Mapping Maternal Health Advocacy: A Case Study of Zambia

This 16-page summary report discusses findings and insights gained from research conducted by Family Care International on the maternal health advocacy situation in Zambia. It outlines systems for maternal health governance, identifies stakeholders, and analyses opportunities and challenges for maternal health advocacy organisations, including the potential of engaging the Zambia private sector. The report concludes that there is a reasonably positive policy framework, key maternal and private-sector health stakeholders on the ground, and significant experience to draw from. However, the private sector is not very engaged, and the advocacy climate for maternal health is weak - "maternal health advocacy is not being planned, budgeted for, or measured in a sustainable or coordinated way. Maternal health advocacy follows from existing programmes, projects, and funding; it does not lead the way forward."

As stated in the report, Zambia has signed a number of national and international commitments to improve delivery, uptake, and outcomes of maternal health services. As a result, there are a number of strategic plans, policies, road maps, guidelines, and curricula at various stages of adoption and implementation. A key policy document is the National Health Strategic Plan 2011–2015, which incorporates provisions for "high impact interventions, and includes a costing analysis aimed at achieving high reductions in maternal, neonatal and under-five child mortality." The research report notes however that despite policies being in place, and including such initiatives as the Campaign on Accelerated Reduction of Maternal Mortality in Africa (CARMMA) launched in June 2010, few advocacy messages focus on these commitments, and, for those that do, there is usually no clear advocacy strategy.

The research mapping exercise found 32 organisations involved in advocacy. According to the report, while these organisations share some of the same priorities, there is lack of harmonised advocacy goals, resulting in diverse, uncoordinated messages. There also seems to be a lack of understanding about the difference between promotion and advocacy, and a lack of budget allocations for advocacy work. On a more promising note, government and other maternal health stakeholders do promote a number of key maternal health messages, and, while some are not yet part of advocacy materials and campaigns, they may be able to serve as launch points for potential advocacy in the future. These messages focus on improving maternal mortality rates, the importance of taking responsibility and working together, the need to access quality services, and the role of community-based providers.

The report mentions some examples of creative advocacy activities. For example, Panos incorporated maternal health into a prevention of mother to child transmission (PMTCT) project by including training and fellowships for journalists and hosting listening clubs in rural areas organised around a radio programme that incorporated maternal health messages. The Planned Parenthood Association of Zambia, on behalf of the MAMaZ project and in support of retaining the Termination of Pregnancy Act, invited parliamentarians, parliamentary health committee members, and political candidates to briefings, working luncheons, and field trips to Mother Shelters, among other activities. However, a key challenge outlined is the lack of monitoring, evaluation, and evidence gathering related to any of these initiatives, which would help to inform replication and scale-up.

In terms of media, the research found that journalists are interested to report on health, and health issues are receiving increasing attention. Unfortunately, "there are no dedicated health desks at media outlets, and therefore it is easy for health stories to be dropped quickly or redirected. Windows of opportunity close as the media lacks the capacity to follow themes, and maternal health stakeholders fail to capitalise on openings in public discourse. As a consequence, there is no consistent, sustained, synchronised means for ensuring maternal health advocacy in Zambia. This often results in missed opportunities for advocacy."

However, respondents participating in the research survey reported being eager to address these challenges. The report offers a number of recommendations for moving forward. It recommends leveraging existing advocacy and private-sector health organisations and networks, while also supporting maternal health advocacy, health provider, and local advocacy organisations as partners. The report also recommends supporting private-sector engagement and partnerships by creating materials and tools to help guide public-sector and non-governmental organisation partners to more productively engage the private sector in maternal health.

The report identifies a need to focus on "local media organisations and encourage them to establish or strengthen health desks to create institutionalised points of contact. Building institutional capacity for health reporting will help to ensure that maternal health remains on the policy agenda." The report also recommends that organisations "harmonise maternal health messaging and tie advocacy messages to a strategic platform with specific, measurable outcomes, and impact. Maternal health advocacy stakeholders need a forum to share advocacy experiences, and build common objectives, messages, tools for planning and budgeting, and indicators of impact."

In addition, regarding maternal and child health commodities provision, the report cites the need to focus on "private-sector engagement across all components of the health system, not simply the private provision of services. Potential partners should look 'outside the box' at the creative public-private partnerships (PPPs) already on the ground in Zambia (e.g. in supply-chain management and health communications) and strive for innovation." And, existing partnerships with the private sector in Zambia should consider "private-sector priorities: particularly the need for long-term, trust-based relationships. There is a need to create materials and tools to help guide public-sector and NGO [non-governmental organisation] partners to more productively engage the private sector in maternal health."