The Mbereko+Men Model: Evaluating the effect of a community based, gender synchronised parenting intervention with mothers and fathers on maternal mental health, care-seeking for maternal, newborn and child health services, and care and support in the home for mothers and infants in Manicaland, Zimbabwe

The Mbereko+Men intervention is delivered through two gender synchronised components. The first component (Mbereko), delivered with women who are pregnant or have a child aged up to 2 years, is monthly facilitated participatory learning and action (PLA) cycles, complemented by saving and lending clubs formed by PLA group members. The second component (+Men), delivered with men resident in the same community, is monthly education and dialogue forums, complemented by a participatory charter developed by men through the dialogue forums that focuses on how men can support family health through their actions. To enable these two components, monthly Health Centre Committees are held that bring together community leaders and health facility staff (for 1-2 hours per month for 18 months) to review clinic performance and community health outcomes, and improve community-facility linkages. The intervention is delivered across 8 sites (4 intervention, 4 control). Each site is the catchment area of a Rural Health Clinic (a primary health facility in rural Zimbabwe), and intervention activities are implemented in collaboration with rural health clinic staff. The intervention is delivered primarily through facilitated group discussion. Physical materials required are minimal, and comprise: (a) Mbereko (women's) component: Action Birth Cards (one per woman) provided to women participating in group education sessions that support women to reflect and plan how to follow the health advice discussed in each group education session; flip chart with information about reproductive, maternal, newborn and child health that is used by the health facility staff member facilitating the women's group discussion session. The Action Birth Card and flip chart have been developed for previous programs led by OPHID Trust and are available for purchase on request to OPHID Trust. (b) +Men component: flip chart with information about reproductive, maternal, newborn and child health that is used by the project staff member facilitating the men's group discussion session. The flip chart has been developed for a previous program led by OPHID Trust and is available for purchase on request to OPHID Trust. Content included in the education modules is the same for women and men, and comprises: services provided during antenatal care, safe childbirth and facility birth, maternal rest during pregnancy and lactation, breastfeeding, prevention of couple or mother-to-child transmission of HIV and sexually transmitted infections during pregnancy and postpartum, family planning and modern methods of contraception, maternal and neonatal danger signs, child immunisation, and recognition of child illness. The Mbereko component is delivered by trained female local health workers under the supervision of a trained female project staff member with minimum 3 years' experience in facilitating women's participatory learning and action (PLA) groups. The +Men component is delivered by a trained male project staff member who is also a trained nurse. The intervention is delivered face to face once per month, through facilitated discussion groups, for 18 months. The Mbereko (women's) component is delivered at local rural health centres, with PLA sessions delivered approximately one hour per month for 18 months, and the saving and lending clubs initiated with a two-hour training followed by meetings at club members' discretion (these subsequent saving and lending club meetings are held either at the local rural health centre or another location at the discretion of club members). The +Men (men's) component is delivered at men's workplaces or accessible community sites, for approximately one hour each month for 18 months. After 18 months, the intervention will be delivered in control sites for a minimum of 12 months during the 3-year study implementation period. The intervention is participatory. The group discussions with women and men are influenced by participants' perspectives and experiences. Beyond this, however, there is no adaption of the intervention. Intervention exposure and effects (primary and secondary outcomes) will be assessed through repeat cross-sectional community based surveys, conducted in intervention and control sites at baseline and after the intervention has concluded in intervention sites. The surveys are to be conducted by trained field researchers who have not been involved in intervention delivery. Intervention adherence and fidelity will not be assessed. Community members' awareness of or satisfaction with the study intervention will not be assessed.