Overview
Our impact in numbers
In 2012–13, AACES maternal and child health programs reached more than 80,000 people. More than:
- 23,500 children received life-saving vaccines
- 47,300 people accessed a modern family planning method
- 10,000 babies were delivered through clean and safe practices
- 897 community health workers were trained.
The Millennium Development Goals for maternal and child health remain out of reach for most countries in Africa. With only 12 per cent of the global population, Africa accounts for half of all maternal deaths and half the deaths of children under five.11 Most of these deaths could have been prevented if women had better access to services to prevent or treat complications associated with pregnancy and birth, such as obstetric fistula.12
Women and children with disability encounter a range of barriers when they attempt to access health services. Examples include not being able to access buildings, discrimination relating to cultural beliefs, and misconceptions about their health needs. Health care workers also often lack knowledge and skills in working with people with disability and their needs are not prioritised by governments for reasons that include lack of information, skills and resources. Meeting the health needs of people with disability is essential for them to live in dignity and in good health. In addition, preventing disability leads to healthier communities with more participation in development activities, which can increase productivity and the economic growth of communities. A key priority for AACES partners during the year was to support women and people with disability by eliminating barriers to accessing health services.
In 2012–13, AFAP, Anglican Overseas Aid, World Vision, Plan International and Marie Stopes International helped more people to access health care by:
- promoting community involvement in maternal and child health
- providing vital health services
- strengthening government health systems
- fostering positive social and behavioural change
- empowering women and people with disability to identify and demand their rights.
Promoting community involvement in maternal and child health
Highlights
Uganda
World Vision worked with the Kitgum District Council Advisory to help people with disability access health services and participate in development and income-generating activities. Local authorities drafted a law to improve access to health centres, particularly for people using wheelchairs, and integrate sign language into primary health care information.
Tanzania and Rwanda
World Vision supported nutrition counselling groups, which ran cooking demonstrations using nutritious locally available foods to provide balanced diets for pregnant and lactating women, and for children under five. The groups were also involved in crop and poultry farming, which helped to improve the health of children, women, men and people with disability, increase incomes and enhance food security.
Malawi
AFAP's partner, Concern Universal, successfully advocated for the opening of an outpatient clinic in Didi province. Before the clinic opened, pregnant women had to travel 35 kilometres to the district hospital for antenatal services. Since opening, 62 women have accessed prevention of mother-to-child HIV transmission services, 94 children have been treated for nutrition-related complications and illnesses, and 21,934 outpatients have received treatment. This has reduced mortality, prevented disability, generated employment and led to healthier communities.
Kenya
Marie Stopes International provided family planning services to 15,000 women and 286 men, an increase of more than 30 percent on the previous year. It is estimated that these services will prevent 20,437 unintended pregnancies and 2794 unsafe abortions over the lifetime of the clients receiving services.
Ethiopia
Anglican Overseas Aid's (AOA's) partner, Afar Pastoral Development Association (APDA), and government health personnel jointly delivered a vaccination program to more than 500 children of nomadic pastoralists. APDA also trucked water to communities most affected by poor rainfall and provided supplementary food to 1680 school children.
In 2012–13, program partners empowered communities to participate in decision-making on health and other development issues, increasing community demand for maternal and child health services through community engagement meetings.
AFAP's partner Concern Universal worked with the Provincial Directorate of Health in Mozambique and held public hearings in N'gauma district with 200 participants to improve delivery of maternal and child health services. This involvement encouraged the government to align its spending to community health needs. This has facilitated safe births in 15 remote communities, benefiting 3750 people.
Plan International facilitated community discussions in Zimbabwe with representatives from the Ministry of Health, Social Services and Education. Afterwards, community-based rehabilitation committees were set up to address the challenges faced by women and people with disability. These community discussions have helped change men's attitudes towards women and girls, including with regard to health. This is increasing the participation of women in decision-making, both at home and in the community. For example, in Chipinge district, a woman was removed from a leadership position in the school development committee because some men did not think it was appropriate for a woman to occupy this position. The female leader was subsequently reinstated after the village head attended a workshop organised by Plan International. This incident has helped community members, particularly men, change their perception of women's roles and involvement in community matters, especially in the need for improved maternal and child health rights and services.
