December 2013 
The author’s views expressed in this publication do not necessarily reflect the views of the 
United States Agency for International Development or the United States Government. 
COMMUNICATIONS 
SUPPORT FOR HEALTH 
(CSH) PROGRAMME 
SAVING MOTHERS GIVING LIFE (SMGL) EVALUATION STUDY 
REPORT 
CONTRACT NO: GHS-1-007-00004-00, ORDER NO. 1-05-07-00004
1 
Contents 
I. Background on Saving Mothers Giving Life Campaign ..............................................................3
1.1. Health Situation Context ..............................................................................................................3
1.2. Saving Mothers, Giving Life Initiative Background.......................................................................3
1.3. Target Audiences for SMGL ..........................................................................................................4
II. Evaluation Study................................................................................................................................4
2.1. Objectives of Evaluation...............................................................................................................4
2.2. Specific Evaluation Questions.......................................................................................................4
2.3. Evaluation Methodology ..............................................................................................................6
2.4. Evaluation Study Implementation................................................................................................7
2.5. SMGL Campaign Implementation.................................................................................................8
III. Findings From Household Survey..............................................................................................9
3.1. Sociodemographic Characteristics of the Sample ........................................................................9
3.2. Access to and Use of Media........................................................................................................10
3.3. General Exposure to SMGL Campaign ........................................................................................13
3.4. Exposure to Birth Plan ................................................................................................................15
3.5. Exposure to Radio Adverts .........................................................................................................19
3.6. Summary of Exposure to Components of the SMGL Campaign.................................................21
3.7. Perception of Impact on Knowledge, Attitudes, and Behaviour................................................22
3.8. Interpersonal Communication....................................................................................................25
IV. Findings From In-Depth Interviews ........................................................................................30
4.1. Perceptions on the Role of a Change Champion........................................................................30
4.2. Perceptions on Safe Motherhood Knowledge and Training ......................................................31
4.3. Implementation of Change Champions Programme..................................................................33
4.4. Mobilization and Perceived Achievements of Change Champions Programme ........................38
4.5. Challenges and Recommendations ............................................................................................39
V. Summary and Discussion of Findings .........................................................................................42
5.1. Media Access and Viewership/Listenership...............................................................................42
5.2. General Exposure to SMGL Campaign........................................................................................42
5.3. Exposure to the Birth Plan..........................................................................................................42
5.4. Exposure to Safe Motherhood Radio Adverts............................................................................42
2 
5.5. Perception of Impact on Knowledge, Attitudes, and Behaviour................................................43
5.6. Interpersonal Communication....................................................................................................43
5.7. Role and Background of Change Champions..............................................................................44
5.8. Implementation of the Change Champions Programme............................................................44
5.9. Achievements of Change Champions Programme .....................................................................45
5.10. Main Challenges of Change Champions Programme .................................................................45
VI. Recommendations and Conclusion .........................................................................................46
VII. Appendices ...................................................................................................................................48
Appendix 1. Rapid Survey Sampling Methodology.................................................................................48
Appendix 2. Rapid Assessment Survey Questionnaire ...........................................................................50
Appendix 3. IDI Guide for MCH District Coordinators............................................................................64
Appendix 4. IDI Guide for Change Champions........................................................................................67
3 
I. Background on Saving Mothers Giving Life Campaign 
1.1. Health Situation Context 
Zambia as a nation has made extensive progress in recent years towards achieving the Millennium 
Development Goals. The Zambian health system continues to improve, and access to services is 
increasing. However, a number of health issues persist. One critical issue is maternal mortality. 
Zambia’s maternal mortality ratio of 591/100, 000 live births ranks amongst the highest in the 
world. This mortality is attributable to a number of complex and interwoven factors. Low 
contraceptive use in Zambia has resulted in high fertility trends over the years, with a current 
average fertility rate per women of 6.3. Only about half of pregnant women initiate antenatal care 
(ANC) by 5.1 months of gestation, preventing the opportunity for early detection of danger signs 
and adequate management of maternal complications. More than half (52 percent) of all births 
occur at home, with rural areas recording much higher rates of home births than urban areas (66.5 
percent as compared to 15.7 percent). But even when a woman delivers in a facility, utilization of 
postpartum care services is extremely low. Nationwide, more than half (51 percent) of women do 
not receive any postnatal care. Further, neonatal mortality, while reducing slowly overall, is 
growing as a proportion of child mortality and is closely aligned with maternal mortality. 
1.2. Saving Mothers, Giving Life Initiative Background 
To directly address these challenges in maternal mortality, the Government of the Republic of 
Zambia (GRZ) together with the United States Government committed to providing intensive 
resources and technical assistance to four targeted districts in Zambia (Mansa, Kalomo, Lundazi, 
and Nyimba) beginning in 2012. This initiative, termed Saving Mothers Giving Life (SMGL), brings 
together a wide variety of partners with the goal of reducing maternal mortality by 50 percent in 
the four districts. The main interventions focus on strengthening the delivery skills of health 
professionals, increasing delivery in health facilities, mobilizing communities to increase birth 
preparedness and complication readiness, and strengthening health facilities to provide quality 
obstetric and newborn care for normal and complicated deliveries. 
In order to accomplish this goal, the implementing partners for SMGL are specifically emphasising a 
set of critical interventions 24 hours immediately before and after delivery. From the demand￾creation perspective, two critical behaviours have been identified within this period: (1) pregnant 
women seek delivery in a facility and (2) pregnant women complete all required postpartum 
follow-up care within 6 hours, 6 days, and 6 weeks after delivery. As a key partner in the SMGL 
initiative, the Communications Support for Health (CSH) project will take responsibility for 
promoting these behaviours and addressing current barriers to their practice. 
Specifically, CSH will implement the following main interventions in the four districts: 
1. Orientation and distribution of a birth plan tool that can be used by health providers, Safe 
Motherhood Action Groups (SMAGs), pregnant women, and their male partners. 
4 
2. Orientation and training of influential leaders to be “Change Champions” in their 
communities, with follow-up support as they roll out mobilization activities within their 
communities. 
3. Development, production, and broadcasting of Safe Motherhood radio adverts. 
4. Implementation of interpersonal communication activities for pregnant women, young 
mothers and their male partners, and other key community members that will be conducted
by Change Champions and SMAGs. 
1.3. Target Audiences for SMGL 
The primary target audiences for the proposed CSH SMGL activities include pregnant women and 
mothers of young children (aged 0–6 months). 
There are other target audiences in the campaign, including male partners of pregnant 
women/mothers, Change Champions, traditional birth attendants/traditional healers, SMAGs, 
neighbourhood health committees (NHCs), health workers, extended family members, women of 
child-bearing age who are not currently pregnant (or who recently had a baby), and teenage girls. 
Due to the main questions of interest in the study as well as the design, these other target 
audiences, with the exception of the Change Champions, were not included in the study. 
II. Evaluation Study 
2.1. Objectives of Evaluation 
The main objectives of the evaluation were three-fold: 
1. To assess the target population’s exposure to the SMGL campaign1 that was designed and 
implemented by the CSH project in Zambia in collaboration with the Ministry of Community 
Development and Maternal and Child Health (MCDMCH), 
2. To assess the primary target population’s perception of the different activities implemented 
under the SMGL campaign and their perception of whether the SMGL campaign has had an 
impact on their knowledge and behaviour, and 
3. To assess how the Change Champion programme in the four SMGL-targeted districts has 
worked and what improvements to implementation can be made. 
2.2. Specific Evaluation Questions 
Table 1 below outlines the specific study questions by the main three study objectives. 
 
1
For the purpose of the report, all references to the SMGL campaign refer specifically to the communication and 
demand-creation activities that were implemented by CSH. Since CSH was only one of a number of implementing 
partners working on SMGL, this report does not provide any information on the other partner activities 
implemented under the larger SMGL initiative.
5 
Table 1. Specific Study Questions by Study Objective 
Study Objective Specific Study Questions
Objective 1: Determine 
exposure of target population 
to SMGL campaign
1. What is the target population’s exposure to the following main 
components of the SMGL campaign?
a. Birth plan tool
b. Safe Motherhood radio adverts
c. Interpersonal communication activity conducted by Change 
Champions and SMAGs
2. What is the target population’s recall of specific messages and 
characteristics of the main components of the SMGL campaign?
Objective 2: Understand target 
population’s perception of 
SMGL campaign and perception 
of the impact of the campaign 
on knowledge and behaviour
1. What is the target population’s perception of the main components of 
the SMGL campaign?
2. Does the target population find the messages of the campaign 
relevant to their own lives?
3. Does the target population perceive that the SMGL campaign has had 
an impact on their knowledge and attitudes/beliefs related to safe 
motherhood?
4. Does the target population perceive that the SMGL campaign has had 
an impact on their behaviours related to safe motherhood? If so, 
which behaviours have they perceived the campaign to have 
affected?
Objective 3: Determine how the 
Change Champion programme 
has worked in the four targeted 
districts
1. What is the role that the Change Champions perceive they had in 
their communities?
2. Have the Change Champions been successful in mobilizing their 
communities around safe motherhood issues? 
a. If so, how have they mobilized their communities?
b. What actions were taken?
c. What specific topic areas were they able to mobilize their 
community around (e.g., ANC, health facility-based delivery, 
postpartum care, family planning)?
d. What changes, if any, have they seen in their communities as a 
result of the mobilization?
3. What challenges did Change Champions encounter in mobilizing their 
community around addressing safe motherhood issues?
4. What, if anything, should be done differently as a way of improving 
the work carried out by Change Champions? 
6 
2.3. Evaluation Methodology 
The evaluation was a mixed-methods study utilizing a rapid household survey complemented with 
a qualitative component of in-depth interviews with Change Champions and District Maternal and 
Child Health (MCH) Coordinators. 
The rapid household survey was used to assess the first two main objectives of the study. 
Specifically, the survey looked at the exposure of the primary target population (pregnant women 
and mothers of children aged 0–6 months) to the different components of the SMGL campaign; the 
primary target population’s perceptions of the different components of the campaign; and their 
perceptions as to whether the campaign has had an influence on their knowledge, attitudes/beliefs, 
and behaviours related to safe motherhood. 
In-depth interviews were conducted with Change Champions and District MCH Coordinators who 
work closely with the Change Champions to complement the findings in the rapid household 
survey. Specifically, the interviews focused on addressing the third main objective of the study—to 
assess how the Change Champions programme worked in the four targeted districts and how the 
programme can be improved upon. 
The sampling frame for the rapid household survey is outlined in Table 2. A detailed description of 
the sampling methodology for the rapid survey can be found in Appendix 1. Informed consent was 
obtained from each participant prior to conducting the interview. 
Table 2. Sampling Frame for the Rapid Household Survey 
Province District Place of 
Residence
# of Interviews
Pregnant 
Women
Mothers Total
Eastern Lundazi Rural 19 19 38
Eastern Nyimba Rural 19 19 38
Luapula Mansa Rural 19 19 38
Southern Kalomo Rural 19 19 38
Total 76 76 152
For the in-depth interviews, a total of 24 Change Champions and four MCH Coordinators were 
initially selected to be interviewed. In each of the four targeted districts, five Change Champions 
were randomly selected to be included in the study sample. In addition, the MCH Coordinator in 
each of the target districts was invited to be interviewed. The sampling frame for the in-depth 
interviews is provided in Table 3 below. 
7 
Table 3. Sampling Frame for In-Depth Interviews 
District District MCH 
Coordinator
Chiefs Other Change 
Champions
Total # of 
Sampled 
Participants
Mansa 1 1 4 6
Kalomo 1 1* 4 6
Lundazi 1 1 4 6
Nyimba 1 1 4 6
Total 4 4* 16 24
*A Chief from Kalomo was not available for the interview, resulting in a total of three Chiefs participating in 
the evaluation, for a total of 23 in-depth interviews. 
2.4. Evaluation Study Implementation 
CSH developed the study protocol, including the methodology and instruments, and it was reviewed 
and approved by GRZ through the National HIV/AIDS/TB Council. Ethical approval was obtained 
from a local ethics review board (ERES Converge) and ICF International’s Institutional Review 
Board in the United States. 
The survey questionnaire consisted of the following sections2: 
1. Sociodemographic characteristics; 
2. General exposure to the campaign and source of exposure; 
3. Exposure to the birth plan and use and perceptions of the birth plan; 
4. Exposure to and perceptions of Safe Motherhood radio adverts; and 
5. Perception of the impact of the campaign on knowledge, attitudes/beliefs, and behaviours, 
and discussion of the campaign messages with others. 
The questions included a combination of spontaneous recall questions and aided questions for 
measuring exposure to the different components of the campaign. Both types of questions were 
included in order to obtain a more accurate measure of exposure; with aided questions, there is a 
likelihood that respondents will overreport their exposure, whilst for spontaneous recall questions 
it is likely that respondents will underreport their exposure.i
 Furthermore, spontaneous recall 
questions are able to better measure the quality of exposure, as they show that respondents can 
recall specific elements of what they were exposed to; for example, recalling the message of an 
announcement heard on the radio. The survey questionnaire tool used can be found in Appendix 2. 
To prepare for deployment of the rapid survey, CSH conducted a pilot-testing of the questionnaire 
and also translated the survey questionnaire into two local languages (Bemba and Nyanja). The 
 
