Delivery Logistics Planner and Big Belly Savings Tracker

How might we support women to consider, plan, and save for the more complex and expensive elements of facility delivery early in pregnancy?

Country: Liberia

Health Area: Maternal and Child Health

Context and Insights

Delivery in well-equipped health facilities significantly reduces maternal mortality, yet according to UNICEF, Liberia has one of the highest maternal mortality rates globally, with one in 10 women dying from pregnancy-related issues. Many Liberian women intend to give birth in health facilities, but lower-income and rural women struggle with the cost. Factors such as securing transportation, managing work time, and handling pressure from influencers contribute to delays in planning and seeking care. These challenges exacerbate risks during pregnancy and childbirth.

The Solution

A Delivery Logistics Planner and Savings Tracking System helps trained traditional midwives (TTMs) and antenatal care (ANC) providers to support pregnant women to consider the costs of facility delivery and to plan for them throughout a pregnancy. The solutions leverage traditional Liberian storytelling to convey messages that are compelling, memorable, and easy for low-literacy populations to internalize. Other components of the System encourage problem solving among health providers and community members to help women overcome savings and transportation barriers.

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“The story is about taking action and making every move and plan most important to delivery and other things. […] Earlier preparation is important. The story is full of wisdom. The card made every explanation simple and beautiful […]. [It’s] good to make transportation arrangements because pain can start at any time, and you have to be prepared.” — Trained traditional midwife, Liberia

“[I am] very happy to be saving money for my baby. I would feel so happy to see the beads in the bowl. When the bowl is full, I would get another one to continue saving.” — Pregnant woman, Liberia

The Innovation

The solution set provides TTMs with a storytelling tool to enhance planning discussions with pregnant women and their families. The simple and compelling stories with clear lessons were developed in collaboration with a traditional Liberian storyteller, are easy for TTMs to remember and share, and have resonated strongly to motivate the community. The solution set also provides a structure to allow women and community members to take ownership of the planning, savings, and transportation, and to produce personal and community-oriented solutions to common childbirth challenges.

The Evidence

Pilot test monitoring suggests that the solution set has been well received by health workers and pregnant women, with key messages about delivery planning being reinforced during both facility and community counseling. Women reported feeling motivated to prepare for their delivery and setting savings goals, and providers reported that women arrive to the facility more prepared for delivery. Communities have also worked to identify local transportation solutions to support women in reaching the facility. Additionally, the solution set has been included in the National Respectful Maternal Care strategy as an intervention to promote facility-based delivery.

Scale-Up & Adapt

Users have appreciated that the tools are intended to be flexible and responsive to the context which enhances the user experience. After a pilot implementation by Americares in the catchment areas of two health facilities in Grand Bassa, the solution set has since been scaled to four additional facilities in the county and will soon be scaled to six more, based on promising results from an internal evaluation that found significant improvements in delivery planning and antenatal care attendance. The Ministry of Health has also incorporated the delivery logistics planner solution into a draft Big Belly Manual intended for TTMs to use as a guide to support facility-based child delivery.

Who can I speak with about this solution?

Jamesetta Smith, Health Services Specialist

Sara Flanagan, Principal Behavioral Designer, ideas42

Other resources

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