Revenue-generating activities should come from multiple sources:

• Health system via government budgets

• Income-generating activities chosen by the community

• Donation or monetary contributions

• Fee for use

Financial training for community members has been shown to be helpful in financial sustainability and increase community involvement.

Challenge: Charging a fee for use or use of supplies may lead to a barrier and decrease the use of the MWH. If this is a consideration, it is important to include the women and understand:

• What is a reasonable fee?

• Would they still use the maternity waiting home if there was a fee?

Whether owned and managed by the community itself or by the government with community decision-making, community involvement is critical to sustainability. Ongoing commitment in times of political change must be maintained.

• Staffing considerations:

• Selected by community

• Responsible for day-to-day operations

• Involvement and oversight of health facility staff

It is important to periodically assess the women’s satisfaction and access to supplies while staying in the homes. Past areas of dissatisfaction with access to supplies have included:

• Overcrowding

• Safety and Quality of supplies

• Lack of access to mosquito nets

• Lack of private storage spaces

• Lack of activities

The MWH must be located within easy access for community members and next to a health facility for emergency situations.

Challenges: Some women do not use the MWH due to distance or the expense of transportation. In some cases providing a transportation incentive could encourage women to travel to the MWHs.

• There are many cultural considerations that must be addressed to ensure optimal use of the home, which include:

  • Visitation and attendance by family members

  • Providing traditional healing practices such as traditional teas, steam baths, etc.

  • Arranging child care

  • Male role

  • Role of traditional birth attendant

• Challenges: Husbands are often the primary decision-makers and do not always allow the women to use the MWHs or leave the home for long periods during pregnancy. Community support early in the planning process could help address this challenge.

Education and communication between community members and health facilities are crucial to the successful use of the MWH, which should include:

• Educational program for community members

• Educational programs for pregnant women and their families

• Educational programs for health facility staff

• On-going outreach within the community

• Continued feedback from community members

Challenges: Lack of knowledge from health facility staff and community members about how or when to use the MWH can cause a disconnect and decrease the overall use of MWH.

Referral System: referring women from the community to MWH and referring from MWH to appropriate level of care

Referral systems have been shown to improve the use of MWHs which include:

• Increased community awareness and engagement

• Women are more likely to use the MWH if referred by a friend or family member

• Providing an incentive to refer

MWHs provide referrals for women in the community to higher levels of care in emergency situations or in high-risk pregnancies. This referral is essential to reducing the risk of maternal and neonatal morbidity and mortality. Access and referral to an appropriate level of care in the case of emergencies is essential.