2
The survey questionnaire initially included questions to assess television media use and exposure; however, the 
data are not included in this report due to an adjustment in the implementation.
8 
translations were reviewed and approved by the CSH technical and monitoring and evaluation 
(M&E) team. The CSH M&E team conducted a 1-day training for the field interviewers. Three 
interview teams, consisting of one supervisor and three interviewers, carried out data collection in 
the four districts over the course of 8 days. Supervisors were responsible for coordinating the 
logistics, overseeing interviewers, and checking the questionnaires upon completion of interviews. 
On average, interviews took 12–20 minutes to conduct. 
2.5. SMGL Campaign Implementation 
For this rapid survey component of the evaluation, the focus was to assess exposure to the different 
SMGL campaign components that were implemented 6 months prior to the survey. For the 6-month 
time period, the main components implemented included the distribution of a pictorial birth plan 
by health providers and SMAG members, radio adverts on safe motherhood, and the 
implementation of the Change Champions programme. For the Change Champions programme, CSH 
provided the selected Change Champions with an initial orientation on the programme approach 
and information on the six steps to safe motherhood (using the birth plan as a reference). The 
programme strategy included having Change Champions collaborate with the District Health 
Officers (DHOs), health workers, and other community-based organisations, such as SMAGs, NHCs, 
and others in their districts, to implement the activities. Across the four districts, 89 Change 
Champions were oriented and selected to be a part of the programme. The main roles of the Change 
Champions were to mobilize, sensitize, and educate their communities on the steps to safe 
motherhood, with the aim of creating demand for health services amongst pregnant women and 
new mothers, and to encourage families to provide support to women during their pregnancy, 
during labour, and after delivery. It is important to note that, in addition to the initial orientation 
for the Change Champions, CSH identified the need for further training, and then provided 
additional mentoring to the Change Champions, particularly to those who felt they needed 
additional support. 
A summary of what was implemented 6 months prior to the survey can be found in Table 4. 
Table 4. Summary of the Implementation of the SMGL’s Different Components 6 Months 
Prior to Evaluation 
SMGL Campaign 
Component
Channel(s) 
Used
Frequency Total Number 
of Times
Aired/
Distributed
Duration
Pictorial Birth Plan Health facility 
personnel and 
SMAGs
Distributed at first 
ANC visit, outreach 
activities and 
home visits 
Ongoing June 2012–
present 
Radio Adverts 
(English Version)
National radio 
stations, Radio 2 
and Radio 4
Multiple 
Each of the six 
versions aired 
once a day during 
primetime
Aired a total of 
8,534 times
December 2012–
October 2013
9 
community radio 
stations (only 
Lundazi district 
covered) 
Radio Adverts 
(Local Languages,
Nyanja and Bemba)
National radio,
Radio 1
Multiple 
community radio 
stations (covering 
Manda and 
Lundazi districts)
Each of the six 
versions of the 
advert aired once a 
day during 
primetime
Aired a total of 
630 times
June–October 
2013
Radio Adverts 
(District Specific)
Yangeni and 
Chikaya 
community radio 
stations (covering 
Mansa and 
Lundazi districts)
Once a day during 
primetime
Aired a total of 
180 times (90 per 
each station)
June–October 
2013
Change Champions 
Programme
Change 
Champions and 
the four DHOs
engaged
Frequency of 
implementation of 
activities varied 
across Change 
Champions
89 Change 
Champions 
oriented and 
engaged in 
programme
Orientation: 
August–
September 2012
Mentorship 
programme:
May–November 
2013
Implementation of 
programme: 
September 2013–
present
III. Findings From Household Survey 
This section contains the findings from the household rapid study. The rapid household survey data 
addressed the first and second study objectives, which focus on assessing the exposure of the target 
population to the SMGL campaign and assessing the target population’s perception of the SMGL 
campaign and perception of the impact of the campaign on the target population’s knowledge, 
attitudes/beliefs, and behaviour. Section four of the report focuses on the findings from the in￾depth interviews, which assessed the third study objective. 
For the household rapid survey, frequency analysis was used for all of the variables in the survey 
and was complemented with Fisher’s exact test to assess if there were any significant differences by 
target audience (pregnant women and mothers of children aged 0–6 months) and district. The 
majority of the results for exposure, recall of specific content of the campaign components, and 
perception of impact are presented for the entire sample (152), by district and target audience. 
When appropriate and as indicated, results are presented amongst other subsamples. 
3.1. Sociodemographic Characteristics of the Sample 
A summary of the sociodemographic characteristics of the household survey sample can be found 
in Table 5. The majority of the women were between the ages of 20 and 29 years (54.6 percent) and 
10
had either a primary (49.3 percent) or secondary (38.2 percent) level of education. About 70 
percent of respondents were literate in English, a local language, or both, and just under a third of 
the respondents were illiterate. The majority of respondents (89.5 percent) were married. Pregnant 
women and mothers of children aged 0–6 months were similar across the different 
sociodemographic characteristics. Amongst the women who were pregnant, 9.2 percent were in 
their first trimester, 32.9 percent were in their second trimester, and 57.9 percent were in the third 
trimester of their pregnancy. Amongst the mothers, the mean age of their children was 2.5 months. 
Table 5. Sociodemographic Characteristics of Sample 
Sociodemographic 
Characteristics
Pregnant Women
(n=76)
Mothers of 
Children Aged 
0–6 Months
(n=76)
Total
(n=152)
Age Group
15–19 18.4 14.5 16.5
20–24 31.6 29.0 30.3
25–29 21.1 27.6 24.3
30–34 13.2 17.1 15.1
35–39 15.8 11,8 13.8
Education Level
None 9.2 13.2 11.2
Primary 46.1 52.6 49.3
Secondary 44.7 31.6 38.2
Higher 0.0 2.6 1.3
Literacy 
Literate 67.1 73.4 69.7
Illiterate 32.9 27.6 30.3
Marital Status
Single 7.9 9.2 8.6
Married 92.1 86.8 89.5
Widowed/Separated 0.0 4.0 2.0
3.2. Access to and Use of Media 
Overall, access to radio and mobile phones in respondents’ households was high: 61.8 percent had a 
radio and 67.8 percent had a phone (Table 6). Radio and mobile phone ownership did not vary 
significantly across the four districts. 
11
Table 6. Target Audience Access to Media in the Household by District (n=152) 
Sociodemographic 
Characteristics
Radio
(%)
Mobile Phone
(%)
District
Kalomo 65.8 79.0
Lundazi 63.2 55.3
Mansa 73.7 71.1
Nyimba 44.7 65.8
Total 61.8 67.8
Radio Listenership 
The survey looked at overall listenership of radio, in addition to the frequency of listenership, the 
time periods that are most listened to, and the most listened-to radio stations, to provide 
information to lead media planning efforts. 
Overall, 65.1 percent of respondents reported that they listen to the radio (Table 7). Listenership of 
radio varied significantly by district, with the highest listenership in Lundazi and Mansa districts, 
but did not vary significantly by target audience. 
Table 7. Radio Listenership by District and Target Audience (n=152) 
Sociodemographic 
Characteristics
Listen to 
Radio
(%)
District*
Kalomo 63.2
Lundazi 79.0
Mansa 71.1
Nyimba 47.4
Target Audience
Pregnant Women 64.5
Mothers of Children 
Aged 0–6 Months
65.8
Total 65.1
* Radio listenership varied significantly by district (p=0.03). 
Of all respondents, about 35 percent reported listening to the radio on a daily basis, followed by 15 
percent who reported listening 2–3 times per week (Table 8). About 35 percent of respondents 
reported that they do not listen to the radio. 
12
Table 8. Frequency of Radio Listenership (n=152) 
Sociodemographic 
Characteristics
Frequency of Listenership
Daily
4–5 
Times 
per 
Week
2–3 
Times 
per 
Week
Once a 
Week*
Not at 
All
District
Kalomo 31.6 5.3 18.4 5.3 36.8
Lundazi 39.5 2.6 13.2 23.7 21.1
Mansa 36.8 10.5 23.7 0.0 29.0
Nyimba 31.6 5.3 5.3 5.3 52.6
Total 34.9 5.9 15.1 8.6 34.9
*p≤ 0.01
For the most listened-to time periods during the day (Table 9), respondents reported that they 
listen to the radio most during the following three time periods: 18:00 p.m. to 21:00 p.m. (36.8 
percent), 6:00 a.m. to 9:00 a.m. (21.7 percent), and 15:00 p.m. to 18:00 p.m. (21.1 percent).
Table 9. Most Listened-to Time Periods for Radio by District (n=152) 
District
Time Period
1:00 to
6:00
% 
6:00 to
9:00
% 
9:00 to 
12:00
% 
12:00 to
15:00
% 
15:00 to
18:00
% 
18:00 to
21:00
% 
21:00 to 
24:00*
% 
District
Kalomo 0.0 23.7 13.2 15.8 13.2 34.2 2.6
Lundazi 0.0 29.0 26.3 31.6 34.2 50.0 2.6
Mansa 2.6 21.1 15.8 13.2 21.1 34.2 21.1
Nyimba 10.5 13.2 10.5 18.4 15.8 29.0 2.6
Total 3.3 21.7 16.5 19.7 21.1 36.8 7.2
*p ≤ 0.01
Amongst all respondents, the most listened-to radio stations were Radio 1 (31.6 percent), Radio 2 
(17.1 percent) and Radio Chikaya (17.1 percent). The top three most listened-to radio stations for 
each district and overall are highlighted (shaded in boxes) in Table 10 below. 
13
Table 10. Most Listened-to Radio Stations (n=152) 
Station
District (%)
Kalomo Lundazi Mansa Nyimba Total
Radio
Radio 1 21.1 23.7 44.7 36.8 31.6
Radio 2* 2.6 23.7 34.2 7.9 17.1
Chikaya* 0.0 68.4 0.0 0.0 17.1
Yangeni Radio* 0.0 5.3 57.9 0.0 15.8
Namwianga* 52.6 0.0 0.0 0.0 13.2
Breeze FM* 0.0 31.6 0.0 13.2 11.2
K FM* 0.0 2.6 26.3 0.0 7.2
Tigabane 0.0 15.8 0.0 0.0 4.0
Petauke 0.0 0.0 0.0 13.2 3.3
Radio Maria 0.0 10.5 0.0 2.6 3.3
Macha 7.9 0.0 0.0 0.0 2.0
* p ≤ 0.001
3.3. General Exposure to SMGL Campaign
In this section of the survey, general exposure to the campaign was assessed by whether 
respondents had heard about the SMGL campaign and, if so, from what source they had heard about 
it. 
Overall, 47 percent of respondents recalled hearing of the SMGL campaign.3 This included 24 
percent who recalled the campaign spontaneously, and 24 percent who recalled the campaign when 
prompted by the interviewer. Total recall of the campaign was slightly higher amongst mothers of 
children aged 0–6 months (51.3 percent) compared to pregnant women (43.4 percent). In addition, 
total recall of the campaign varied significantly by district and literacy. Recall of the campaign was 
much higher in Kalomo (60.5 percent) and Mansa (52.6 percent) than in Lundazi (29.0 percent). 
Similarly, total recall of the campaign was higher in literate respondents (51.9 percent) compared 
to illiterate respondents (37 percent). Spontaneous, prompted, and total recall of the campaign by 
all sociodemographic characteristics can be found in Table 11. 
 