In Kenya, community health forums supported by Plan International enabled communities to engage with district and provincial health service providers. For instance, in Ndhiwa district this saw the Department of Health grant the community's request to have additional staff posted to the local health facility. Also through the community health committees' advocacy, $5882 was provided by the Municipal Local Area Transfer Fund to establish and equip a maternity unit at a local dispensary.
World Vision promoted the integration of nutrition programs in primary health care services. In Rwanda the development of the Village-Based Child Nutrition Centres grew out of project activities focusing on children's health. The communities continued to build on activities, setting up community centres as an integrated approach to address under-five malnutrition and child protection. These centres are owned and managed by local leaders, including women, and offer nutritious food, early childhood education activities and health information for young children. Children who are stunted or otherwise malnourished are benefiting from effective nutritional interventions, especially before the age of two.
Reaching marginalised communities with vital health services
During the year, program partners helped to deliver basic health services to people in remote areas. Communities living in these areas are often unable to access health services, including sexual and reproductive healthcare, because the services are too expensive or far away. This results in high rates of maternal and child deaths.
Outreach for sexual and reproductive services
In Kawere, Zimbabwe, AFAP's partner Community Technology Development Trust (CTDT) built a maternity waiting home where women from remote areas can wait before giving birth at a health facility. Since it opened, the clinic has helped to deliver 29 babies. CTDT also engaged the government on the need for more resources, and as a result, health officers have been posted to the clinic. The home has increased opportunities for early interventions to ensure safe pregnancies and minimise the risk of mother-to-child HIV transmission, as well as reduced the distance travelled by people with disability to access health care services. A woman attending the health facility noted: 'Thank you so much for this home, this is very good. People used to travel (for so long) and sometimes would give birth in the bush. This will bring a great change and our women will no longer deliver on the side of the roads.'
Through outreach to rural and remote communities in Tanzania, Marie Stopes International provided more than 26,000 women and 511 men with a modern family planning service and provided voluntary counselling and testing for HIV to 7205 women and 408 men.
Reaching people with disability
Women and girls with disability can experience unmet healthcare needs because of negative attitudes and beliefs held by health care workers and communities. To strengthen their own skills and knowledge in disability engagement, program partners collaborated with DPOs, which provided expertise as well as staff training.
In Kenya, Marie Stopes International partnered with the Kenya Association for the Intellectually Handicapped and the Kenya Association of the Blind to design information and educational materials suitable for people with disability. Consequently, more than 3000 people with disability have better access to information on sexual reproductive health and 900 people with disability were referred for sexual reproductive health and family planning services. Marie Stopes International also engaged a disability coordinator (who has a visual impairment) to better understand and meet the needs of people with disability.
In Uganda, World Vision is promoting meaningful participation of marginalised people, including women and people with disability, to access water and sanitation and health services. For example, it has helped to set up water and hygiene committees, ensuring the sub-county leadership criteria are enforced. The criteria encourage equity, including representation of women and men. This has resulted in an increase in the number of women and people with disability actively participating in these committees. For example, the Kitgum District People Living with Disability Union was made part of the technical supervision team. The team supervises the village health teams and community health volunteers.
Strengthening government health systems
During the year, program partners continued their collaboration with health authorities to strengthen government health systems as an essential step to making health services accessible and affordable for marginalised groups.
Training community health workers
The shortage of trained health workers is a significant challenge for meeting the health needs of remote communities. Most maternal and infant deaths are preventable when a mother gives birth with a skilled health worker in attendance. These places a high importance on community health workers - people trained in basic health skills and who live within their communities - to provide essential and affordable health care to mothers and children.
In Kenya, Uganda, Tanzania and Rwanda, World Vision trained 897 community health workers who are delivering maternal and child health and nutrition messages and counselling in marginalised communities.
