Impact of World Vision's Core Intervention Package on Maternal, Neonatal and Child Health in Zambia: Insights from Qualitative Research

Introduction: The Child Health and Nutrition Impact Study (CHNIS) on which results of this paper are based on a five-year (2012-2017) research collaboration between World Vision and the Johns Hopkins Bloomberg School of Public Health implemented in four countries; Cambodia, Guatemala, Kenya and Zambia. In Zambia, the study was conducted by the Institute of Economic and Social Research (INESOR) at the University of Zambia. Objectives: The study was designed to measure the impact of World Vision?s maternal, neonatal and child health and nutrition programs on the health of mothers and children under five years. However, in this paper, only qualitative results from Zambia are presented. The purpose of the qualitative study was to describe the mechanism of operation of core intervention package (CIP), its effect on strengthening community structures and on the quality of community health worker (CHW) functioning. Methods: The study used a quasi-experimental (two-arm) before and after design. After a 36-month intervention period compared changes between the intervention and comparison in four Area Development Programs (ADPs) in Zambia. The study comprised of both quantitative and qualitative components. The qualitative component of the study which is the focus of this paper employed in-depth interviews (IDIs) and focus group discussions (FGDs). Results: Neighbourhood health committees (NHCs) contributed to the development of local partnerships to enhance the delivery of mother and child health services while citizen voice action (CVA) intervention successfully advocated and lobbied for community identified needs and rights. Further, implementation of targeted timed counseling (ttc) by safe motherhood action groups (SMAGs) promoted positive behaviors among women and other family and community members. Key behaviors observed include, early attendance of antenatal care (ANC) delivery at health facility (HF), exclusive breast feeding of young children up to six months, involvement of men in maternal and child health care such as escorting their spouses / partners to ANC and/or under five services and sourcing transport to HCs especially in cases of emergency. Other behaviors include adoption of personal and environmental positive behaviors such as washing hands before eating and after using a toilet and construction of dumping pits for disposing of household waste and dish racks to keep kitchen utensils clean and safe. More positive behaviors were observed in the intervention ADPs than comparison ADPs. For example, there was more awareness of maternal health and nutrition in the intervention than comparison ADPs. Further, use of traditional healing remedies was reported more in the comparison than intervention ADPs. The major barriers to maternal and child care are long distances to HFs, shortage of staff and lack and cost of public transport. Conclusions: The CIP implemented by World Vision (WV) in Zambia has impacted positively on community health systems and maternal and child health and nutrition knowledge and behaviors. The government and its partners should facilitate the construction of mother?s shelters at health facilities to cut down on travelling long distances by expectant mothers and should scale up the implementation of CIP to sustain the observed behaviors, increase access and improve maternal and child health service delivery in the country.