3
All references to the SMGL campaign are inclusive of the Mothers Alive campaign, as the campaign names were 
used interchangeably in the four districts. For the report, we are using the term SMGL to also encompass Mothers 
Alive.
14
Table 11. Percentage of Respondents Who Had Heard of SMGL Campaign by 
Sociodemographic Characteristics (n=152)
Sociodemographic 
Characteristics
Spontaneous 
Recall of 
Campaign
(%)
Prompted Recall 
of Campaign
(%)
Total Recall of 
Campaign*
(%)
Target Audience
Pregnant Women 19.4 23.7 43.4
Mothers of Children 
Aged 0–6 Months
27.6 23.7 51.3
District
 Kalomo 36.8 23.7 60.5
Lundazi 10.5 18.4 29.0
Mansa 23.7 29.0 52.6
Nyimba 23.7 23.7 47.4
Age Group
15–19 16.0 20.0 36.0
20–24 21.7 28.3 50.0
25–29 24.3 18.9 43.2
30–34 39.1 8.7 47.8
35–39 19.1 42.9 61.9
Education Level
None 29.4 29.4 58.8
Primary 18.7 18.7 37.3
Secondary 29.3 27.6 56.9
Higher 0.0 50.0 50.0
Literacy
Literate (English, local 
language, or both)
26.4 25.5 51.9
Illiterate 17.4 19.6 37.0
Marital Status
Single 15.4 38.5 53.9
Married 25.0 22.1 47.0
Separated or Widowed 0.0 33.3 33.3
Total 23.7 23.7 47.4
* For total recall of the campaign, the results varied significantly by district (p≤0.05) and literacy (p≤0.05).
When respondents were asked from where they had heard, read, or seen anything about the SMGL 
campaign, just under one third of respondents (28 percent) reported having heard of the campaign 
at a health facility (Table 12). The second and third most reported sources of their exposure to the 
campaign were through print materials (14 percent) and via the radio (9 percent). Exposure to the 
15
campaign via print materials, radio, and health facilities varied by district. For example, about 42 
percent of respondents in Kalomo reported having heard of the campaign through print materials, 
while no respondents in Lundazi reported being exposed to the campaign via print materials. 
Table 12. Source of Exposure to Campaign by District (n=152)
District
Source of Exposure 
(%)
Health 
Facility**
Print 
Material***
Radio*
Community 
Activity
Friend/ 
Family
SMAG
T-shirt/ 
chitenge
Induna
Kalomo 50.0 42.1 7.9 2.6 0.0 5.3 0.0 2.6
Lundazi 15.8 0.0 2.6 10.5 1.6 0.0 0.0 0.0
Mansa 15.8 10.5 23.7 0.0 5.3 0.0 2.6 0.0
Nyimba 29.0 2.6 2.6 2.6 0.0 0.0 2.6 0.0
 Total 27.6 13.8 9.2 4.0 2.0 1.3 1.3 0.7
* p≤0.05
** p≤0.01
*** p≤0.001
3.4. Exposure to Birth Plan 
In this section, the survey assessed the target audience’s exposure to the pictorial birth plan, the 
timing and location of when they received the birth plan, their spontaneous recall of the 
topics/messages presented in the birth plan, how respondents used the birth plan and their overall 
perceptions of the birth plan. 
Exposure to Birth Plan 
Overall, just over 70 percent of respondents recalled having seen the birth plan (Table 13). Of these, 
61 percent recalled the birth plan spontaneously, while another 10.5 percent recalled having seen 
the birth plan when prompted by the interviewer. Total recall of the birth plan varied significantly 
by target audience, with overall recall amongst mothers of children aged 0–6 months at 80 percent, 
and only 62 percent amongst women who are currently pregnant. Recall by district also varied 
significantly, with higher recall in Nyimba, Mansa, and Kalomo districts, and lower recall in Lundazi 
district. 
16
Table 13. Exposure to Birth Plan (n=152) 
Sociodemographic 
Characteristics
Spontaneously 
Recalled Birth Plan*
(%)
Recalled Birth Plan 
When Prompted**
(%)
Total Who Recalled 
Birth Plan***
(%)
Target Audience
Pregnant Women 50.0 13.2 61.8
Mothers of Children 
Aged 0–6 Months
72.4 7.9 80.2
District
Kalomo 57.9 18.4 76.3
Lundazi 50.0 5.3 52.6
Mansa 76.3 0.0 76.3
Nyimba 60.5 18.4 79.0
Total 61.2 10.5 71.1
* For spontaneous recall of the birth plan, the results varied significantly by the target audience (p≤0.01).
** For prompted recall of the birth plan, the results varied significantly by district (p≤0.01).
*** For total recall of the birth plan, the results varied significantly by target audience (p≤0.05) and district (p≤0.05).
Timing and Location of Receipt of Birth Plan 
Of all respondents, 47.4 percent reported having received their own copy of the birth plan. This 
varied significantly by target audience, with 60.5 percent of mothers with children aged 0–6 months 
reporting that they received the birth plan, while only 34 percent of currently pregnant women 
received a copy. Receipt of the birth plan also varied by district, with 63.2 percent of respondents in 
Nyimba district reporting that they received their own copy, while only 39.5 percent of respondents 
received it in the Lundazi and Kalomo districts. 
Of those who received the birth plan, the majority of respondents (86.1 percent) reported that they 
received it from a health worker at a health facility. This did not vary by target audience but did 
vary significantly by district, with 100 percent of women reporting they received it from a health 
worker in Nyimba and Kalomo, 86.7 percent of women in Lundazi, and only 55.6 percent in Mansa. 
Interestingly, in Mansa, 44.4 percent of women reported that they received the birth plan from a 
SMAG member, while overall, only 16.7 percent of all respondents reported that they received it 
from a SMAG member. Of those who received the birth plan (n=108), just over 80 percent of women 
reported that someone did explain the birth plan to them. This varied significantly by district, with 
almost all women in Nyimba (96.7 percent) stating that someone explained the birth plan to them, 
compared to only 65.6 percent of women in Mansa. It was most common for a health worker at a 
health facility to explain the birth plan to the women (78.4 percent), compared to a SMAG member 
(22.7 percent). However, this varied significantly by district, with many more women in Mansa 
reporting that a SMAG member explained the birth plan to them (57.9 percent), compared to only 
10.3 percent of women in Nyimba. 
17
When asked the timing of when the women received the birth plan, the majority received it 4–6 
months into their pregnancy (62.5 percent), 20.8 percent received it during months 7–9, and only 
16.7 percent received it during the first 3 months of their pregnancy. The timing of when women 
received the birth plan did not vary significantly by target audience or district of residence. 
Recall of Topics in Birth Plan 
Of all respondents, 66.5 percent were able to spontaneously recall at least one topic or message 
from the birth plan. Just over a quarter of respondents (27 percent) were able to recall two 
messages from the birth plan, while 22.4 percent recalled three messages and about 10 percent of 
respondents recalled four or five different messages on the birth plan. 
The most recalled messages from the birth plan were topics presented in the education, logistics, 
and nutrition and care sections of the plan (Table 14). Amongst all respondents, 54.6 percent 
recalled information presented in the education section of the birth plan, 35.5 percent from the 
logistics section, and 33.6 percent from the nutrition and care section. 
Table 14. Spontaneous Recall of Topics/Messages Presented in the Birth Plan 
Topic/Message
Respondents 
Who Were 
Exposed to 
Birth Plan 
(n=108)
All 
Respondents
(n=152)
Education (information on due date, labour signs, 
danger signs, breastfeeding, and/or care for the baby)
76.9 54.6
Logistics (information on saving for transport and 
supplies for delivery)
50.0 35.5
Nutrition and care (information on a healthy diet, 
vitamin and mineral supplementation)
47.2 33.6
ANC and postnatal visits (information on timing and 
number of visits)
27.8 19.7
Social support (information on importance of support 
from family and/or partner or husband)
13.9 9.9
Importance of resting during pregnancy* 6.5 3.6
Malaria prevention during pregnancy 4.6 3.3
Importance of health facility delivery 4.6 3.3
Information on family planning 3.7 2.6
Prevention of mother-to-child transmission (PMTCT)* 1.9 1.3
*These specific messages were not part of the birth plan; however they likely were included in the counselling provided to 
pregnant women by health workers or SMAGs. 
Use of Birth Plan 
Amongst respondents who were exposed to the birth plan, when asked how they used the birth 
plan, the most common use of the birth plan was to learn about danger signs during pregnancy, 
delivery, and postpartum (Table 15). Other commonly reported uses included preparing logistics 
18
(48.2 percent), saving money (43.5 percent), and learning about facility-based delivery (40.7 
percent). A total of 17.6 percent of respondents who had been exposed to the birth plan reported 
that they did not use it. 
Table 15. How Respondents Used the Birth Plan (n=108)
Use %
Learning about danger signs 50.9
Preparing logistics 48.2
Saving money 43.5
Learning about facility-based delivery 40.7
Learning about how to care for a baby 21.3
Learning about services provided at ANC
visits
13.9
Eating healthy 10.2
Learning about partner/family involvement 2.8
Exercising/resting during pregnancy* 1.9
*This specific use and message was not part of the birth plan; however, it was likely included in the counselling provided 
to pregnant women by health workers or SMAGs. 
Perceptions of the Birth Plan 
Overall, respondents perceived the birth plan to be easy to use and useful (Table 16). More than 82 
percent of respondents either agreed or strongly agreed with the statement “I find the birth plan 
easy to use.” Similarly, almost 98 percent of respondents agreed or strongly agreed with the 
statement “I find the birth plan useful.” The majority of respondents also either agreed or strongly 
agreed that the birth plan was helpful in preparing for childbirth, that they follow/followed the 
monthly birth planning steps in the birth plan, and that they would recommend the birth plan to a 
family member or friend. 
Table 16. Respondents’ Perceptions of Birth Plan 
Statement (n)
Agreement With Statement (%)
Strongly 
Disagree
Disagree Neutral Agree Strongly 
Agree
I find the birth plan easy to use.
(n=86)
9.3 8.1 0.0 26.7 55.8
I find the birth plan useful. (n=87) 1.2 1.2 0.0 41.4 56.3
The birth plan helps/helped me 
during my pregnancy to prepare 
for childbirth.* (n=88)
1.1 3.4 34.1 34.1 61.4
I follow/followed the monthly birth 
planning steps presented on the 
birth plan. (n=87)
1.2 5.8 13.8 44.8 34.5
19
Statement (n)
Agreement With Statement (%)
Strongly 
Disagree
Disagree Neutral Agree Strongly 
Agree
I would recommend the birth plan 
to a family member or friend.
(n=87)
0.0 4.6 1.2 28.7 65.5
* For this statement, results varied significantly by target audience (p=.05). 
3.5. Exposure to Radio Adverts 
In this section, the survey assessed the target audience’s exposure to the Safe Motherhood radio 
adverts, their recall of the main topics and messages in the adverts, and their perceptions of the 
adverts. 
Exposure to Safe Motherhood Radio Adverts 
Of all respondents, about 20 percent recalled having heard of the Safe Motherhood radio adverts 
(Table 17). This varied significantly by district, with the highest recall of the radio adverts in Mansa 
(34.2 percent) and the lowest in Nyimba (7.9 percent). This is likely due to greater coverage of the 
radio adverts in Mansa and Lundazi districts, which included both national- and community-level 
radio stations. In Nyimba district, radio adverts were only aired on national-level radio stations. 
Recall of the radio adverts did not vary significantly by target audience but was slightly higher 
amongst mothers of children aged 0–6 months than pregnant women. 
Table 17. Recall of Safe Motherhood Radio Adverts (n=152)
District
Pregnant 
Women Recalled 
Advert
(%)
Mothers of 
Children Aged 
0–6 Months 
Recalled Advert
(%)
Total Who 
Recalled Advert
(%)*
Kalomo 26.3 10.5 18.4
Lundazi 10.5 26.3 18.4
Mansa 31.6 36.8 34.2
Nyimba 0.0 15.8 7.9
Total 17.1 22.4 19.7
*Total recall of the radio advert varied significantly by district (p≤0.05).
Recall of the Safe Motherhood radio adverts amongst only the respondents who had access to a 
radio in the household was 29.8 percent (n=94). Similarly, recall amongst respondents with access 
to a radio was highest in Mansa at 42.9 percent and lowest in Nyimba district at 17.8 percent, and 
slightly higher amongst mothers of children aged 0–6 months (34 percent) than pregnant women 
(25.5 percent). 
20
Recall of Radio Station for Safe Motherhood Adverts 
When respondents were asked what radio station they heard the advert on, the most commonly 
reported stations were Radio Yangeni (23.3 percent), Radio 1 (20 percent), and Radio Numwianga 
(16.7 percent). A few others mentioned K FM and Radio Chikaya stations (10 percent each). Recall 
of the community stations that aired the adverts varied significantly by district, which was expected 
since coverage of the different radio stations varied by district. For example, 53.9 percent of 
respondents in Mansa district recalled hearing the advert on Radio Yangeni, while none of the 
respondents from the other districts recalled hearing the advert on the station. Recall of the adverts 
on the national-level radio station 1 did not vary by district. 
Spontaneous Recall of Topics/Messages in Safe Motherhood Radio Adverts 
Of all respondents, 17.8 percent were able to spontaneously recall at least one topic or message 
presented in the radio adverts. Amongst only those who recalled the radio advert (n=30), 90 
percent reported recalling at least one topic or message from the advert, 20 percent recalled one 
message from the adverts, more than 40 percent recalled two messages, and 30 percent recalled 
three to five different messages from the adverts. 
The most commonly recalled topics or messages from the radio adverts were saving money during 
pregnancy; the importance of delivering in a health facility; and the danger signs to watch for 
during pregnancy, delivery, and/or postpartum (Table 18).
Table 18. Spontaneous Recall of Topics/Messages Presented in the Safe Motherhood Radio 
Adverts 
Topic/Message
Respondents Who 
Saw the Advert
(n=30)
All Respondents
(n=152)
Saving money 40.0 7.9
Importance of facility-based 
delivery
40.0 7.9
Danger signs during pregnancy, 
delivery, and/or postpartum
33.3 6.6
Attending ANC early 30.0 5.9
Family planning 20.0 4.0
Healthy diet 16.7 3.3
Importance of resting/doing light 
work during pregnancy
10.0 2.0
How to care for child after delivery 10.0 2.0
Perception of Safe Motherhood Radio Adverts 
Overall amongst the respondents who recalled hearing the safe motherhood radio adverts, the 
majority reported understanding the messages presented in the adverts and felt that the adverts 
21
contained important information that was relevant to them (Table 19). For example, when 
respondents were asked if the information in the radio advert is important for women who are 
pregnant and their partners, 85 percent of respondents strongly agreed. 
Table 19. Perception of Safe Motherhood Radio Adverts (n=27) 
Statements
Agreement With Statement (%)
Strongly 
Disagree
Disagree Neutral Agree Strongly 
Agree
I understood the messages in the 
radio advert/spot.
0.0 0.0 0.0 44.4 55.6
I found the message in the radio 
spot/advert more compelling since 
it was communicated by a chief.
0.0 3.7 3.7 25.9 66.7
I think it is important to follow 
what the chief was saying in the 
advert/radio spot.
0.0 0.0 0.0 37.0 63.0
The radio spot made me seriously 
think about how to achieve better 
health for me and my baby during 
and after my pregnancy.
0.0 0.0 3.7 37.0 59.3
The information in the radio 
advert/spot is important for 
women who are pregnant and their 
partners.
0.0 0.0 3.7 11.1 85.2
3.6. Summary of Exposure to Components of the SMGL Campaign 
Table 20 below provides a summary of the respondents’ exposure to the various components of the 
SMGL campaign. Overall recall of the SMGL campaign was just under 50 percent. The most 
commonly recalled component of the campaign was the birth plan, with more than 70 percent of 
respondents reporting that they had seen the birth plan. Overall, 77 percent of respondents 
reported having recalled at least one of the main components of the campaign (birth plan, radio 
adverts, and/or interaction with a Change Champion in their community). 
Table 20. Summary of Target Population’s Exposure to the Various Components of the SMGL 
Campaign (n=152) 
Components of the SMGL Campaign 
Recalled
Exposure 
(%)
General Exposure to Campaign
Heard of SMGL campaign 47.4
Exposure to Birth Plan
Recalled birth plan 71.1
22
Exposure to Radio Adverts
Recalled Safe Motherhood radio 
adverts
19.7
Spontaneously recalled radio advert 
topics/messages
17.8
Exposure to SMGL Campaign by Media Channel
Radio 19.7
Print product (birth plan) 71.1
Exposure to at Least One SMGL Campaign Component
 At least one SMGL campaign 
component*
77.0
* Refers to exposure to at least one of the following campaign components: the birth plan, the radio adverts, and/or interaction with a 
Change Champion in the respondent’s community.
3.7. Perception of Impact on Knowledge, Attitudes, and Behaviour 
This section presents findings related to the audience’s perception of the impact of the SMGL 
campaign on their knowledge, attitudes/beliefs, and behaviour. Examining perception of impact is 
helpful because it provides an indication of whether the population perceives an effect and, if so, on 
which specific areas of their knowledge, attitudes, and behaviours. Findings showing that the 
audience perceives an impact are encouraging and indicate that the messages are having an effect.4
However, it is important to note that perception of impact results is not an actual true estimate of 
impact and is only a crude measure, highly subject to social desirability bias. This means that the 
results should not be interpreted as the effect size of the campaign. To measure the actual impact of 
a campaign, the knowledge, attitudes, and reported behaviours of those exposed to the campaign 
have to be compared with those who are unexposed, and this can only be done through a large 
representative survey conducted specifically for this purpose. 
Perception of Impact on Respondents’ Knowledge and Attitudes/Beliefs 
When respondents were asked if they had learnt anything from the Safe Motherhood messages that 
they had heard, seen, or read, 82.9 percent responded that they had. Amongst the respondents who 
were able to recall at least one specific component of the SMGL campaign (n=117), 91.6 percent 
reported that they had learnt something from campaign. It is important to note that when 
compared to those who had recalled at least one main component of the campaign (77 percent, 
Table 23), the number of respondents reporting that they learnt something from the campaign was 
slightly lower. This is likely due to over-reporting amongst respondents about what they learnt 
from the campaign. 
The most commonly recalled information and knowledge from the campaign amongst the 
respondents was the importance of saving money, danger signs, the importance of seeking care at 
their onset, the importance of facility-based delivery, and the importance of attending ANC early 
(Table 21).
 
4
 Perception of impact results is always presented for the whole target audience and not just for those exposed 
and those who answered the questions about impact. 
23
Table 21. Knowledge Learnt From SMGL Campaign 
Knowledge Learnt
% of 
Respondents’ 
Reporting 
Exposure to the 
SMGL Campaign
(n=117)
% Amongst All 
Respondents
(n=152)
Importance of saving money 63.3 55.3
Danger signs and importance of seeking care at 
their onset
64.1 54.0
Importance of facility-based delivery 52.1 46.7
Importance of attending ANC early 36.8 32.2
Mother/baby care after pregnancy 11.1 9.2
Family planning 9.4 7.2
Vitamin supplementation during pregnancy 6.8 6.6
Importance of HIV/sexually transmitted infection 
(STI) testing
5.1 4.6
Use of insecticide-treated nets (ITNs) for malaria 
prevention during pregnancy
2.6 4.0
Hygiene 4.3 3.3
PMTCT 1.7 1.3
Of the respondents who were able to recall at least one component of the SMGL campaign, 89.7 
percent were able to recall at least one topic or message that they learnt from the campaign. Of 
these, 56.4 percent recalled two or three topics/messages and 23.1 percent were able to recall four 
or more topics/messages that they learnt from the campaign. 
Respondents were asked whether they agreed or disagreed with a number of statements regarding 
their knowledge and attitudes/beliefs on safe motherhood. Table 22 below summarises the 
respondent’s agreement/disagreement with the 10 statements. Overall knowledge around safe 
motherhood was high, and respondents exhibited ideal attitudes and beliefs on the various safe 
motherhood topics. For example, the majority of respondents (98.5 percent) either strongly agreed 
or agreed with the statement “It is beneficial for the mom and baby’s health to attend antenatal care 
early in pregnancy.” Similarly all respondents either strongly agreed or agreed with the statement 
“I believe that delivering from a health facility is safer than delivering a baby at home.” 
Overall, respondents also felt that the messages in the SMGL campaign were relevant for women in 
their community, with 70.6 percent of respondents stating that they strongly agreed and 29.4 
percent stating that they agree that the messages were relevant. 
24
Table 22. Agreement With Safe Motherhood Knowledge and Attitude Statements (n=126) 
Statements
Agreement With Statement (%)
Strongly 
Disagree
Disagree Neutral Agree Strongly 
Agree
I fear that when I go for ANC I will 
be tested for HIV.
75.4 17.5 0.0 4.0 3.2
It is beneficial for the mom and 
baby’s health to attend ANC early in 
a pregnancy.
0.0 0.0 1.6 18.3 80.2
I do not fear the process or 
experience of delivering a baby in a 
health facility.
4.0 3.2 0.0 27.8 65.1
I believe that delivering from a 
health facility is safer than 
delivering a baby at home.
0.0 0.0 0.0 17.5 82.5
The safe motherhood programme 
made it easier to get support from 
my family during pregnancy and 
childbirth.
0.0 7.1 11.1 42.1 39.7
I am aware of the danger signs 
during pregnancy/labour/ 
postpartum.
1.6 3.2 10.3 31.0 54.0
I am aware of the various safe 
motherhood services provided by 
health facilities.
0.8 7.1 16.7 41.3 34.1
I believe that the quality of care and 
treatment at the health facility in 
my community is adequate.
1.6 2.4 12.0 27.2 56.8
I believe that it is beneficial/ 
important to plan for childbirth 
when one is pregnant.
0.8 0.8 1.6 23.8 73.0
The messages in the Safe 
Motherhood programme are 
relevant for women in my 
community.
0.0 0.0 0.0 29.4 70.6
Perception of Impact on Respondents’ Behaviour
Amongst all respondents, 72.4 percent reported that the SMGL campaign had an impact on their 
behaviour. Of only the respondents who were able to recall at least one specific component of the 
campaign (n=117), 82.4 percent reported that the campaign influenced their behaviour. 
The most commonly reported influences on respondents’ behaviours amongst the respondents 
were that they saved money while pregnant, attended ANC early in their pregnancy, and delivered 
or planned to deliver in a health facility (Table 23). 
Table 23. SMGL Campaign Influence of Respondents’ Behaviours 
25
Behaviour
% of 
Respondents’ 
Reporting 
Exposure to the 
SMGL Campaign
(n=117)
% Amongst All 
Respondents
(n=152)
Saved money 47.0 40.8
Attended ANC early 35.0 29.0
Delivered in a health facility or plan to 
deliver in a health facility
32.5 28.3
Sought care for danger signs 30.8 25.7
Improved diet 23.9 19.7
Involved family in preparing for logistics 12.8 11.2
Attended postnatal care or plan to attend 
postnatal care
7.7 7.2
Improved breastfeeding practices or plan 
to improve breastfeeding practices
6.0 5.3
Improved duration of rest during 
pregnancy
4.3 4.0
Used an ITN 3.4 4.0
Went for an HIV test 4.3 3.3
Started family planning 1.7 1.3
Took vitamin supplementation 1.7 1.3
 
