In 2010, AMURT launched a program in Ebonyi State, Nigeria aimed at developing rural primary heathcare systems to help reduce the country’s maternal mortality rate, one of the world’s highest.
Seven years later, AMURT’s model of community-based collaborative healthcare has proven effective, with over 1965 successful births taking place in 2016 in the seven AMURT-supported health centers in three local government areas in Ebonyi state. In Offia Oji alone, 85% of the women are coming to the health center for delivery. This is remarkable given that when AMURT first entered the area the vast majority of women were giving birth at home or with a traditional birth attendant, a risky endeavor if faced with any birth-related complications.
How has the project been able to change the cultural outlook of traditional societies that go back generations? This cultural outlook defines a strong woman as one who can deliver in her own home, and links traditional birth attendants (TBAs) and herbalists to traditional rituals, especially for the older people. From this perspective, modern maternal health practices would be seen as a betrayal of their traditional ways.
Some TBAs welcome the project as they became TBAs to fill a vacuum: no one else was providing women with support with their births. Now they are happy that the maternal and neo-natal death rates have dropped.
And many village elders are supporting the program, even by financially penalizing husbands if they prevent their wives from visiting the health centers.
In AMURT’s assessment, the behavior shift is due to the quality of care in the health centers, which builds confidence, and the hiring and training of local health workers, which builds familiarity. The women feel comfortable when the nurse is a neighbor.
Broad continuum of care
AMURT uses the World Health Organization’s “Continuum of Care” model for maternal, newborn and child health that includes integrated service delivery for mothers and children, lasting through pregnancy and delivery, as well as the immediate postnatal period. This translates into health center staff visiting every pregnant woman in her home; pregnant women support groups that bring mothers together to share personal issues and health education; and a network of community-based maternal health promoters who are constantly encouraging women to access antenatal and delivery services.
The security of familiarity
Another AMURT strategy is to employ local people in the health centers. They have the same culture and language as the patients, and are often known to each other. A health worker can scroll down a list of 70 patients and say that she knows them all. So women find the same familiarity in the health centers as they do with the traditional birth attendants. This personalized approach is important in building confidence in a new method of childbirth for the women. Students from the School of Health, who regularly intern at the health centers, say that AMURT health center staff “pamper” the mothers.
One of the collaborate pillars of the project is the health management committee. In accordance with the national policy in Nigeria, AMURT strives to establish strong community management in all the health facilities. With good management of the drug revolving fund, the management committee can avoid wastage and ensure that essential drugs and supplies are always available in the health center. With a modest profit on drugs, the health centers can cover operating expenses like cleaning supplies, cleaners, fuel, maintenance and repairs. All the AMURT assisted health centers have been able to save funds for expansion and upgrades. With an empowered community as the leading partner, we have taken a big step towards sustainability.
AMURT also provides support for emergency cases, with ambulances stationed at the health centers, and an emergency medial fund available for people unable to pay their hospital bills. Mothers know that if they develop a complication at birth, they will be looked after, which provides a feeling of health security. FETHA (Federal Teaching Hospital Abakaliki), along with St. Vincent, Ndubia and Mile Four Hospital are used as referral centers. In 2016 emergency referrals increased by 32 %. Of all the referrals, 54 % were related to childbirth or pregnancy
AMURT believes that talent exists everywhere, from the urban slum to the remote village, and simply needs opportunities to express itself. Hence, 90% of the staff in the AMURT-supported health centers are indigent to the project area.
Health workers are recruited as trainees and then evolve professionally according to their capacity. One of them, Chinyere Mwakwuva, a 26-year old mother of three, joined Offia Oji health center in March 2011 as a trainee with no prior experience. With mentorship from AMURT’s doctors she grew in skill in confidence, becoming a midwife assistant. She is now training as a CHEW (community health extension worker) in the School of Health with a scholarship from AMURT. For her this is a dream come true; she never imagined she would get such an opportunity.
AMURT is sponsoring two other worthy candidates in the School of Health, and has 5 on the waiting list.