Delivering transformative, rights-based family planning
Community Support System (CmSS)
Community Support System (CmSS)
Project Name: Safe Motherhood Project – Community Support System (CmSS)
Partners: UNICEF, WHO, Government of Bangladesh
Objective: The Community Support System (CmSS), a model developed and implemented by CARE within the Safe Motherhood Project, aimed to ensure the health and survival of pregnant women by building community support of access to quality services and creating mechanisms for accountability between clients and providers.
Globally, 80% of maternal deaths are due to a few direct obstetric complications; most could be prevented or managed if the woman had access to a skilled birth attendant with the necessary back-up and support. In Bangladesh, only 42 percent of women have access to skilled birth attendants – well below the global rate of 73 percent – and high maternal and newborn mortality rates continue to be a challenge in remote areas.
It is widely acknowledged that the causes of these deaths can be categorized into “three delays”, first articulated by Thaddeus and Maine in 1994. The first delay, the delay in seeking care, is related to both a lack of understanding of the risks and danger signs associated with child birth and oftentimes a lack of agency on the part of the mother. In many contexts women do not make the decisions over their own health care including when and where to seek treatment. Instead, these decisions are often left to their male partners or relatives. The second delay, a delay in arrival at the health facility, often occurs because facilities are far away and geographic barriers may exist that impede physical access. Socioeconomic divisions can also act as barriers to physical access as poorer families may lack the financial means needed to get to the facility. The third and final delay is a delay in the provision of adequate care. Many facilities in low-resource settings lack the resources and equipment needed to provide quality, safe, emergency obstetric care when a pregnant woman arrives. Acknowledging these delays, CARE was tasked with developing a mechanism to address both the first and second delay (while other partners addressed the third).
CARE developed and employed the CmSS model, a mechanism for establishing a community-led structure which tracks all pregnant women, and provides need-based support for making their pregnancy safer, including timely use of lifesaving emergency obstetric care services. CmSS consists of a process where the causes of maternal mortality and morbidity are identified through a death and disability review in the community. Then, this information is shared with the community through village meetings led by local volunteers. The community then identifies their role in preventing avoidable maternal death and promotes a zero tolerance to maternal deaths and violence against women. Lastly, the community forms a committee, known as a Community Support Group — and establishes linkages with the health system and local government.
CmSS provide the following key functions:
- Conducts community surveillance for tracking and registration of pregnancy and gender-based violence
- Facilitates birth planning with pregnant women, including dialogue with husbands and in-laws
- Mobilizes local funds and resources to support emergency transportation and referral
- Promotes accountability and responsiveness through community feedback and advocacy
- Creates an enabling environment for pregnant women – community members serve “watch dog” role to monitor and prevent harmful practices.
By fulfilling these roles and functions, the CmSS process has made safe motherhood not just a family responsibility but a community responsibility.
An impact study of the Safe Motherhood Promotion Project (in which CmSS was implemented) in 2010 showed that CmSS is associated with reduced wealth disparities for key maternal health outcomes and that women who were registered by the Community Support Groups were more likely to use a skilled birth attendant.
The success of the CmSS has led to full adoption by the Government of Bangladesh and scale up in the entire country. Implementation is now fully carried out by Ministry of Health staff through country-wide community clinic networks, including the formation and orientation of the Community Support Groups and reinforcing the linkages between the health centers, the communities, and the local officials.
For full evaluation results, click here.