3.8. Interpersonal Communication 
Interpersonal Communication With Health Workers and Change Champions 
When respondents were asked if anyone had discussed safe motherhood with them in the past 6 
months, a total of 69.7 percent responded “yes.” The majority of respondents reported having 
discussed safe motherhood with a health worker (48.7 percent) or a SMAG member (30.9 percent). 
Of all respondents, 14.5 percent either spontaneously recalled or recalled when prompted by the 
interviewer that they had discussed safe motherhood with a Change Champion (Table 24). Recall of 
having a discussion on safe motherhood with a Change Champion did not vary significantly by 
district but was slightly higher in Mansa (18.4 percent) than in Kalomo (10.5 percent). 
Table 24. Recall of Safe Motherhood Discussion With Change Champions (n=152) 
26
District
Spontaneously 
Recalled Safe 
Motherhood 
Discussion With 
Change Champion
(%)
Recalled, When 
prompted, Safe 
Motherhood 
Discussion With 
Change Champion 
(%)
Total Who Recalled 
Safe Motherhood 
Discussion With 
Change Champion
(%)
Kalomo 2.6 7.9 10.5
Lundazi 7.9 7.9 15.8
Mansa 2.6 15.8 18.4
Nyimba 7.9 5.3 13.2
Total 5.3 9.2 14.5
Spontaneous Recall of Topics Discussed With Change Champions 
Amongst respondents who reported discussing safe motherhood issues with a Change Champion, 
the most common spontaneously recalled topics that were discussed included the need to save 
money during pregnancy; the importance of attending ANC early in pregnancy; importance of 
facility-based delivery; and danger signs during pregnancy, delivery, and postpartum, and the 
importance of seeking care at their onset (Table 25). 
Table 25. Spontaneous Recall of Topics Discussed With Change Champions 
Topics/Messages
Respondents Who 
Recalled Discussion 
With Change 
Champion
(n=22)
All Respondents
(n=152)
Save money 57.9 7.2
Importance of attending ANC early 57.9 7.2
Importance of facility-based 
delivery
52.6 6.6
Danger signs and importance of 
seeking care at their onset
47.4 5.9
Healthy eating 10.5 1.3
Family planning and birth spacing 5.3 0.6
Importance of postnatal care 5.3 0.6
PMTCT 5.3 0.6
Hygiene 5.3 0.6
When respondents were asked if they had talked with someone about the messages in the SMGL 
campaign, just under half (49.3 percent) reported that they had discussed the messages with 
someone (Table 26). This varied significantly by district, with more than 70 percent of respondents 
in Kalomo reporting that they had discussed the messages of the campaign with someone, 
27
compared to only 15.8 percent of respondents in Lundazi district. Similarly, this varied significantly 
by age group, with 87 percent of those between the ages of 30 and 34 reporting they had talked 
with someone, while only 32 percent of younger respondents between the ages of 15 and 19 years 
had discussed the messages with someone. Discussion of the campaign messages did not vary 
significantly by target audience, education level, literacy, or marital status. However, there was a 
clear trend observed by education level and literacy. More respondents with a higher level of 
education, and respondents that were literate, reported that they had discussed the campaign 
messages with someone than respondents with less education and those who were illiterate. 
Table 26. Percentage of Respondents Who Talked With Someone About the Messages in the 
SMGL Campaign, by Sociodemographic Characteristics (n=152) 
Sociodemographic 
Characteristics
Talked With Someone 
About Messages
(%)
Target Audience
Pregnant women 46.1
Mothers of children 
aged 0–6 months
52.6
District*
Kalomo 71.1
Lundazi 15.8
Mansa 68.4
Nyimba 42.1
Education Level
None 35.3
Primary 45.3
Secondary 56.9
Higher 100.0
Literacy
Literate 53.8
Illiterate 39.1
Age Group*
15–19 32.0
20–24 34.8
25–29 56.8
30–34 87.0
35–39 47.6
28
Marital Status
Single 61.5
Married 48.5
Separated or 
Widowed
33.3
Total 49.3
*p ≤ 0.001
The majority of respondents reported discussing the campaign messages either with a friend or 
neighbour (56 percent) or with their spouse/partner (52 percent) (Table 27). Of the respondents 
who reported talking about the messages from the SMGL campaign with someone else, the most 
commonly discussed topics were the importance or need to save money during pregnancy (64 
percent); danger signs during pregnancy, delivery, and postpartum and seeking care at their onset 
(60 percent); the importance of facility-based delivery (52 percent); and the importance of 
attending ANC early (45.3 percent) (Table 28).
Table 27. Person With Whom Respondents Discussed Messages From SMGL Campaign 
(n=75) 
Person With Whom 
Respondent Discussed 
Message
Percentage of 
Respondents 
Reported
Friend/neighbour 56.0
Spouse/partner 52.0
Other family relation 29.3
Mother/mother-in-law 8.0
Health worker 6.7
Father/father-in-law 1.3
29
Table 28. SMGL Topics Discussed by Respondents (n=75) 
Topics
% of 
Respondents 
Reported
Importance of saving money 64.0
Danger signs and seeking care at their onset 60.0
Importance of facility-based delivery 52.0
Importance of attending ANC early 45.3
Importance of having a good diet during 
pregnancy
9.3
Family planning methods and birth spacing 8.0
Safety during pregnancy 5.3
PMTCT 4.0
How to care for a baby 1.3
Importance of taking vitamin 
supplementation/medication during 
pregnancy
1.3
30
IV. Findings From In-Depth Interviews 
The qualitative component of the study used in-depth interviews with Change Champions—Chiefs 
and other community leaders—and the District MCH Coordinators to assess how the Change 
Champion programme worked in each district and how it could be improved. Specifically, the 
interviews were aimed at assessing the following: (1) perceptions on roles and knowledge on safe 
motherhood, (2) the implementation and success or achievements of the Change Champion 
programme, and (3) the challenges the respondents faced and recommendations for addressing 
them. 
4.1. Perceptions on the Role of a Change Champion 
District MCH Coordinators 
The four District MCH Coordinators were asked what it meant to be a Change Champion and about 
the role Change Champions played in promoting safe motherhood in their districts. The 
coordinators saw the Change Champions as educators and disseminators of information on ideal 
safe motherhood practices. They often cited visiting community members and holding meetings on 
safe motherhood, and promoting behaviour change as the role of Change Champions. 
“Doing health talks by meeting women, men as well as families … they are between health 
workers and the community … advocating for good health … also encouraging male 
involvement.”
“They tell people not to deliver in villages” and “encourage them to deliver at the clinic.”
One coordinator added that Change Champions were well-known, influential community members 
who led by example and were easily listened to by their community members. The coordinator 
mentioned chiefs, headmen, and traditional leaders as examples. Another added that Change 
Champions were individuals who wanted to change the way community members viewed safe 
motherhood issues. 
Chief Change Champions 
Of the three participating Chiefs, two felt the orientation helped them clearly understand their role 
as a Change Champion. They believed their role was to use their leadership to gather their 
community members and address health issues that affected pregnant mothers and their babies. 
“We are to use our influence in society to have an impact, to speak at functions and in villages 
about safe motherhood issues.”
“I gather people, mostly headmen, to discuss the plight of women and how we must encourage 
health centre delivery.”
One Chief was not able to identify his role or any training topics. 
31
Other Change Champions
The Change Champions had a common understanding of their role in their communities. The 
majority of Change Champions envisioned themselves as influential community members tasked to 
change attitudes and behaviours related to safe motherhood—in particular, increasing facility￾based deliveries, antenatal and postnatal care attendance, family planning, and male involvement. 
“Actually, a Change Champion is a person like me who sit and teach people and explain about 
safe motherhood and how people should plan for their pregnancies and also how people 
should have safe deliveries. I also explain other things like family planning and how people 
should space their children and not having too many of those little ones. As a Change 
Champion, I encourage people to visit the hospitals and health centres each time they have a 
problem, and I want to change people’s lives. So, that’s just how I understand who a change 
champion is.”
Other Change Champions also saw their role as preventing maternal and child deaths, dispelling 
myths related to safe motherhood, identifying problems, and serving their community. 
4.2. Perceptions on Safe Motherhood Knowledge and Training 
Chief Change Champions 
Participating Chiefs were asked about their motivations for becoming Change Champions and if 
they had prior knowledge about safe motherhood before the CSH orientation. The three 
respondents stated they had received no prior safe motherhood training, and only one mentioned 
having some knowledge before the orientation. The others were not familiar with the topic. The 
Chiefs listed a number of reasons for their motivation to participate in the program. One Chief felt 
that hehad already been addressing similar health issues and that the training further motivated 
and increased his knowledge. Another Chief felt motivated by an awareness of and concern over the 
number of childbirth deaths in their area, while the other pointed to his position and authority as 
Chief. 
 