Plan International trained 188 community volunteers in sexual and reproductive health in Kenya. The volunteers support village health workers in door-to-door outreach and education, resulting in a significant increase in people accessing public sexual and reproductive health services.
Reaching people with disability through social franchising13
Private operators provide almost half of all family planning services in Kenya. Marie Stopes International recruited 20 of these service providers into a social franchising network to provide sexual and reproductive health services to marginalised people in six counties on the Kenyan coast.
Marie Stopes International also recruited a full-time community engagement coordinator and trained 30 youth peer educators. Through support to private sector clinics located in areas of high need, Marie Stopes International aims to reach more women, men and young people with disability and provide access to sexual and reproductive health services. This approach known as social franchising supports local businesses to improve the quality of services and reach more people.
Fatuma Katana is a resident of Maledi, Msambweni district, in Kwale County in Kenya. Her husband, Mr Katana, works in Mombasa town, some 130 kilometres away. Despite her husband working, Fatuma's family still faces high levels of poverty. Fatuma is relatively young. At the age of 26 she is a mother of six children with her youngest child only two months old. Fatuma, who was born with a physical impairment, does not have any source of income and relies on the meager earnings of her husband.
Due to lack of finances and limited awareness of her options, Fatuma did not use a regular method of family planning and relied on contraceptive pills borrowed from her neighbour whenever her husband came home. On one particular day when her husband was coming home, Fatuma's neighbour did not have any pills to share with her. Worried about becoming pregnant a seventh time, she panicked. She did not know where to buy the pills, or any other form of family planning. Sadly enough, she did not know where to go for advice. Having a seventh child was a fear for Fatuma, but it would be even worse if her husband knew that she was using a family planning method.
Fatuma gathered courage and walked to the nearest clinic, which happened to be supported by Marie Stopes International. This is where the Marie Stopes International social franchising coordinator, a nurse by profession, met Fatuma with her
two-month-old baby in her arms. From afar, Fatuma looked worried and confused. Later she informed the coordinator that she was concerned about how to approach the service provider with her reason for coming to the facility.
At first, Fatuma was reluctant to share her concerns. However, the nurse reassured and counselled her about the range of family planning methods available to her. With counselling, Fatuma made an informed choice to take a three-year family planning method from the clinic, with enough time before her husband arrived for his next visit. Fatuma now has time to recover from child birth and the baby's health can be prioritised.
The proximity of the social franchising clinic, the detailed counselling and the subsidised costs of the family planning commodities allowed Fatuma to make an informed choice as well as avoid an unwanted pregnancy. Fatuma is overjoyed that for the next three years she will not again have to ask her neighbour for contraception. She is even happier to have received family planning information that she is now sharing with other women in the community, as well as her own husband.
Enhancing institutional capacity
Marie Stopes International has been working closely with government partners to develop their capacity to deliver equity-sensitive sexual and reproductive health services. In Tanzania, it provided on-the-job training to 134 public health service providers and seconded 22 local government nurses to the outreach service for a month.
'It is unbelievable, I was not expecting any NGO to conduct [an] outreach visit to our island with a lot of challenges, mainly infrastructure. Thank
you Marie Stopes International for visiting our island to provide family planning service to our communities and skill building to our staff for more than three weeks,' says Adeline Anselim, the District Reproductive Health Coordinator for Mafia, a small island in the Indian Ocean.
In Kenya, Marie Stopes International has developed a network of 20 private service providers, training them and equipping them with subsidised medical equipment. It aims to support the service provider network, develop the capacity of local providers and ensure reliable access to quality services for marginalised communities.
Program partners strengthened health information systems to help governments monitor demand for services and deploy resources to reach the greatest number of women and children. World Vision is working in Rwanda and Uganda with the Ministry of Health to strengthen the mHealth (mobile heath) system by providing a platform that will collect additional maternal and child health information and remove the need for hard copy data collection at the community level. mHealth is a health information system that aims to improve accountability and monitor the use of expanded or improved services. It also aims to verify whether interventions are achieving the desired outcomes, such as increases in antenatal care and uptake of family planning services.
