community health service
- Leaders of religion and of culture
All councils can:
- Advise on maternal health list of actions
- Find the obstacles and provide local mitigations
- Take part in the monitoring and evaluation
Policies made based on knowledge of the local councils have much better chances of being topical and admitted.
- Invest in Community Based Workforce Development
Instead of concentrating all efforts on the growth of skilled health professionals, governments are to:
- Give constant mentorship and oversight by official health personnel.
- Community-based workers are paramount contributors; this is something that should be recognized and compensated.
- Train community health workers and TBAs on the practice of clean delivery, danger signs and referrals.
The method would develop a competent, trusted, and embedded in the local situation workforce.
- Foster Collaborative Regulation
As opposed to prohibiting traditional practices wholesomely, governments are supposed to:
- Register and establish a certification on TBAs
- Give guidelines of safe conduct
- Track the progressive outcomes through healthcare systems alliances
Such a regulatory regime maximizes safety, where it does not acquire the status of communal estrangement.
- Integrate Grassroots Data into National Systems
Governments should implement systems, through which, grassroots actors, can supply information about:
- Maternal and births progressions
- Lateness and referrals
- Trends in community health
The data can be of great help when focusing resources and evaluating policy effectiveness.
- Prioritize Respectful Maternity Care
Treatments should be mandated to be treated with respect at the facilities and in this way any abuse and neglect that usually propel women to take their chances with home births should be eliminated by policies. Grassroots advocates can:
- Enlighten society about individual rights of patients
- Track facilities practice
- Provide leadership on a great accountability system in health
Having a dignified care is more than a morality but an essential component to bettering results in maternal health.
- Allocate Funding for Community Led Innovations
The governments and aid agencies ought to budget the funding to:
- Perfectly level grassroots models
- Test-new community-initiated maternal health intercessions
- Analyse the impact and cost effectiveness
Community-driven change is what sustainable funding means.
The Future: A Hybrid Model for Maternal Health
Top-down policies play an important part in defining national standards, securing funding, and providing directions in infrastructure building. But however well-conceived they are they cannot stand alone. In the future of maternal health, there is a hybrid solution in which:
- National governments grant resources, regulations and technical standards.
- The solutions are fit to the local communities to their cultural and practical conditions.
- Partnerships develop between grass root actors and formal health systems.
This joint platform is very useful in that any intervention put in place to help improve maternal health is technically competent but still locally owned and sustainable.
Conclusion
Mother health is not just a medical matter, it is closely connected to culture, and building of societal systems, and building confidence in the community. Any solutions coming out of remote offices will never survive without those lived experiences and solutions of the people who are to be served by these applications.
Other maternal health efforts that are limited to the grassroots need to be taken seriously by governments and should not be considered marginal players. In Bangladesh we have seen time and time again local community based midwives expressing knowledge, creativity and commitment to transform maternal health outcomes, and Nigeria with 2 good examples of local TBA integrated programs.
As you can likely guess, the way forward is by listening to the people and hearing what they have to say in improving care in all spheres of care to all women: equitable, respectful, and effective. An improvement in maternal health is sustainable at ground level.