Two Chiefs indicated that the overall training was sufficient and left them feeling confident about 
their ability to discuss safe motherhood issues. Amongst others topics covered during orientation, 
they mentioned caring for pregnant women and their babies, encouraging the use of health 
facilities, encouraging early antenatal visits and registration, having a birth plan, receiving 
postpartum care, and remembering the six steps to safe motherhood. 
All respondents mentioned the need for additional or frequent trainings. One Chief repeatedly 
expressed his concern over possibly not being able to answer the interview questions correctly and 
attributed it to insufficient training and the lack of post-orientation follow-up. Before abruptly 
ending and instructing his guard to complete the interview, the Chief was unable to identify any 
safe motherhood topics. His guard shared that they had stopped participating due to a lack of 
follow-up from their coordinator, adding “we have SMAGs who go to villages to sensitize women 
about antenatal and the importance of going with partners … there is even punishment for the ones 
32
who refuse to go.” A second Chief also expressed concern over not being able to answer questions 
but chose to continue the interview. 
Other Change Champions 
The other Change Champions cited a few different reasons for becoming Change Champions. Most 
Change Champions felt motivated to join the initiative because of what they witnessed in their 
villages—death during childbirth or death from pregnancy complications, poor attendance at AMC 
clinics, and limited family planning. 
“What motivated me to become a Change Champion is because of a lot of suffering … on the 
part of women. You will find that women are giving birth in homes, while others are dying of 
pregnant-related complications. Some of them don’t go and register for antenatal visits when 
the hospital was teaching us. It’s when I realised that there is need for things to change, that 
was when I became a Change Champion for things to change.”
The remaining Change Champions explained that their commitment to the general well-being of 
women and children, as well as their experience doing volunteer work and community 
development for other projects, motivated them to join the initiative. 
All of the Change Champions reported receiving a training covering a range of topics related to safe 
motherhood. The Change Champions most commonly cited that the training covered issues related 
to ANC and the birth plan. Other common topics in the trainings included facility-based deliveries, 
male involvement, postnatal care, family planning, maternal and child nutrition, hygiene, pregnancy 
danger signs, and dangers of early marriages. A few Change Champions also reported discussing 
programme reporting, PMTCT, male circumcision, malaria prevention, and common myths about 
pregnancy and delivery. Several of the Change Champions also mentioned learning about the six 
steps of safe motherhood, but only a couple were able to explain the steps when asked by the 
interviewer. 
About half of the Change Champions had received previous trainings that addressed safe 
motherhood topics. They specifically mentioned being trained in family planning (including 
condom use and birth control pills), ANC, and PMTCT. One champion was a trained and practicing 
midwife. These Change Champions received training from various sources, including St. Francis of 
Midwifery, the United States Agency for International Development (USAID), Child Fund, World 
Vision, and local SMAGs and health workers. 
In terms of the effectiveness of the Change Champions training, the Change Champions appeared to 
be equally divided. Half of the Change Champions found that the training was sufficient in preparing 
them for their work in the communities. “The training was enough because we understood 
everything very well and after lessons they could ask us different questions based on what we were 
doing. We were also free to ask them where we were not very clear.” Many of these Change 
Champions found that the field mentorship following the initial orientation solidified the lessons 
and allowed an opportunity to ask questions. The other half thought the training was too short and 
33
required either a medical background to grasp the information or follow-up trainings to provide 
further details on the many safe motherhood topics. 
Responses to probing questions on the effectiveness of the training resulted in some conflicting 
results. Despite the division in opinion on the sufficiency of the training, the majority of the Change 
Champions felt the trainings helped them to better understand their roles as Change Champions. 
The overwhelming majority also reported feeling confident discussing safe motherhood topics in 
their communities. However, half of the Change Champions still felt uncomfortable providing 
information on a range of topics. These topics included postnatal danger signs, ANC, female 
condoms, breastfeeding for HIV-positive mothers, child spacing, differences in exclusive and 
complementary breastfeeding, family planning, and determination of the delivery due date. 
4.3. Implementation of Change Champions Programme
District MCH Coordinators 
When asked about organisation—how the Change Champions were selected, whether they worked 
with the Change Champions and met at the district level, and if they involved other community safe 
motherhood volunteers—District MCH Coordinators offered mixed responses and revealed some
implementation challenges. 
Selection of Change Champions 
Most of the communities followed a common process for selecting Change Champions. Most of the 
coordinators reported focusing their selection efforts on influential leaders in the community and 
inviting them to participate. “The Change Champions were selected using influential people such as 
headmen, Chairmen, Chiefs, and those people who are popular in our community,” said an MCH 
Coordinator. One of these coordinators reported that his DHO sent a letter inviting these leaders to 
serve as Change Champions. One coordinator was new to the position and was unaware of the 
selection process. 
Implementation Activities 
All of the coordinators explained that Change Champions implemented the programme by 
delivering health talks and in some cases speaking with community members one on one. A couple 
of the coordinators emphasised educating communities about the need for facility-based deliveries 
and the possible penalty for delivering in the village. 
"They've put a penalty for anyone who delivers into the community that maybe they are going 
to pay a certain amount of money, not necessarily charging them but to encourage them to 
deliver at the clinics … they tell them they'll have to pay an amount they can't afford so they'll 
deliver in a clinic out of fear they can't pay or ‘the chief can chase them out of the village’ ... to 
encourage them.”
34
Other coordinators reported that their Change Champions also focused on the importance of early 
ANC and male involvement, and the dangers of not practicing safe motherhood. 
Coordination With Other Change Champions and DHOs 
Most of the coordinators highlighted that many Change Champions worked together in groups 
when visiting communities and conducting health talks. One coordinator found groups of male and 
female Change Champions to be useful when speaking with different community members. Another 
coordinator thought Change Champions supporting one another during community visits was 
important in the event that one coordinator was unable to address a specific community question, 
as the other champion could step in. 
Despite the efforts of the group outings, coordination of Change Champions at the district level 
appeared to be a challenge. Some participants indicated limited interaction at the district level, 
stating that they had never met or had only done so once. One coordinator attributed the lack of 
interaction to having a busy schedule and a difficulty in dealing with Chiefs. “It’s not very easy when 
you are dealing with Chiefs to just call them and say ‘let’s go this way, let us do that,’” the coordinator 
stated. The coordinator added that reaching pastors and other community members was easy, but 
Chiefs were “very dignified,” so “someone at a higher level” needed to reach them. The respondent 
suggested that the District Commissioner could work with the Chiefs, concluding that he was in 
charge and “the one who is supposed to call these meetings.” 
Coordinators differed in their opinions on whether the programme was reaching their entire 
district. A couple of coordinators noted that it was difficult for DHO staff to travel across their 
districts due to hectic schedules and poor transportation options, but they felt confident that the 
Change Champions stationed in the villages would reach their designated populations. Two 
coordinators reported using a zone system for their Change Champions to ensure coverage of the 
villages without overlap. Another coordinator also explained their plans to use local radio and the 
distribution of fliers to help spread safe motherhood information throughout the district. 
Most coordinators believed that Change Champions are linked to the DHO. They reported that the 
office works “hand in hand” with the Change Champions by providing materials and support when 
they encounter challenges with implementing the programme in their communities. One 
coordinator specifically mentioned that hisoffice has a Change Champion Chairman to serve as the 
primary point of contact for their Change Champions. Although most of the coordinators stressed a 
clear linkage, one coordinator underscored the difficulties in reaching some of his Change 
Champions due to hectic schedules and a lack of commitment on the part of the Change Champions. 
Coordination With Other Safe Motherhood Groups 
Most of the coordinators also reported collaborating with other safe motherhood groups and 
volunteers—including SMAGs, NHCs, growth promoters, and health educators. All of the 
coordinators stressed that these groups conduct activities that are similar to those of the Change 
Champions in the same communities, and in some cases these groups have stronger interpersonal 
35
relationships with the communities. To help connect the work of the Change Champions to other 
groups, two coordinators mentioned inviting the other groups to their events and disseminating 
information to use with community members. One coordinator reported not working with other 
groups at all, despite hisconnections to the communities, because hs has been unable to schedule a 
meeting with them. 
Chief Change Champion 
Implementation Activities 
Two of the Chiefs explained that they organised the community by using their leadership position 
to gather and train others (mostly Indunas and headmen), and then working with them to spread 
information about safe motherhood practices. 
“I first sent word out that all the headmen should come here (the palace) for a meeting. When 
they came for this meeting, I told them all I had been taught at the orientation, such as early 
antenatal booking and emphasised that they must keep a look out for pregnant women and 
ensure that they all deliver at the health centre. Also, that anyone who delivers at home would 
be summoned to the palace to pay a fine. After that, the meetings that followed was for 
everyone in the community.”
“Immediately after I came from Lusaka, I invited village headmen from two wards and a total 
number of 75 village headmen … after that we made another meeting which had 26 … I have 
seven wards so I picked key figures from each ward to lead.”
“[W]e quickly send them (community leaders) out to go and sensitize others, to say this is what 
has come from the palace, and his royal highness wants to do this on these issues … they will 
quickly come back here and say that we have gone out but these are the issues, so we can 
quickly settle them and be able to implement the programmes quickly, efficiently, and 
effectively.”
One Chief mentioned leveraging other activities (e.g., quarterly Chief council meetings, visits to sub￾chiefs or headmen) and using them as opportunities to spread messages about safe motherhood 
practices to community members. This Chief also reported tasking Indunas with the responsibility 
of reaching all villages in each of their wards, addressing traditional issues that affected safe 
motherhood, and providing reports on their area during the Chief’s council meetings. Further, the 
Chief detailed how he or she selected three leaders from each of his or her seven wards to serve as 
Change Champions and used Ward Counsellors to address issues and report on maternal deaths 
during meetings with government officials. 
To both Chiefs, the Indunas played a key role in collecting information and reporting on their 
wards. “They write progress reports for me to take to the district health office, and then the district 
health office comes here to see how things are going here in the community,” reported the other Chief.
Coordination With the DHO 
36
The Chiefs mentioned good coordination with District Health Officers, stating that they provided 
the officer status reports and were in constant touch. In addition, they shared that they received 
material from them that supported their efforts, with one chief adding that he preferred to work 
with government officials, as “that is where the money is and what can we Chiefs offer [people]?”
Coordination With Other Change Champions and Safe Motherhood Groups 
Chiefs coordinated with other area Change Champions and community volunteers, such as SMAGs, 
women’s groups, and HIV/AIDs action groups. The Chiefs believed this was advantageous, as their 
members knew the community well. However, they saw distance and the lack of adequate 
transportation as barriers to meeting and improving coordination. One Chief mentioned that he 
also worked with nurses but found them not responsive to coordination. “They say they don’t want a 
programme, to be told what to do, [and] that they know what they are doing,” he responded. Another 
Chief stated that he had asked the area District Commissioner about ways to coordinate efforts but 
did not hear back. 
Other Change Champions 
Implementation Activities 
The Change Champions reported implementing the programme through a few types of activities. 
Most of the Change Champions explained holding meetings in the community or speaking at 
meetings held by other organisations, such as local churches, women’s groups, and sports teams. In 
the meetings, they explained their role and provided basic information on safe motherhood. A few 
of the Change Champions reported distributing the birth plan during the meetings. Several Change 
Champions also discussed going door to door to speak with women and their families and working 
with community leaders (e.g., Chiefs) to call attention to the project. One champion reported 
moving expectant mothers to the women’s shelter to wait for delivery at the health facility. Another 
champion reported collecting the contact information of pregnant women at meetings to conduct a 
follow-up visit on birth planning. 
Coordination With Other Change Champions and DHO 
About half of the Change Champions reported working with other Change Champions by hosting 
meetings, visiting local hospitals, and travelling to the resource centre. Other Change Champions 
indicated that far distances and lack of transportation inhibited their abilities to work with other 
Change Champions. 
Coordination of Change Champions at the district levels followed a similar pattern. About half of the 
Change Champions reported meeting on a regular basis, mostly meeting quarterly, monthly, or as
needed. A few of the Change Champions mentioned meeting only once, while two stressed never 
meeting at the district level due to hectic schedules and lack of transportation. Of those who did 
meet, common discussion topics for the meetings included planning for health talks, performance 
37
and challenges, coordination of resources, and support of SMAGs. “I would say to share our 
performance, what is going well, and the challenges we have so that we share opportunities, 
challenges, and solutions. At these meetings, we receive encouragements from health workers in the 
district, the DMO, the MCH Coordinators, and other leaders,” said a Change Champion. 
Some of the Change Champions explained that the coordination with other Change Champions was 
helpful. They learnt ways to address challenges when speaking with women and their families, the 
importance of working with Chiefs and other key stakeholders, and the usefulness of having 
another champion to help respond to community questions. The most common challenge to 
working with other Change Champions was the lack of transportation, followed by lack of regular 
meetings, relationship building, and commitment on the part of some Change Champions. 
The Change Champions varied in their opinions on whether the programme was reaching the entire 
district. A quarter of the Change Champions thought the programme successfully reached the entire 
district through a zoning system and special field trips for Voluntary Counselling and Testing Day, 
World Malaria Day, and World AIDS Day. Conversely, a few of the Change Champions adamantly 
said that the programme was not reaching the entire district due to an insufficient number of 
Change Champions and a lack of transportation. 
Coordination With Other Safe Motherhood Groups 
All but one Change Champion discussed working with other safe motherhood groups when 
implementing the programme. Most Change Champions reported working with SMAGs, noting that 
they do much of the same type of work, but they found it helpful to collaborate in disseminating and 
counselling women and their families on the birth plan. Similar to the Chief Change Champions, 
several Change Champions also mentioned coordinating with community health workers, women’s 
groups, community volunteers, Chiefs, and headsmen. A couple of Change Champions also worked 
with PMTCT lay counsellors, traditional birth attendants, and the NHC. In addition to their work 
with SMAGs to disseminate and counsel on the birth plans, Change Champions reported 
collaborating with their partners to 
 Hold health talks on a range of safe motherhood issues; 
 Provide safe motherhood reports (e.g., pregnant women, facility deliveries, registration for 
facility deliveries); 
 Share safe motherhood information for dissemination; and 
 Use influence (Chiefs and headmen) to organise community members for health talks and to 
charge penalties for home deliveries. 
The most commonly cited challenges to working with other safe motherhood groups was the lack of 
transportation for meeting and the groups’ expectations of incentives for partnering with the 
Change Champions. Other champions also reported being challenged with the lack of authority to 
correct partners for relaying incorrect information, and unknowingly working with volunteers with 
bad reputations in the community or a limited knowledge of safe motherhood. 
38
4.4. Mobilization and Perceived Achievements of Change Champions Programme 
District MCH Coordinators 
Most of the coordinators believed they had been successful in mobilizing their communities to 
practise safe motherhood. They discussed several strategies they viewed as being successful—
including selecting Change Champions who are influential figures in their communities, taking 
advantage of opportunities to talk about safe motherhood in everyday situations (e.g., shopping or 
working at the markets), and using radio to promote in-person health talks. These coordinators 
claimed that, as a result of the Change Champion programme, there was been an increase in facility￾based deliveries, ANC visits, and male involvement. One coordinator could not state whether the 
programme has been successful in his district because he has not met with or received any 
feedback from his Change Champions. 
Chief Change Champions 
The Chiefs primarily used headmen, training them on safe motherhood practices, using them to 
reach all of their wards, and relying on them to collect status reports. The reports gathered 
information on the number of pregnant women and related deaths in assigned areas; Chiefs then 
shared the reports with District Health Officers and District Commissioners. These reports 
facilitated collaboration between Chiefs and district offices, helping them ensure that all pregnancy 
and pregnancy-related deaths are captured, assess how well a Chief’s region faired, and identify 
issues of concern that need to be addressed. 
Holding community meetings and having other community groups assist were also common 
methods. The respondents felt these methods were successful and had seen results such as fewer 
maternal deaths, increased health facility deliveries, more women seeking ANC, fewer C-sections 
needed for young mothers, and increased male involvement in safe motherhood practices in their 
areas. “It is not like before, where it was considered an issue for only women to be concerned about,” 
stated a Chief. Another Chief shared that he had people mold bricks and donated his own resources 
to build a mother’s shelter, adding that people are more likely to pay attention and receive safe 
motherhood messages if the project is “materialised.”
Other Change Champions 
Most of the other Change Champions believed their activities were successful in mobilizing 
communities around safe motherhood. Change Champions most commonly reported their most 
successful strategy as involving influential community leaders to encourage community members 
to attend events and practise safe motherhood behaviours. Several other Change Champions found 
success in mobilizing by promoting events over the radio, conducting health talks, going door to
door, working with women’s groups, and disseminating information in workplaces (e.g., markets 
and farms). These strategies predominately focused on facility-based deliveries, ANC, postnatal 
care, male involvement, family planning, and birth planning. 
39
Most of the Change Champions reported seeing changes in safe motherhood behaviours in their 
communities and believed the changes to be a result of their efforts. Change Champions most 
commonly cited an increase in facility-based deliveries and early ANC visits. One Change Champion 
said, “Seen people go to clinics, register, and deliver, which is a big change because people—including 
my own relatives—didn't use to go.” Change Champions also witnessed an increase in male partners 
bringing women to the health care facility for ANC and delivery; an increase in women using family 
planning options; and a reduction in pregnancy-related deaths, number of pregnancies, and early 
marriages. 
When asked what factors enabled them to perform well, Change Champions gave similar responses. 
They most commonly spoke of their commitment and passion for improving the lives of women and 
children. Several Change Champions also discussed the training and ability to review the guidelines 
provided in the training as a factor in supporting their performance. Other factors included good 
communication skills, existing positive relationships with communities, and their family’s 
encouragement. 
4.5. Challenges and Recommendations
District MCH Coordinators 
The coordinators cited several challenges in implementing the programme. All of the coordinators 
stressed a problem in transportation when trying to gather Change Champions for meetings and for 
supporting Change Champions travelling to communities, especially in districts with a great 
distance between villages. Another common challenge was a lack of supplies (e.g., paper and pens) 
for preparing reports. Other reported challenges included lack of participation incentives for 
Change Champions and hectic DHO work schedules, which inhibited efforts to schedule meetings 
with Change Champions. To address these challenges and to improve the programme, District 
Coordinators recommended the following: 
 Increase the number of Change Champions per village, and train them as a group; 
 Expand recruitment of Change Champions to include church leaders and women who will 
work with the Chiefs; 
 Provide transportation and fuel; 
 Provide protective clothing for the rainy season; 
 Provide printed brochures in English and local languages; 
 Provide incentives to Change Champions, such as soap or allowances for lunch or 
transportation; and 
 Provide identification cards or t-shirts to distinguish the Change Champions from the rest of 
the community. 
Chief Change Champions 
The Chiefs shared some challenges with regards to mobilization of their community and 
implementation of the programme. For community mobilization, they mentioned working with 
nurses, gender concerns, and traditional beliefs and myths as key barriers. Nurses, as mentioned 
40
above, preferred to work independently and, further, some women did not wish to be cared for by 
male nurses. One Chief saw a lack of interest by males in practising family planning; women, on the 
other hand, believe “refusing” a husband is taboo and that it can destroy their home. The Chief also 
shared that community members often argue that their ancestors did not deliver in facilities but did 
not elaborate on the other barriers. 
With implementation of the programme, the Chiefs pointed to distance and the lack of adequate 
transportation, a lack of various programme resources, insufficient coordination, and a need for 
additional training. They offered the following recommendations as solutions for addressing the 
challenges and improving the Change Champion programme: 
 Provide trainings on a regular basis, 
 Include trainings that allow Change Champions to understand why some are resistant to 
accepting messages, and offer guidelines for convincing them and workshops on 
presentation, 
 Select and train those who “can be taught,”
 Increase the role of the government and nongovernmental organisations (NGOs), 
 Provide meals (e.g., breakfast, lunch, snacks) for meetings, and 