Fostering positive social and behavioural change
Some traditions, cultural norms and social behaviour such as forced early child marriages and feeding infants with solids instead of exclusive breastfeeding, are often barriers for positive change. This year, AACES partners held training sessions, promoted discussion though community radio and worked with community leaders to encourage marginalised communities to change certain behaviours to better manage their own health. Positive results were achieved in many communities but progress will be gradual if it is to be long-lasting.
World Vision's work with communities in Rwanda resulted in greater use of health services by women and children. Prior to community sensitisation, women would hide their use of modern family planning methods from their husbands. Now more
men are discussing family planning with their wives and more couples are using it with a variety of methods available within the community. Marie Stopes International is seeing similar results in Tanzania and Kenya, where family planning services are becoming more acceptable for women and men. By educating men about their own sexual and reproductive health needs and providing services that are acceptable to them, they are more likely to support their partners to receive sexual health and family planning services, reducing family conflict.
Plan International facilitated training using 'culture in development' approaches with community representatives, civil society organisations, local leaders and government officials in Zimbabwe, Kenya and Uganda. The approaches engage traditional and cultural leaders who are the custodians of norms and decision-makers in disputes to identify positive aspects of culture that can promote positive social change. For example, in Masheedze village, Zimbabwe, the village head managed to influence the selection of a woman into traditional court structures, a practice that is not common in Chipinge communities. Energy Maraidza says that her appointment as a law enforcement officer has helped to ensure that the traditional dispute resolution system is gender sensitive. Through her membership to the advisory council of the village court, Energy managed to encourage other women to come to the village court and give their perspectives during village mediation processes. These represent significant changes in women's participation in decision making processes.
Empowering women to identify and demand their rights
When women are healthy their families and communities benefit, but in many communities cultural norms result in women remaining silent and deferring to males for key decisions concerning their health. A key priority for the AACES program is to promote women's rights and empower women so that they are better able to both understand their rights to health and effectively demand health services.
Plan International worked with 20 village heads and community volunteers in Zimbabwe to address gender-based violence, particularly domestic violence. Consequently, traditional leaders are now providing mediation cases in their courts that are fairer to women and in line with the law, particularly the Domestic Violence Act. In addition, women are now given the opportunity to speak during the court process, while village heads are facilitating roles for women in traditional structures. For instance, in one village, a village head has created a new position for a woman in the village head's advisory council to provide a channel for women to report cases. To date she has managed to bring two cases for arbitration to the village court. This has helped to reduce discrimination against women in the community.
Challenges and opportunities
AFAP's partner CTDT notes that cultural beliefs and social norms around birthing and breastfeeding practices in Zimbabwe, such as feeding infants solids rather than exclusive breast feeding, have hampered efforts to increase use of maternal and child health services. In response, CTDT is developing practical strategies such as breast feeding campaigns, medical outreach programs and mobile baby clinics in collaboration with the Ministry of Health and Child Welfare and Paediatrics to engage communities and address cultural and religious barriers.
AOA's partner APDA states that traditional practices in Ethiopia are a barrier to change, particularly forced and early marriages as well as female genital mutilation. However, through training, advocacy and awareness-raising efforts, this is gradually changing.
11. United Nations, The Millennium Development Goals Report, 2012, 2012 pp. 30–37.
12. Obstetric fistula is a medical condition in which a fistula (hole) develops between the rectum or vagina or between the bladder and vagina after severe or failed childbirth, when adequate medical care is not available.
13. Social franchising is based on the concept of franchising in the commercial sector, where a successful business replicates their business model elsewhere. It works by grouping existing small scale self-employed service providers under a shared brand to form a network of practitioners that offer standardised services. Service providers can benefit from social franchising through access to training, ongoing technical assistance, brand promotion and marketing support, as well as subsidised high quality services.