Chua, N. B. R. T. (2015). Multistakeholder approach in reducing the three delays of maternal mortality in Kumalarang, Zamboanga Del Sur (Unpublished master's thesis). Graduate School of Public and Development Management, Development Academy of the Philippines.

Graduate School of Public and Development Management Health Systems and Development Batch 5 Thesis (MPM-HSD)--Development Academy of the Philippines.

In the past 4 years, the municipality had been struggling in decreasing the maternal death to zero. Many strategies have already been done to resolve this issue but the problem had remained. This paper will study how a multistakeholder approach can reduce the three delays of maternal mortality in Kumalarang, Zamboanga del Sur. Specifically, this paper aims to determine what delays are present among the maternal deaths and postpartum women. Another aim is to determine the factors affecting the delays. Lastly, the study also aims to identify strategies to reduce the three delays. The study design was descriptive. Maternal death review records of the five maternal mortalities since 2012 up to the first quarter of 2015 were reviewed last December 2014. The survey questionnaires were conducted by six trained health staffs to 61 randomly selected postpartum women on November to December 2014 coming from 3 geographically isolated and depressed areas (GIDAs) such as Suminalum, Bolisong, and Mahayahay, and 3 non GIDAs such as Poblacion, Bogayo and Diplo. After the interventions, the same set of questions was administered to 55 randomly selected postpartum women. Key informant interviews were done by the author to different stakeholders in maternal health care. The study used forms and questionnaires translated into Visayan dialect by the interviewers during the interview. The data were collected and analysed through descriptive statistics of frequencies, means, modes, averages, ratios and percentages. The result of the survey showed that the sociodemographic profiles of the maternal deaths and the postpartum women before and after the interventions were similar. The 3 delays of maternal mortality are present in the maternal deaths and the postpartum women. In the first delay, the most common reasons were failure to recognize danger signs, the cost of medical care and transportation, the lack of capability to decide by the woman or family member present at childbirth. In the second delay, the top reasons identified were the distance from mothers home to the facility or health care provider, the lack of emergency transportation whether by land or water, the lack of awareness of existing services, and the lack of roads or poor condition of roads. In the third delay, the most common reasons are the shortage in medicines and supplies like blood, the lack of health care personnel, the weak referral system includes transportation and communication and gender insensitivity of health care providers. The health indicators like facility based delivery, skilled birth attendance and contraceptive prevalence rate have increased while the maternal mortality had decreased to zero up to 2nd quarter pf 2015. The multistakeholder approach was catered through the activation and the expansion of the Local Health Board where all the stakeholders are regular members of the board. Through this approach 3 control knobs were turned causing the reforms in the health system of Kumalarang in terms of maternal care. The 3 Delays are present in the maternal deaths and postpartum women. The 3 Delays of maternal mortality are difficult to reduce because of factors affecting them like sociocultural aspect, the accessibility to the facilities and health services and the quality of care being received by the patients. The reasons for each of the three delays may worsen the other delays causing a complex cycle of delay. This is the reason why solutions and interventions should be holistic and multistakeholder in approach.