Table 1 MAHMAZ Intervention Components and Features

1. Infrastructure, Equipment & Supplies

Implementation of a high quality, structurally sound MWH that is designed and furnished to be comfortable, safe, and meet community standards of acceptability as defined by a formative evaluation.

• Lighting (lanterns)

• Lockable doors, windows

• Cooking area and supplies

• Bathing and laundry areas

• Latrines

• Beds, bedding, & bed nets

• Staff room (for storage, office, etc.)

• Space for postnatal women/newborns to stay

• Functional equivalence: concrete floors, no leaky roofs and water

2. Governance, Management & Finances

Formation of governance and management structures made up of local community members to oversee the long-term vision and daily operations of the MWH, adhering to established policies and standard operating procedures, and ensuring compliance with financial management procedures.

• Formalized management and governance structures with government and facility representation

• Clear definition of ownership (land, material assets, income generated)

• Revenue and asset management

• Standard operating procedures (SOPs) for clear roles and responsibilities

• Mechanism for community/women’s feedback

• Intake, registration, and monitoring procedures

• Eligibility: prioritize women living

> 10 km from health facility, available for postnatal stays

3. Linkages with Health Facilities & Services

Establishment of close linkages between the MWH and the health facility, including educational classes for waiting women.

• Adjacent to BEmONC within 2 h of a CEmONC facility

• Daily end-of-day check-ins by facility staff

• ANC and PNC visits conducted at health facility

• Emergency transport system identified

• Family planning/post-partum family planning education

• Breastfeeding and infant and young child feeding education

• Education on newborn danger signs, well-baby care

• Education on antenatal and postpartum period

• Entertainment, recreational activities

4. Financial Sustainability Strategy using Income-Generating Activities (IGA)

Creation of a financial sustainability model to fund the operations and maintenance of the MWH, with revenue derived from various sources, including community donations, health facility donations, and the creation of income generating activities (IGAs). The IGAs are managed by the MWH governance committees and function as social enterprises, generating revenue to operate and maintain the MWH.

• Selection and implementation of one of three IGAs by each site:

 ▪ A hammermill to grind maize, the local staple crop

 ▪ An agro-dealership to sell agricultural inputs as well as dry goods

 ▪ A goat rearing business, to raise and sell goats for meat

• Financial management and financial literacy training and in-service mentorship for governance committee members