 Provide transportation and fuel. 
Other Change Champions 
 . 
Change Champions also indicated facing many challenges in their attempts to mobilize 
communities. They most commonly reported community members being unable to travel to 
meetings due to a lack of transportation. Two other common problems were community 
expectations of incentives or meals for attending events and hostility or unwillingness to discuss 
safe motherhood, especially on the part of male partners. Other challenges included lack of 
identification cards, dispelling of myths, and community leaders who are not fully committed. 
“Challenges of transportation and meal allowances, we have communicated this to the district 
medical office and are hoping they can do something about it. However, we have also tried to 
share communities in such a way that each of us operates within their nearest communities, 
though I have to say distances remain. On hostility among some men to programme activities, 
we inform the traditional leaders, who in turn summon such men and punish them. This has 
greatly helped.”
The Change Champions suggested a number of solutions to address the main challenges mentioned. 
Some Change Champions found that creating a zoning system has helped the issue of 
transportation. A couple of Change Champions also mentioned pooling resources to help provide 
food to meeting participants. Several Change Champions recommending providing districts with 
funds to give incentives to meeting participants and to train more Change Champions, particularly 
community leaders and men, to address the issues of reaching more communities and encouraging 
41
openness to discuss safe motherhood. Another champion recommended providing t-shirts to help 
identify them as Change Champions. 
The other Change Champions provided a number of recommendations on how to improve the 
programme training. Change Champions most commonly suggested providing incentives to training 
participants to pay for the costs of transportation, lodging, and food. This suggestion was closely 
followed by increasing the number of the training days to allow for more discussion, providing 
print lesson materials, training more Change Champions to cover all of the zones, and reaching 
beyond the district level to community level. “I would recommend that these lessons are also 
extended from the district level to the ground level where even the people working at the grassroots 
should also have a feel of them,” said a Change Champion. A few of the participants also discussed 
the problems with training the Change Champions and Chiefs together because Chiefs have 
different roles and are provided incentives. Other recommendations included: 
 Provide more information on healthy hygiene and sanitation, 
 Provide more information on maternal and child nutrition, 
 Provide information on family counselling, 
 Creating drama groups,
 Producing videos demonstrating male involvement,
 Providing identification cards or t-shirts,
 Increasing the number of training days,
 Facilitating the development of action plans with the DHO,
 Providing venues for meetings and visits from women,
 Offering follow-up trainings, 
 Involve other ministries in the training and programme (e.g., Ministry of Education and 
Agriculture), and 
 Conduct more field trips to remote areas that are not close to health facilities. 
42
V. Summary and Discussion of Findings 
5.1. Media Access and Viewership/Listenership 
Overall, radio and mobile phone access in the household amongst the respondents was moderately 
high at about 62 percent for radio and 68 percent for phone. Overall, 65 percent of respondents 
reported listening to the radio and 35 percent stated that they listen to the radio on a daily basis. 
The most commonly listened to radio stations amongst all respondents were Radio 1, Radio 2, and 
Radio Chikaya. 
5.2. General Exposure to SMGL Campaign 
Just under half of respondents reported to have heard of the SMGL campaign. This varied by district 
and literacy. There was overall higher recall of the campaign amongst respondents from Kalomo 
and Mansa district and respondents who were literate. The most common source of exposure to the 
campaign was at a health facility (27.6 percent) and from print material (13.8 percent), which likely 
referred to the pictorial birth plan. 
5.3. Exposure to the Birth Plan 
The birth plan was the most commonly recalled component of the campaign, with just over 70 
percent of respondents reporting that they saw the birth plan. Exposure to the birth plan varied 
significantly by target audience, with more mothers of children aged 0–6 months reporting that 
they saw the birth plan than pregnant women. Similarly, exposure to the plan also varied 
significantly by district, with more respondents from Nyimba, Mansa, and Kalomo districts (all over 
70 percent) reporting that they saw it, compared to Lundazi district (52.6 percent). Of all 
respondents, 47.4 percent received their own copy of the birth plan. The majority of respondents 
received the birth plan from a health worker at a health facility, and most (80 percent) reported 
that someone explained the birth plan to them. In terms of the timing of receipt of the birth plan, 
the majority (62.5 percent) received the birth plan during their second trimester in their 
pregnancy. The most commonly recalled information from the birth plan came from the education, 
logistics, and nutrition and care sections. Similarly, the most common uses reported for the birth 
plan were to learn about the danger signs, prepare the logistics for delivery, and save money, which 
were all presented in the most commonly recalled sections of the birth plan. Overall, respondents 
perceived the birth plan to be easy to use and useful, and they would recommend its use to a family 
member or friend. 
5.4. Exposure to Safe Motherhood Radio Adverts 
Respondents’ exposure to the Safe Motherhood radio adverts was overall low, at about 20 percent. 
Recall of the radio adverts was slightly higher amongst those who had access to a radio in their 
household, at about 30 percent. Recall of the radio adverts varied by district, with higher recall in 
Mansa district (34 percent) compared to only 8 percent in Nyimba. These differences are likely due 
to lower radio access and listenership in Nyimba, as well as higher coverage of the radio adverts in 
Mansa and Lundazi districts compared to Nyimba. Amongst respondents who reported they had 
seen the radio adverts, the most commonly recalled messages were: the importance or need for 
43
saving money during pregnancy; the importance of attending ANC early and delivering in a health 
facility; and the danger signs to watch out for during pregnancy, delivery, and/or the postpartum 
period and to seek care immediately at their onset. Of the respondents who had heard the radio 
adverts, their overall perceptions were positive. They felt that they understood the messages 
presented in the adverts, that the information presented in the adverts was important and relevant, 
and that adverts made them seriously think about how to achieve better health for themselves and 
their baby during and after pregnancy. 
5.5. Perception of Impact on Knowledge, Attitudes, and Behaviour 
Overall, respondents perceived the campaign to have an impact or influence on their knowledge 
and behaviour. Just over 80 percent of all respondents reported that the campaign messages 
changed their knowledge, and just over 70 percent felt that the campaign had an influence on their 
behaviour. It is important to highlight, however, that there is likely to be some over reporting of 
impact/influence by respondents, as less than 80 percent of respondents were able to actually 
recall a specific component of the campaign. Amongst only the respondents who were able to recall 
at least one component of the campaign, about 92 percent stated that they learnt something from 
the campaign and 82 percent reported that the campaign had an influence on their behaviour. The 
main messages that respondents reported to have learnt and how the campaign influenced their 
behaviour were aligned with the most commonly reported topics and messages recalled by 
respondents from the different campaign components (e.g., the birth plan, the radio adverts, the 
television programme, and interaction with the Change Champions). Thus, it is evident that there 
was good consistency in the messages promoted across all the campaign components and overall 
high recall and perceived influence of these main messages. 
5.6. Interpersonal Communication 
The majority of respondents (about 70 percent) reported that someone had discussed safe 
motherhood messages with them in the past 6 months. Of these respondents, the majority reported 
that they had discussed safe motherhood with a health worker or a SMAG member. About 15 
percent of respondents recalled having discussed (either spontaneously or when prompted) safe 
motherhood with a Change Champion in their community. This coverage is as expected, since many 
of the Change Champions reported working collaboratively with health workers, SMAGs, and other 
community-based organisations (CBOs) to promote and disseminate safe motherhood messages. 
The challenge of adequate transport for the Change Champions to travel across the districts as well 
as the limited number of Change Champions engaged per district also helps explain why there was 
lower coverage of interpersonal communications with Change Champions and higher coverage 
amongst health workers and SMAGs. 
As with the other campaign components, the main messages reported to have been discussed with 
a Change Champion were similar: the importance of/need for saving money, importance of 
attending ANC early and delivering at a health facility; the danger signs to watch out for during 
pregnancy, delivery, and/or postpartum; and the importance of seeking care immediately at the 
onset of these danger signs. 
44
Just under half of respondents reported that they spoke with someone else about the messages in 
the SMGL campaign. The main topics discussed were the same as those discussed with the Change 
Champions, and the most commonly reported person with whom respondents talked were a friend 
or neighbour and their spouse/partner. 
5.7. Role and Background of Change Champions 
There was an overarching consensus amongst the District MCH Coordinators, Chiefs, and other 
Change Champions about the role of the Change Champions in the community. They were primarily 
seen as educators and disseminators of information, with the aim of promoting safe motherhood 
attitudinal and behavioural changes related to their communities/districts. Furthermore, they were 
perceived as influential community members or leaders. 
Prior knowledge of safe motherhood amongst the Change Champions varied considerably. Some 
Change Champions had received additional trainings on safe motherhood through other 
organisations or donor agencies. There were mixed responses amongst the Change Champions as to 
whether the training was adequate; about half felt the training was sufficient, while the other half 
felt the training was too short. It is important to note that this gap was identified early on by CSH, 
and therefore additional field mentorship was provided to Change Champions. This additional 
mentorship was noted by the Change Champions as helpful in solidifying the topics covered in the 
orientation. In general, the Change Champions felt that the training helped them to understand 
their role as Change Champions and to be comfortable discussing safe motherhood issues in their 
communities. Further training was seen as more useful in terms of being able to comfortably 
understand and discuss all the topic areas or issues they felt they were expected to be able to 
address related to safe motherhood in their communities. 
5.8. Implementation of the Change Champions Programme 
The selection of the Change Champions was the same across the districts, with the aim of selecting 
influential leaders or members of the community. In general, the main activities implemented by 
the Change Champions included delivering health talks through a variety of forums such as 
community meetings, women’s groups, and church events. Additionally some of the Change 
Champions reported speaking with community members one on one or going door to door to speak 
with community members on safe motherhood issues. 
There was some coordination across some of the Change Champions; with some champions 
reporting that they worked together to visit communities and conduct health talks, but this was not 
consistently reported across the Change Champions. All respondents reported that coordination at 
the district level encountered challenges due to a number of factors, such as lack of adequate 
transportation and funds for coordination meetings as well as busy schedules for the Chiefs. In 
general, there was good coordination with other community groups, including SMAGs, NHCs, health 
educators, women’s groups, and other community health workers; however, this wasn’t the case for 
all Change Champions. 
45
5.9. Achievements of Change Champions Programme 
Overall, the District Coordinators and the Change Champions felt they were successful in mobilizing 
their communities around safe motherhood. For the Chiefs specifically, they explained that they 
trained and used their headmen to help mobilize and disseminate information in the communities. 
Change Champions also explained that they were able to leverage and take advantage of already 
existing structures to promote the messages, such as through other community groups, via 
community meetings, and even through the radio. On the whole, the use of influential leaders for 
the programme was perceived to be a successful strategy. 
In terms of achievements in safe motherhood, the majority of respondents reported that they saw 
improvements in safe motherhood behaviours including, for example, increases in facility-based 
deliveries and ANC attendance, improvements in male involvement, and fewer maternal deaths. 
5.10. Main Challenges of Change Champions Programme 
The main challenges noted amongst respondents were the lack of adequate transportation and 
funds, which impacted coordination across the Change Champions and coordination at the district 
level for the programme. Other challenges noted by some respondents were the lack of incentives 
for Change Champions, the expectation of incentives from beneficiaries and/or other groups with 
which the Change Champions coordinated, and the need for training more Change Champions to 
improve the coverage of the programme. While these were noted challenges by respondents, the 
programme strategy emphasised that the Change Champions see the programme/initiative as 
something to integrate into their already existing community activities to help ensure its 
sustainability. This was explained during the orientation; thus, CSH emphasised that additional 
funding for transport would not be available. Further, Change Champions received some material 
incentives for their participation in the programme (e.g., books for recording activities, bags with a 
Change Champion identification card, and other campaign materials and resources). 
46
VI. Recommendations and Conclusion 
Based on the main findings from the evaluation, the following is a list of recommendations for the 
SMGL campaign moving forward: 
1. Overall, the majority of respondents were reached with safe motherhood messages either 
through the birth plan or interpersonal communication activities with health workers 
(including SMAGs) or Change Champions. Since this was the most effective way of reaching 
the target audience, the focus should continue on promotion of the messages through these 
communication channels. 
2. The media plan for the Safe Motherhood radio adverts should be reviewed to ensure that 
they are airing on the most listened-to radio stations and during the most listened-to time 
periods for the target audience in the specific districts targeted for the campaign. 
3. In general, respondents’ reported discussions and interactions with the Change Champions 
were lower than with health workers and SMAGs. This lower coverage was likely due to the 
challenge of transportation and the limited number of Change Champions working across 
the four districts. Since health workers and SMAGs are able to extend greater out into the 
communities, it will be important for the initiative to continue work with all of these 
different cadres of workers to continue to promote the messages of the campaign and 
encourage changes in the target audiences’ attitudes and behaviours. 
4. The strategy of selecting influential community leaders or members worked well for the 
Change Champions programme, as did collaboration with other key stakeholders (e.g., 
health workers, SMAGs, NHCs, and other CBOs). It was evident that the busy schedules of 
the Chiefs and the challenge of adequate transportation made it difficult for Change 
Champions to cover an entire district. Thus, it was effective to have the Chiefs act more as 
leaders, and collaborate and coordinate the work with other key community members to 
disseminate the messages. Moving forward, it is suggested that additional influential 
leaders from the communities be engaged to help improve coverage across the targeted 
areas. 
5. Since some of the Change Champions did not feel the initial orientation was sufficient in 
preparing them with information on all safe motherhood topics, it will be important to 
continue providing them with additional mentorship as they implement the programme. 
This will be particularly important for those with less background on safe motherhood, as 
many Change Champions noted the usefulness of the additional mentorship. 
6. With regards to the implementation of the Change Champions programme, since many of 
the Change Champions and District Coordinators requested additional resources for 
meetings to help improve coordination at the district level and additional incentives for the 
Change Champions, it will be important to better emphasise in the orientation and through 
direct mentorship that the aim of the programme is really to have the Change Champions 
focus on integrating the effort into their daily or normal community activities. The 
47
programme was set up this way to help ensure its sustainability, rather than offering the 
Change Champion programme activities as separate and an additional campaign. 
Overall, the SMGL campaign was well received by the community, particularly the pictorial birth 
plan and the interpersonal communication activities with the different health workers and Change 
Champions. Furthermore, there was great consistency in the messaging across the campaign’s 
different components/communication channels, which was evidenced by respondents’ recall of the 
key messages and the reported perceived impact on their knowledge and behaviour. Resources 
should be mainly targeted for expanding access to the birth plan and other interpersonal 
communication activities, as these were the most effective channels in reaching the target audience 
with the campaign messages. 
48
VII. Appendices 
Appendix 1. Rapid Survey Sampling Methodology 
Lot quality assurance sampling methodology will be used for the rapid household survey. Since 
there are two sample groups of interest, pregnant women and mothers of children 0-6 months, 
parallel sampling will be used. The Zambia 2010 census data will be used to define the sampling 
frame for each survey. For this survey, the following steps will be used to develop the sample and 
selection of participants: 
Steps for selection of interview sites within the four districts: 
1. Within each supervisory area, census supervisory areas (CSAs) will be listed out. Using 
probability proportionate to size (PPS) sampling, 19 CSAs will be selected. 
2. Within each CSA, all standard enumeration areas (SEAs) will be listed out and one will be 
randomly sampled. The selected SEA will be used as the interview site. 
3. At each interview site, two participants will be interviewed. This will include one 
participant from each sample group, which includes: 1) pregnant women; and 2) mothers of 
children 0-6 months. 
Steps for selection of a household within each interview site (SEA): 
1. The interviewer will locate a central location within the interview site. 
2. At the central location, a random direction will be chosen by using the spinning the bottle 
method. 
3. A random number from 1-10 will be chosen. The interviewer will select the house that 
corresponds to the number chosen. For example, if the number 5 is selected, the 
interviewer will go to the 5th house from the central location (in the selected direction). In 
the event that there are less than 10 households in the selected direction, count the number 
of households (X) in the selected direction and select one number at random between 1-X. 
Steps for selection of participants within the household: 
1. At the selected household, a household listing of the people present who qualify from both 
sample groups (pregnant women and mothers of children 0-6 months) to participate will be 
conducted by the interviewer. It is permissible to select two participants from the two 
sample groups from one household as long as they are deemed eligible and both consent to 
participate. It is also permissible to select the two participants from the different sample 
groups from two different households. 
2. In the event that there is one person from each sample group in the same household that 
are eligible to participate, both will be asked to participate. If one or both of the persons 
eligible do not consent to participate, the next closest home will be selected. For example, if 
a pregnant woman agrees to participate in the first selected household, but the mother of a 
child 0-6 months does not consent to participate, then the next closest household will be 
selected to see if there is an eligible mother. This process will be repeated until two 
49
participants from the two sample groups have consented to participate in the survey per 
site. 
3. In the event that there is more than one person from the same sample group (e.g., there are 
two pregnant women in the household) who qualifies to participate, the person whose 
birthday is closest to the date of survey visit will be selected to be interviewed. In the case 
that the person selected does not consent to be interviewed, the next eligible person in the 
household (based on the next following birthday) will be interviewed. This process will 
continue until an eligible person present in the household consents to the interview. If no 
one in the household consents to be interviewed, the next closest house will be selected. 
4. In the event that there are no household members at the selected household that meet the 
eligibility criteria from the two sample groups, the interviewer will select the next closest 
house to interview. 
5. Once the interviewer completes the interviews with the two participants, he/she will 
proceed to the next interview site and repeat the same steps for randomly selecting a 
household and participants. 
50
Appendix 2. Rapid Assessment Survey Questionnaire
Saving Mothers Giving Life Campaign 
August/September 2013
IDENTIFICATION
PROVINCE: _________________________________________
DISTRICT: __________________________________________
SITE: ______________________________________________
RANDOM NUMBER SELECTED FROM CENTRAL 
LOCATION: ______________________l___________________
PROVINCE: 
DISTRICT:
CSA/SEA:__/__/___ | __/__/__
INTERVIEW INFORMATION
DATE: …..…/………/…..….
INTERVIEWER NAME: 
_______________________________________________
INTERVIEW START TIME: 
_______________________________________________
INTERVIEWER CODE:
LANGUAGE OF QUESTIONNAIRE: 
_______________________________________________
LANGUAGE: 
DATA QUALITY CHECK
SUPERVISOR EDITOR DATA ENTRY CLERK
NAME:____________________
DATE:____________________
NAME:_____________________
DATE: ____________________
NAME:___________________
DATE:___________________
SIGNATURE:______________ SIGNATURE: _______________ SIGNATURE:_____________
51
Introduction and Consent
Interviewer: Introduce the study as outlined in the Information sheet and proceed with the interview as follows. 
Please check to confirm that the participant has given consent to be interviewed: 
YES NO 
Section 1: Background Characteristics
No. Questions and Filters Coding Categories Skip
101. How old were you at your last birthday? Age in completed years....
102. Mark category: Pregnant Woman…………………...
Mother with child (0-6 months)…….
1
2
If 
mother 
-> Q104
103. How old is your pregnancy? 0-3 months………………………….
4-6 months…………………………..
7-9 months…………………………..
Do not know……….…………..........
1
2
3
9
Skip to 
Q105
104. How old is your youngest child? Age in completed months....
105. What is the highest level of education you have 
attended?
None……………………………..
Primary…………………………..
Secondary……………………….
Higher……………………………
0
1
2
3
106. Can you read and understand a letter or newspaper 
with ease in English or in a local language?
In English……………………….
In local language……………….
Both English and local………….
Not at all…………………………
1
2
3
4
107. What is your marital status? Single…………………………….
Married…………………………..
Widowed….……………………..
Separated………………………..
Divorced………..........................
1
2
3
4
5
108. Do you/your household own the following? [Record 
only items which have been functioning within 6 
months]
Radio?
Television?
Mobile?
Yes No 
Yes No 
Yes No 
52
Section 2: General Exposure
201. In the past 6 months, have you heard or seen any 
messages on Safe Motherhood? 
Yes……………………………...
No……………………………….
 1
 2
If no -> 
Q204
202. Where did you hear or see these messages?
[Spontaneous response only. Do not read out the 
list of responses.]
Radio……………………………
Television………………………
Print Materials………………….
Community Activities………….
Newspaper……………………..
Friend…………………………..
Community worker from local 
NGO…………………………….
Other: ___________________ 
 (SPECIFY)
Do not recall……….…………...
 1
 2
 3
 4
 5
 6
 7
 8
 
