Introduction
Maternal health has served as an important indicator of health systems around the world in terms of health strength and equity over many decades. Although there has been a tremendous achievement in the decrease of maternal deaths, there remains a deep gulf, particularly among low-resource, rural, as well as marginalized communities. Maternal care systems have conventionally been service-intensive on the facility-based and centralized components. Nevertheless, a large number of women are still out of the reach of hospitals and city clinics because of distance, expense, difficulties of access, and mistrust of formal health systems.
Several studies outline the potential potential of decentralized care systems on the way. The ingenuity of grassroot solutions is transforming the way women receive health services in places where health is a road away, such as women being taken into the harsh terrain via the mobile health clinic and the community health workers (CHWs) who go door to door, to deliver essential care to women. These cultures are also enhanced through the peer support groups which promote trust, education, and social solidarity.
This article looks at the new ways in which decentralized care initiatives are being used to redefine what maternal health looks like, the things that governments can learn by watching successful grassroots models, and what specific strategies can be employed to take these innovations across the country.
The Limitations of Centralized Maternal Health Systems
Distance and Access Barriers
In most low-resource places centralizing maternal care presumes women have access to hospitals or the city clinics when they are required. In practice, there are lots of obstacles to timely access:
- Great travel distance from 10 to 20 kilometres and more.
- Low levelled road infrastructure
- The expensive freight.
- The absence of obstetric complications emergency services.
The women in those distant villages often reach very slowly to provide care or they choose home delivery with some traditional people, which increases the possibilities of maternal and newborn complications.
Cultural and Social Constraints
During the facility-based care, there are certain conflicts with the cultural understanding. Wesen blasted woman`s fear:
- Being in unknown hospital settings.
- Inability to keep privacy during delivery.
- Deliberately rude behaviour of health personnel.
- Language difference with urban providers.
Such anxieties prevent the women to pursue institutional care helping the menace of preventable maternal deaths to persist.
Workforce Shortages
Existing health workforces are compromised by the existence of centralized systems. Numerous facilities do not have enough:
- Well educated birth attendants.
- Emergency obstetric care trained midwives.
- Patient follow up resources.
By the decentralization of maternal health care, we should be able to take pressure off the facilities and evenly spread the services nearer to where women reside.
The Promise of Decentralized Maternal Health Models
Mobile Health Clinics: Bridging the Gap
Mobile clinics are transportable clinics that carry medical materials, and have personnel in the form of medical experts who travel among needy regions. Including Their advantage:
- Taking health services to the doorstep of the communities with regard to antenatal and postnatal care.
- Providing emergency referral on high-risk pregnancies.
- Giving immunization, HIV tests and dietary advice.
In Kenya mobile clinics in rural setting substantially boosted the antenatal visit rates (by more than 50 percent), and in Indian state Rajasthan maternal deaths went down in the area where mobile health clinics were available.
Community Health Workers: Trust Partners
In decentralized maternal health, community health workers are an important job:
- They reside within those communities.
- Talk local languages and understand cultural predispositions.
- Provide safety sign education, nutritional education and birth preparedness.
- Conduction of home visits for ante natal and post natal care.
- Detect complications early enough and make referrals.
The CHWs of Bangladesh have played a relevant role in the decrease in maternal mortality in Bangladesh where between 1990 and 2017 the number of maternal deaths per 100,000 live births decreased to 574 to 173 respectively.
Peer Support Groups: Strengthening Social Fabric
Women are empowered with the collective experience of peer support groups. These groups:
- Offer pregnancy care and post partum care.
- Dispel flaws and misconception about maternal health.
- Support the consultation of care early.
- Facilitate mental well-being, and de-stigmatize the problem of maternal complications.
Peer-collected groups in Uganda under the guidance of trained community mentors turned out to be more successful in facility delivery and enhance confidence among women in seeking skilled services.
Case Studies: Grassroots Innovations in Decentralized Care
Bangladesh: Mobile Midwifery on the Move
Bangladesh combined services of mobile clinics with midwife services. Midwives:
- Motorcycle that can be used to travel to the distant villages.
- Perform periodical check-ups and uncomplicated obstetrics.
- Complex cases should be referred to higher places.
This model is a combination of professional care and mobility, removing barriers of distance.
