The challenge
Deciding to seek care from a skilled health worker by a woman at the time of delivery is highly encouraged in order to improve health outcomes for both mother and baby. When a woman delivers under skilled care, it is easier to detect and attend to any emergences that arise. However in Uganda, 42 per cent of the estimated 1.2 million women who conceive every year do not deliver under skilled care. Some of the drivers of this sad state of affairs include: poor understanding of complications and risk factors in pregnancy and of when emergency medical interventions are necessary; previous unfortunate experiences of health care services; and acceptance of maternal death as something normal in many communities.
Our Intervention
Still under the community mobilisation and sensitisation component of the study, around 1,691 community health workers (CHWs, also known as village health teams or VHTs), were trained across the three study districts of Kamuli, Pallisa and Kibuku. The training focused on early detection of emergencies, birth preparedness and care for mothers who just delivered and their newborns. During the visits, CHWs provide households with information needed to ensure mothers have a safe delivery and remain healthy with their babies. Two home visits happen during pregnancy and two after delivery.
Initial Success
Ms Grace Asio is a mother of five with her youngest child delivered in early 2014. A mother of five, Grace has conceived seven times since getting married, but lost two pregnancies. She attributes that loss to a failure to appreciate the danger signs and to seek medical care in time.
"On both occasions I bled to near death and would get to hospital late. But all this happened because I did not know that bleeding was a danger sign. But now I can at least tell what the danger signs are during pregnancy. Upon detecting any I quickly tell my husband and we find ways of going to the health centre as fast as possible."
Mr Francis Kedi is the CHW for Okisiran central village in Akisim sub-county of Pallisa district, where Grace resides. Grace has nothing but praise for him. According to Francis, it was not easy "to get into some homes initially because the men thought we were going in to use their families as bait for some personal economic gains."
He adds: "We persisted and explained that what we were doing was for their good and many came on board save for a few perennial drunkards."
Beaming with pride, Francis further intimates that he is increasingly seeing the women he has visited seeking care in time whenever they suspect a problem with the pregnancy, and opting to deliver from health facilities. Francis has visited 65 homes with pregnant women in the last year.
And the outcomes are not any different from Grace's.
A total of 35,108 home visits had been made by the end of August 2014 across the three districts.The home visits by the CHWs who are always armed with flipbooks and demonstration mama kits are enabling women and families prepare better for birth and make informed timely decisions.
By Kakaire Ayub Kirunda, FHS Uganda Policy Influence and Research Uptake Officer
[Editor's note: This article is the first in a series of updates from the FHS Uganda team that were also compiled in their recent Showcase.]