99
203. What was the name of the programme that brought 
you these messages?
[Spontaneous response only. Do not read out the 
list of responses.]
Named Mothers Alive/SMGL
Named other Safe Motherhood
Programme: 
_______________________
 (SPECIFY)
Do not 
know……………………………
 1
2
 
 
99
If 
named 
Mothers 
Alive/ 
SMGL 
->Q206
204. Have you heard, read or seen anything about a
programme called Mothers Alive or Saving Mothers 
Giving Life?
Yes……………………………...
No……………………………….
 1
 2
If no -> 
Q301
205. Where did you hear, read or see anything about the 
Mothers Alive or Saving Mothers Giving Life
programme?
Radio……………………………
Television………………………
Print Materials………………….
Community Activities………….
Friend…………………………..
Community worker from local 
NGO…………………………….
Health Facility/ Health Worker……
Other: ___________________ 
 1
 2
 3
 4
 5
 6
 7
 8
53
 (SPECIFY)
Do not recall……….…………...
 
99
206. SHOW THE PARTICIPANT THE FOUR LOGOS (3 
FAKE/1 REAL) AND ASK: Have you seen any of 
these logos before today?
Yes……………………………...
No……………………………….
 1
 2
If no -> 
Q301
207. Which one or ones have you seen (Circle all that 
apply)?
Logo 1………………………………
Logo 2……………………………...
Logo 3……………………………..
Logo 4……………………………...
 1
 2
 3
 4
208. Where did you see the logo that you just chose? Television…………………………..
Print Materials……………………..
Other: ___________________ 
 (SPECIFY)
Do not recall……….…………........
 1
 2
 3
 
 
 
99
 
Section 3: Print Materials
No. Questions and Filters Coding Categories Skip
301.3In the past six months, have you seen any print 
materials on Safe motherhood?
Yes……………………………...........
No…………………………………….
1
2
If no -> 
Q401
302. What print materials on Safe Motherhood have you 
seen?
[Spontaneous response only. Do not read out the 
list of responses.]
Birthplan……………………………..
Chitenge……………………………..
Other: ______________________
 (SPECIFY)
Do not recall……….…………..........
1
2
 
3
 
 
99
 
If 1-> 
Q304
303. Have you ever seen this birthplan before?
[Show respondents a copy of the birth plan. After 
they have seen the birth plan, remove it from their 
sight so they cannot reference it.]
Yes……………………………...........
No…………………………………….
1
2
304. Did you receive your own copy of this birthplan? Yes……………………………………
No…………………………………….
1
2
If no ->
54
305. From whom did you receive the birthplan? Health Worker……………………….
SMAG…………………………..........
Other Community Health Worker….
Other: ___________________ 
 (SPECIFY)
Do not recall……….…………..........
1
2
3
4
9
306. During which month of your pregnancy did you receive 
the birthplan?
0-3 months…………………………..
4-6 months…………………………..
7-9 months…………………………..
Do not recall……….…………..........
1
2
3
99
307. Did anyone explain the birthplan to you? Yes……………………………...........
No…………………………………….
1
2
308. Who explained the birthplan to you? Health Worker……………………….
Change Champion/ Chief…………..
SMAG………………………………...
Other Community Health Worker....
 
Other: ____________________ 
 (SPECIFY)
Do not recall/Do not know……..
 1
 2
 3
 4
 5
 
 9
309. What are the main message(s) presented in the
birthplan (Circle all that apply)?
[Spontaneous response only. Do not read out loud 
the list of responses.]
Education (due date, labor signs, 
danger signs, breastfeeding, care 
for baby)………………………..
Social Support (support from 
family, male involvement)………….
Logistics (Saving for transport and 
supplies)……………………………
Nutrition and Care (Good diet, 
ITN use, Iron and folic acid tablets, 
vitamin A)………………………….
Medical (Antenatal and Postnatal 
Care visits)…………………………
Other: ___________________ 
 (SPECIFY)
1
2
3
4
5
6
55
Do not recall……….…………... 9
310. How have you used/ did you use the birthplan? To prepare logistics for the arrival 
of baby……………………………….
To save money for 
transport/supplies for delivery……..
To learn about danger signs……….
To learn about services provided at 
ANC…………………………………..
To learn about facility delivery…….
To learn about how to care for 
baby…………………………………..
To learn about how to involve 
partner/family………………………..
Other: ___________________ 
 (SPECIFY)
Other: ___________________ 
 (SPECIFY)
Do not recall……….…………..........
1
2
3
4
5
6
7
8
9
Interviewer text: I am now going to read a few statements about your perceptions of the birthplan. I am interested in 
the extent to which you agree or disagree with each statement. After I have read each statement, please indicate 
whether you strongly disagree with the statement, you disagree with the statement, you are neutral about the 
statement, you agree with the statement or you strongly agree with the statement. 
Statement: Strongly 
disagree
Disagree Neutral Agree Strongly 
agree
311. I find the birthplan easy to use. 1 2 3 4 5
312. I find the birthplan useful. 1 2 3 4 5
313. The birth plan helps/helped me during my 
pregnancy to prepare for child birth. 1 2 3 4 5
314. I follow/followed the monthly birth planning steps 
presented on the birthplan. 1 2 3 4 5
315. I would recommend the birthplan to a family 
member or friend. 1 2 3 4 5
Section 4: Radio
No. Questions and Filters Coding Categories Skip
401. Do you listen to the radio? Yes……………………………........... 1 If no -> 
56
No……………………………………. 2 Q501
402. How often do you listen to the radio? Daily…………………………………..
4-5 days in a week………………….
2-3 days in a week………………….
Once per week………………………
1
2
3
4
403. Which Zambian radio station(s) do you listen to the 
most, starting with the most listened to? 
Name up to three stations: 
1.________________________
2.________________________
3.________________________
404. At what time(s) do you listen to the radio the most?
Name up to three times in a day:
Early Morning (1:00-6:00)………….
Morning (6:00-9:00)…………………
Mid-Morning (9:00-12:00)…….........
Afternoon (12:00-15:00)……………
Late-Afternoon (15:00-
18:00)………
Evening (18:00-21:00)……………...
Late Evening (21:00-24:00)………..
1
2
3
4
5
6
7
405. In the past 6 months, have you listened to any radio 
advert/spot involving chiefs talking about safe 
motherhood?
Yes…………………………………..
No……………………………….......
1
2
If no -> 
Q501
406. Do you remember the names of the Chiefs in the radio 
advert/ spots?
Yes……………………………………
No……………………………….........
1
2
407. What is/are the name(s) of the Chiefs in the radio 
advert/spot you listened to?
[Spontaneous response only. Do not read out 
loud the list of responses.]
See List below:
1. Nyimba (Chief Mumbi & Kathumba))
2. Mansa (Chiefs Chisunka, Mibenge & 
Mwansakombe)
3. Lundazi (Chief Mpamba)
4. Kalomo (Chief Simamba)
Identifies at least one Chief………..
Fails to identify any Chief…………..
1
2
408. What are the messages presented in the radio 
adverts/spots that you have heard (Circle all that 
apply)?
[Spontaneous response only. Do not read out loud 
the list of responses.]
The need to prepare logistics 
(supplies/transport) for the arrival of 
baby……..……….
The importance of early antenatal 
care attendance……………………..
Danger signs during pregnancy/ 
labour/ after child birth and the 
need for seeking care for these 
signs………………………….………
Importance of facility 
delivery………..……………………
Family planning methods and the 
1
2
3
4
57
importance of birth spacing………..
Other(s): 
_________________________
 (SPECIFY)
_________________________
Do not recall/Do not know………..
5
6
9 
Interviewer text: I am now going to read a few statements about your perceptions of the radio advert/spot. I am 
interested in the extent to which you agree or disagree with each statement. After I have read each statement, please 
indicate whether you strongly disagree with the statement, you disagree with the statement, you are neutral about the 
statement, you agree with the statement or you strongly agree with the statement. 
Statement: Strongly 
disagree
Disagree Neutral Agree Strongl
y agree
409. I found the information in the radio advert/spot to 
be relevant 1 2 3 4 5
410. I think it is important to follow what the chief was 
saying in the advert/radio spot. 1 2 3 4 5
411. I understood the messages in the radio 
advert/spot. 1 2 3 4 5
412. I found the message in the radio spot more useful 
since it was communicated by my chief. 1 2 3 4 5
414. The radio spot made me seriously think about how 
to achieve better health outcomes during and after 
pregnancy
1 2 3 4 5
415. The information in the radio advert/spot is 
important for women that are pregnant and their 
partners.
1 2 3 4 5
Section 5: Television
No. Questions and Filters Coding Categories Skip
501. Do you watch television? Yes…………………………………..
No……………………………………
1
2
If no 
-> 
Q601
502. How often do you watch television? Daily………………………………..
4-5 days in a week………………..
2-3 days in a week………………..
Once per week…………………….
1
2
3
4
503. Which Zambian television channels/stations do you 
watch the most, starting with the one you watch most? 1.________________________
2.________________________
3.________________________
504. At what times do you watch television the most?
Name up to three times in a day.
Early Morning (1:00-6:00)……………..
Morning (6:00-9:00)…………………….
1
2
58
Mid-Morning (9:00-12:00)…….............
Afternoon (12:00-15:00)……………….
Late-Afternoon (15:00-18:00)…………
Evening (18:00-21:00)…………………
Late Evening (21:00-24:00)…………...
3
4
5
6
7
505. In the past 6 months, have you ever seen a television 
programme involving a Chief discussing safe 
motherhood? 
Yes…………………………………..
No……………………………………
1
2
If no 
-> 
Q601
506. What television channel(s)/station(s) did you see the 
programme on (Circle all that apply)?
[Spontaneous response only. Do not read out loud 
the list of responses.]
ZNBC………………………………..
MUVI TV…………………………….
Do not recall/Do not know…………
1
2
9
507. What were the names of the Chiefs who are featured 
on the television programme?
Yes…………………………………..
No……………………………………
1
2
508. Can you tell me the name(s) of the Chief(s) that 
featured on the programme?
[Spontaneous response only. Do not read out loud 
the answers listed below.]
List of Chiefs:
1. Chieftainess Nawaitwika
2. Chief Mumena
3. Chief Mphuka
4. Chief Nawasilundu
Identifies at least one Chief……
Fails to identify any Chief……..
1
2
509. What message(s) or lesson(s) are presented in the 
programme (Circle all that apply)?
[Spontaneous response only. Do not read out loud 
the list of responses.]
The need to prepare logistics 
(supplies/transport) for the arrival of 
baby……..…………………………….
The importance of early antenatal 
care attendance……………………….
Danger signs during pregnancy/ 
labour/ after child birth and the need 
for seeking care for these 
signs………………………….………..
Importance of facility 
delivery………..………………………..
Family planning methods and the 
importance of birth spacing…………..
Other(s): 
_________________________
 (SPECIFY)
_________________________
Do not recall/Do not know………..
1
2
3
4
5
6
9 
59
Interviewer text: I am now going to read a few statements about your perception of the television programme on 
Safe motherhood featuring Chiefs. I am interested in the extent to which you agree or disagree with each statement. 
After I have read each statement, please indicate whether you strongly disagree with the statement, you disagree 
with the statement, you are neutral about the statement, you agree with the statement or you strongly agree with the 
statement. 
Statement: Strongly 
disagree
Disagree Neutral Agree Strongl
y agree
510. I found the information in the TV programme to be 
relevant. 1 2 3 4 5
511. I would do what the chief was saying in the TV 
programme. 1 2 3 4 5
512. I understood the messages in the TV programme..
1 2 3 4 5
513. I found the message in the TV programme more 
useful because the message was said by my 
chief.
1 2 3 4 5
514. I would recommend the TV programme to a family 
member or friend. 1 2 3 4 5
515. The TV programme made me seriously think 
about how to achieve better health outcomes 
during and after pregnancy.
1 2 3 4 5
Section 6: Change Champions
No. Questions and Filters Coding Categories Skip
601 Has anyone discussed Safe Motherhood with you in the 
past 6 months (alone or as a group)?
Yes…………………………………...
No…………………………………….
 1
 2
If no 
->
Q701
602 Who discussed Safe Motherhood with you? (Circle all 
that apply)?
[Spontaneous response only. Do not read out loud 
the list of responses.]
Health Worker……………………….
Change Champion/ Chief…………..
SMAG……………………………….
Other Community Health Workers..
 