Nigeria: CHWs Saving Lives in Rural Communities
In Nigeria, the community health extension workers have been proven to play key roles in:
- Educating communities of what are danger signs.
- Encouraging antenatal clinic.
- Giving clean delivery kit
- Aid to birth planning.
CHW/facility-based interventions reduced maternal deaths in half within five years in rural Lagos.
Ethiopia: Peer Support Network
At Ethiopia, its female development army trained local women to be peer educators. These groups:
- Carry out home visits to identify pregnant women.
- Give maternal health education.
- Women who are expecting will escort to the clinics during delivery.
Ethiopia attributes this grass roots movement as a force in reduction of the maternal mortality rate of 871 to 401 per 100,000 live births between 2000 and 2017.
The Economic Argument for Decentralized Maternal Health
Cost Effectiveness
Smaller care-models where the focus is on decentralization are frequently more economical than building up hospital systems in the cities:
- Mobile clinics don’t have to construct costly new clinics.
- CHWs can be trained in shorter courses at lower costs as compared to professional midwives or doctors.
- The groups that are peer based do not require a lot of monetary investment.
The money that can be saved can be channelled to the necessary drugs, emergency transportation network, and the wages of health professionals.
Sustainability and Local Ownership
Decentralized models cultivate native ownership:
- The community members also feel imbedded in the health outcomes.
- Peer groups increase social networks of support.
- CHWs are people who gain recognition in their communities.
These sustainable models are sustainable in the sense that they do not depend on funding only but also on the human resources and goodwill of the community.
Challenges in Scaling Decentralized Care
Nevertheless, the idea of decentralized models is not without trouble:
- Funding irregularities posed program to continue in doubt.
- Delivery by mobile units may be impeded with the bad road network.
- CHWs often are not regularly trained and supervised.
- Decentralized efforts leave data collection through those efforts fragmented.
Decentralized care must be integrated in national health plans and national health budgets to sustain them.
Policy Recommendations for Governments
Lessons have been learnt in grassroots success that could be very relevant to governments that want to attempt the idea of scaling decentralized maternal health care.
- Institutionalize Mobile Health Services
- Lawmakers should set money allocations for mobile clinics.
- Collaborate with Non-governmental organizations who have expertise in healthcare on wheels.
- Extravascular units should be equipped with required medication, ultrasound equipment and communicational devices.
- Map out, under-served areas and schedules for service.
- Professionalize Community Health Workers
- Ensure that CHWs are included into national health workforce approach.
- Submit a standard training and certificate.
- Provide balanced career progressive pathways and remuneration.
- Connect CHWs to referral facilities in an area.
- Empower Peer Support Groups
- Identify peer groups in the national maternal health strategies.
- Offer minor grants on the meeting venues and training resources.
- Engage the peer mentors as part community outreach and in center-based care campaigns.
- Integrate Decentralized Models into Health Systems
- Develop systems which track services supplied by mobile clinics, CHWs and peer groups.
- Incorporate decentralized services into monitoring and evaluation platforms of maternal health.
- Build referral networks between decentralized services and more sophisticated level of care.
- Invest in Transportation Infrastructure
- Finance community-based emergency transport systems.
- Keep up roads to allow mobile clinic access.
- Fund motorcycle ambulances in the rural areas.
- Promote Community Engagement and Trust
- Collaborate with the community leaders in planning programs.
- Introduce safe health measures with respect to cultural practices.
- Train all health providers in offer respectful training on maternity care.
Conclusion
Decentralization of maternal health care is less a logistical change, but a redesigning of how health systems can attend to the most in need. Useful solutions, like mobile clinics and community health workers, as well as peer support networks, exist and prove that unique, community-cantered solutions could save lives, establish trust, and construct sustainable systems.
Governments should understand that the issue of maternal health cannot be fixed only by hospitals. Incorporation of the decentralized model into the national strategies will make sure that no women will be left behind, no matter in which country she resides.
Through the reinvention of a success at the grassroot level, the policymakers will be able to design maternal health systems that are not only technically competent but also aligned with culture, economically sustainable and very much admirable, affordable and acceptable in the communities where they are installed. The solution to this is obvious: care should be taken nearer to women- because, maternal health should begin on the ground.