Other: ____________________ 
 (SPECIFY)
Do not recall/Do not know……..
 1
 2
3
 4
 
 5
 9
603 Has any Change Champion/ Chief discussed safe 
motherhood with you either alone or as a group?
Yes……………………………….
No………………………………..
 1
 2
If no 
->
Q701
604 What topic(s) did you discuss?
[Spontaneous response only. Do not read out loud 
the list of responses.]
The need to prepare logistics 
(supplies/transport) for the arrival of 
baby……..……………………………
The importance of early antenatal 
care attendance…..………………..
Danger signs during pregnancy/ 
labour/ after child birth and the 
need for seeking care for these 
1
2
60
signs………………………….….
Importance of facility 
delivery………..…………….
Family planning methods and the 
importance of birth spacing……
Other(s): 
_________________________
 (SPECIFY)
_________________________
Do not recall/Do not know………….
3
4
5
6
9 
Section 7: Facility delivery
Note: This section is for mothers with children 0-6 months only. 
No. Questions and Filters Coding Categories Skip
701. Do you have any other child apart from the one who is 
aged 0-6 months?
Yes…………………………………..
No……………………………………
1
 2
 If no 
->
Q801 
702.
Where was the youngest child aged 0-6 months born? Health Facility……………………….
Home…………………………………
 1
 2
703.
Where was the child before the one aged 0-6 months 
born?
Health Facility……………………….
Home………………………………….
 1
 2
Section 8: Perception of Impact
Note: If respondent answered “no” to all of the following questions, Q201, Q301, Q303, Q401, Q405, Q501, Q505, 
Q601 end the interview (this indicates he/she was not exposed to the Safe Motherhood Programme). 
No. Questions and Filters Coding Categories Skip
801. Have you learned anything from the Safe motherhood 
programme messages you heard, saw or read about?
Yes……………………………….
No………………………………...
 1
 2
If no 
-> 
END
802. What have you learned as a result of the Safe 
Motherhood programme messages [either through what 
you have heard, seen or read about the programme]?
[Spontaneous response only. Do not read out loud 
the list of responses.]
The need to prepare logistics 
(supplies/transport) for the arrival of 
baby……..…………………………..
The importance of early antenatal 
care attendance……………………..
Danger signs during pregnancy/ 
labour/ after child birth and the 
need for seeking care for these 
signs………………………….………
Importance of facility 
1
2
3
61
delivery………..……………………..
Family planning methods and the 
importance of birth spacing………..
Other(s): 
_________________________
 (SPECIFY)
_________________________
Do not recall/Do not know………….
4
5
6
9 
803. Have you talked with anyone about the messages in 
the Safe Motherhood programme?
Yes……………………………………
No…………………………………….
 1
 2
If no 
->
Q606
804. With whom did you talk to about messages in the Safe 
Motherhood program (Circle all that apply)?
Spouse/Partner……………………...
Friend/Neighbor……………….........
Mother/Mother-in-law……………….
Father/Father-in-law………………..
Other family relations……………….
Health worker……………………….
Other: ____________________ 
 (SPECIFY)
 1
 2
 3
 4
 5
 6
 
805. What did you talk about (Circle all that apply)?
[Spontaneous response only. Do not read out loud 
the list of responses.]
The need to prepare logistics 
(supplies/transport) for the arrival of 
baby……..……………………………
The importance of early antenatal 
care attendance……………………..
Danger signs during pregnancy/ 
labour/ after child birth and the 
need for seeking care for these 
signs………………………….………
Importance of facility 
delivery………..…………………….
Family planning methods and the 
importance of birth spacing………..
Other(s): 
_________________________
 (SPECIFY)
_________________________
Do not recall/Do not know………….
1
2
3
4
5
6
9 
806 Has the Safe Motherhood programme influenced or 
changed your behavior in anyway? 
Yes……………………………………
No………………………………........
 1
 2
If no 
-> 
Q610
62
807 Did any specific Safe Motherhood programmes
influence or change your behaviour? 
Yes……………………………………
No………………………………........
 1
 2
If no 
-> 
Q610
808 What programme(s) influenced or changed your 
behaviour? Birthplan……………………………...
Chiefs radio spots…………………..
Chiefs TV program……….…………
Change Champion…………..……..
SMAGs………………………………
Other : __________________
 (SPECIFY)
Do not recall………………………..
1
 2
 3
 4
 5
 6
 9
809 How has the Safe Motherhood programme influenced 
or changed your behavior (Circle all that apply)?
[Spontaneous response only. Do not read out loud 
the list of responses.]
Started attending antenatal 
care/attended ANC early in 
pregnancy……………………..…….
Started preparing/saving money for 
child birth………………………
Involved family in child birth 
preparations……………………….
Went to health facility upon 
experiencing danger sign of 
pregnancy/during labour/after child 
birth…………………………………...
Gave birth in facility…………………
Improved on dietary intake/ 
supplement intake during 
pregnancy or during breastfeeding..
Started attending postnatal 
care…………………………………...
Improved breast feeding practices 
(e.g., positioning, exclusively 
breastfeeding)……….………………
Other(s): 
_________________________
 (SPECIFY)
_________________________
 (SPECIFY)
Do not recall………………………
1
2
3
4
5
6
7
8
9 
99
63
Interviewer text: I am now going to read a few statements about your perception of the Safe 
Motherhood beliefs and practices. I am interested in the extent to which you agree or disagree with 
each statement. After I have read each statement, please indicate whether you strongly disagree with 
the statement, you disagree with the statement, you are neutral about the statement, you agree with 
the statement or you strongly agree with the statement.
Statement:
Strongly 
disagree
Disagree Neutral Agree Strongly 
agree
810. I fear that when I go for antenatal care I will be 
tested for HIV. 1 2 3 4 5
811. It is beneficial for the mom and baby’s health to 
attend antenatal care early in a pregnancy. 1 2 3 4 5
812. I do not fear the process/experience of delivering 
a baby in a health facility. 1 2 3 4 5
813. I believe that delivering from a health facility is
safer than delivering a baby at home. 1 2 3 4 5
816. Because the safe motherhood program, it was 
easier for me to involve and get support from my 
family during pregnancy and child birth.
1 2 3 4 5
817. I am aware of the danger signs during 
pregnancy/ labour/ postpartum. 1 2 3 4 5
818. I am more aware of the various safe motherhood 
services provided by health facilities 1 2 3 4 5
819. I believe that the quality of care and treatment at 
the health facility in my community is adequate. 1 2 3 4 5
820. I believe that it is beneficial/important to plan for 
child birth when one is pregnant. 1 2 3 4 5
821. The messages in the Safe Motherhood
programme are relevant for women in my 
community.
1 2 3 4 5
INTERVIEW END TIME: _______________________________________________
END OF INTERVIEW
64
Appendix 3. IDI Guide for MCH District Coordinators
In-Depth Interview Guide 
DISTRICT MCH COORDINATOR 
INTRODUCTION 
Good morning/afternoon. My name is _______________ and I will be the interviewer for this 
session. I work for the Communications Support for Health (CSH) programme based in Lusaka. 
If asked: CSH is a USAID-funded programme that fosters sustained individual and 
collective action for health through effective activities in information, education, 
and communication/behaviour change communication. It is comprised of staff from ICF 
International, Chemonics International, and the Manoff Group. 
Today, we’re going to discuss your opinions on the Change Champions programme in your 
community. We hope that this information will help us better understand how to best improve 
and provide support to this programme in the future. 
I want to let you know that I’m not a medical professional, and I am not an expert on the subject 
matter we are going to discuss today. I am a trained interviewer. I want to hear your honest 
opinions about the topics we will discuss today. There is no right or wrong answer to the 
questions I’m going to ask. Please just relax and enjoy the discussion. 
Please keep in mind that your participation in this discussion is completely voluntary. If for any 
reason you wish to leave the discussion, you may do so. 
We’re doing this as part of a project to implement effective communication channels to promote 
key safe motherhood behaviors and address current barriers to their practice. Other project staff 
from CSH may also be in the room to observe the discussion. Kindly state whether it is okay to
continue with the discussion. 
Interview Guidelines 
Before we begin, I’d like to review some important points about today’s discussion. We have a 
lot we’re going to discuss, and I want to make sure you are informed about how it will work and 
your rights. 
 You have been invited here to share your views, experiences and opinions. 
 Your answers will be confidential, so feel free to say exactly what is on your mind. 
Nothing will be attributed to any particular person in our report. 
 There are no right or wrong answers. 
65
 This session will be audio taped. This allows us to capture everything that is being said 
today, and we will include the information in a report to our client. 
 We have a note taker here in the room with us. His/her name is ______. S/he is here to 
make sure that we capture all of your comments in the case that something goes wrong 
with the recording. S/he has signed a confidentiality agreement, and won’t be telling your 
comments to anyone. S/he will not be taking part in the conversation, so we can just 
pretend s/he’s not there. 
 You may excuse yourself from the conversation at any time for any reason. 
Lastly, please turn off the ringer on your cell phone. Any questions before we start?
Ice Breaker: 
Before we start this interview, please share with me what your role is as a MCH Coordinator and 
how long you have been in this position. 
Section I: Selection of Change Champions 
We would like to begin by discussing the Change Champions programme in your district. 
1. How were the Change Champions selected in your district? 
Probe: 
 What criteria, if any, were used in selecting the Change Champions? 
 Who was involved in the selection process? 
Section II: Implementation 
2. What do you think it means to be a Change Champion? 
3. What role do Change Champions play in promoting safe motherhood in their communities? 
4. What, if any, events or activities have the Change Champions organized in their 
communities? 
Probe:
 What safe motherhood topics have they focused on addressing? 
5. How are the Change Champions organised at district level?
6. Do they work with other change champions? 
If yes, probe: 
 Please explain how they have worked together. 
 Do you think having them work together has improved the programme? If so, how? 
7. Do you have meetings with them at district level? 
 If so, how often and what do you do during those meetings? 
8. How do they ensure that they reach the entire district as a group? 
66
9. Are they linked to the District Health Office? If yes, please explain how they have worked 
with the District Health Office. 
10. Do they work with other safe motherhood community volunteers? If yes, please explain how 
they have worked with the volunteers. 
11. What, if any, challenges have the Change Champions experienced in implementing this 
programme in their communities? 
If yes, probe: 
 Why do you think they have experienced these challenges? 
 Do you have any suggestions on how to overcome these challenges in the future? 
Section III: Achievements 
12. Do you think the Change Champions have they been able to mobilize communities around 
safe motherhood issues? 
 If yes, probe: 
 How have they mobilized their communities? 
 Do you think the strategy/ies they have used to mobilize the communities has been 
successful? If yes, please explain why? 
 What, if any, actions have the communities taken to improve safe motherhood? 
 What changes, if any, have you seen in their communities as a result of their
mobilization?
If no, probe: 
 What challenges have the Change Champions encountered in mobilizing their 
communities? 
 How do you think these challenges could be overcome? 
Section IV: Challenges and Recommendations 
13. What challenges, if any, did you face in working with the change champions? If yes, how 
could these challenges be overcome? 
14. What, if anything, do you think could be done differently to improve the work carried out by 
Change Champions? 
15. What, if anything, could be done differently to better support Change Champions to mobilize 
their communities to action on safe motherhood issues? 
Closing 
Thank you very much for coming and for sharing your ideas with us—we really appreciate your 
time. 
67
Appendix 4. IDI Guide for Change Champions
In-Depth Interview Guide 
CHANGE CHAMPION 
INTRODUCTION 
Good morning/afternoon. My name is _______________ and I will be the interviewer for this 
session. I work for the Communications Support for Health (CSH) programme based in Lusaka. 
If asked: CSH is a USAID-funded programme that fosters sustained individual and 
collective action for health through effective activities in information, education, 
and communication/behaviour change communication. It is comprised of staff from ICF 
International, Chemonics International, and the Manoff Group. 
Today, we’re going to discuss your opinions on the Change Champions programme you have led 
in your community. We hope that this information will help us better understand how to best 
improve and provide support to this programme in the future. 
I want to let you know that I’m not a medical professional, and I am not an expert on the subject 
matter we are going to discuss today. I am a trained interviewer. I want to hear your honest 
opinions about the topics we will discuss today. There is no right or wrong answer to the 
questions I’m going to ask. Please just relax and enjoy the discussion. 
Please keep in mind that your participation in this discussion is completely voluntary. If for any 
reason you wish to leave the discussion, you may do so. 
We’re doing this as part of a project to implement effective communication channels to promote 
key safe motherhood behaviors and address current barriers to their practice. Other project staff 
from CSH may also be in the room to observe the discussion. Kindly state whether it is okay to
continue with the discussion. 
Interview Guidelines 
Before we begin, I’d like to review some important points about today’s discussion. We have a 
lot we’re going to discuss, and I want to make sure you are informed about how it will work and 
your rights. 
 You have been invited here to share your views, experiences and opinions. 
 Your answers will be confidential, so feel free to say exactly what is on your mind. 
Nothing will be attributed to any particular person in our report. 
 There are no right or wrong answers. 
68
 This session will be audio taped. This allows us to capture everything that is being said 
today, and we will include the information in a report to our client. 
 We have a note taker here in the room with us. His/her name is ______. S/he is here to 
make sure that we capture all of your comments in the case that something goes wrong 
with the recording. S/he has signed a confidentiality agreement, and won’t be telling your 
comments to anyone. S/he will not be taking part in the conversation, so we can just 
pretend s/he’s not there. 
 You may excuse yourself from the conversation at any time for any reason. 
Lastly, please turn off the ringer on your cell phone. Any questions before we start?
Ice Breaker: 
Before we start this interview, Please share with me what your role is in this community and how 
long you’ve had the role as change champion. 
Section I: Knowledge and Training on Safe Motherhood 
We would like to start talking about issues related to the work you do as a Change Champion in 
your district. 
16. What motivated you to become a change champion? 
17. Did you receive an orientation on being a Change Champion in your community? 
If yes, probe: 
 What topics were discussed/covered in the orientation? 
 Did you feel that the orientation you received was sufficient to help you understand 
safe motherhood issues in your community? Please explain. 
 Did the orientation you receive from CSH help you understand your role in 
promoting safe motherhood in your community? Please explain. 
 After the orientation did you feel confident as a change champion to discuss various 
topics in safe motherhood with the community? Please explain. 
18. Did you have knowledge in safe motherhood prior to the change champion orientation? If 
so, from where did you learn about safe motherhood issues? 
19. Did you have any training related to safe motherhood prior to the change champion 
orientation you participated in? 
 If yes, probe: 
 Who/What organization trained you? 
 When and where did it take place? 
 What aspects of safe motherhood where you trained in? 
 Did you find the training helpful for carrying out your role as a change champion? If 
yes, please explain how it was helpful? 
69
20. Are there topics in safe motherhood that you do not feel knowledgeable enough to discuss 
with the communities? Please explain. 
21. What, if any, recommendations do you have for how to improve the orientation provided for 
Change Champions? 
Section II: Implementation 
22. What does it mean to you to be a Change Champion in your community? 
Probe: What role do you play in promoting safe motherhood in your community? 
23. What, if any, activities or events have you helped to organize for your community around 
safe motherhood? 
24. Do you work with other change champions? 
If yes, probe: 
 Please explain how you’ve worked together. 
 Do you meet as change champions at the district level? If so, how often and what do 
you do during those meetings? 
 How do you ensure that you reach the entire district as a group? 
 What, if anything, have you learned from working with other change champions? 
If no, probe: 
 Have you had challenges working with the other change champions? If yes, what 
have the challenges been? 
25. Do you work with the District Health Office? 
If yes, probe: 
 Please explain how you’ve worked with them. 
If no, probe: 
 Have you faced any challenges working with the district health office? 
26. Do you work with other safe motherhood community volunteers? 
If yes, probe: 
 Please explain how you’ve worked with them. What has been their role? 
If no, probe: 
 Have you faced any challenges working with the volunteers? 
Section III: Achievements 
27. Have you been able to mobilize your communities around safe motherhood issues? 
If yes, probe: 
 How have you mobilized your communities? 
 Do you think the strategy/method(s) you used to mobilize the communities was 
successful? If yes, please explain why. 
 What, if any, actions has your community taken to improve safe motherhood? 
70
 Where there any specific topic areas were you able to mobilize your community 
around (ANC, health facility based delivery, postpartum care, family planning, etc.)? 
 What changes, if any, have you seen in your communities as a result of the 
mobilization/Change Champion programme? 
 Have you faced any challenges in mobilizing your community(ies) around safe 
motherhood issues? If yes, what challenges? 
If no, probe: 
 What challenges have you faced in mobilizing your community(ies) around safe 
motherhood issues? 
 How do you think these challenges could be overcome? 
 Has your community(ies) taken any action to improve safe motherhood issues? If so, 
what actions? 
 Have you seen any changes in your community as a result of the Change Champion 
programme? If yes, what changes? 
Section IV: Recommendations 
28. What are some of the factors that enabled you to perform well as a Change Champion in your 
community? Where there any factors that inhibited your work as a Change Champion? If 
so, please explain? 
29. What, if anything, do you think could be done differently to improve the work carried out by 
Change Champions? 
30. What, if anything, could be done differently to better support Change Champions to mobilize 
their communities to action on safe motherhood issues? 
Closing 
Thank you very much for coming and for sharing your ideas with us—we really appreciate your 
time. 
71
Endnotes 
 
i
 Freimuth, V., G. Cole, and S. Kirby. (2000). Issues in evaluating mass media-based health communication 
campaigns. WHO Monograph. Accessed July 12, 2013, from 
http://www.dors.it/marketing_sociale/docum/Eval_Media_Campaign_WHO.pdf.