The Women and Child Health Support Project based in Awash, in the Afar region Ethiopia, is now completed after the initial 10 month period. The goal of the project was to contribute to the reduction of vulnerability of mothers and children and to the poor health conditions of the pastoral and agro-pastoral communities.
Key Activities Implemented:
Planning and Launching/sensitization workshop: 38 participants.
Capacity building training for untrained Local community Health Promoters-Traditional Birth Attendants (TBAs): 15 TBAs trained on types of mal- presentation, prolonged labor, obstructed labor and excessive blood loss, how to refer pregnant women to the nearby health facilities before complications, how to identify danger labor signs etc..
Organize Monthly Village Level Community Conversations: 3411 people of whom 1673 females participated and discussed the consequence of FGM.
Organize training for Health Extension Workers: seven days of CC facilitation training was provided for 11 HEWs (all women).
Organize 5 days training/workshop for traditional opinion leaders and key government partners on SRH and MCH: 48 traditional opinion leaders and key government partners participated and issues like equality and gender.
Public Education on Open Markets and community gathering Sites on MCH and SRH : 16 rounds of announcements/awareness raising campaigns in both market places at Awash town and Sabore. Around 14800 people were reached.
Conferences at district level: 92 (44 Female) district and sub district level stakeholders and project beneficiaries have participated in 3 rounds. The participants reviewed each stakeholders roles, achievements, project progresses, challenges, lesson learned and best experiences
Establish and Support district and rural community health prevention taskforces through training: 30 (13 Female) Anti-FGM task force members trained on health promotion and communication, MCH and harmful traditional practices.
Strengthen anti FGM clubs in 10 schools through training and materials: three days of training on FGM and its impact was delivered to 36 participants (18 Female) of anti-FGM clubs.
Support the annual uniform celebration of anti FGM day in all schools
Capacity building training for rural health workers/nurses on health promotion and communication :Training on health education, health promotion and communication skills was delivered to 28 ( 19 females) rural health workers: 14 health extension workers (F=11), 14 (6 F) selected nurses .
Provision of basic medical equipments and essential MCH related drugs for rural health posts.
Key Achievements so far:
Traditional birth attendants promised to quit practicing FGM and to link pregnant women to the nearby health facilities instead of staying at home.
Community Conversation participants decided to report whenever a woman let her baby child be circumcised. Therefore, the women who are allowing this practice to continue will be known to the government.
The clan and religious leaders of the area promised and started to convince the community that FGM is not right under Islamic principles, but rather it is only tradition.
Anti-FGM club members have started out-reach workin the community to promote anti-FGM and raise awareness.
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Besides conducting community conversations in all the sub districts of Awash, two other major activities were implemented in this quarter.
1. District Level Conferences
AISDA engaged itself in increasing knowledge and changing the attitudes and behaviors of the pastoralist communities of Dawe district in the area of Maternal and Child Health, reproductive health and other related cross cutting issues.
It is often difficult to decide ending FGM and addressing MCH issues on an individual basis as social pressure and sanctions are too heavy for an individual to bear. Decisions need to be reached collectively and hence the support and affiliation of Key partners and Stakeholders is vital in order to insure sustainable change in the community. District level Quarterly conference, which is an innovative approach of AISDA is the best settings to bring together the variety of stakeholders, and key partners of the project to discuss the critical MCH & SRH problems and reach on shared resolutions.
During this quarter a district level quarterly conferences was conducted. 92 (44 Female) district and sub district level stakeholders and project beneficiaries have participated in the conferences.
In this conference, it is revealed/learned that the trained TBAs have been providing a safe delivery services in their respective villages and all of them have quit practicing FGM as well; Collaborating with HEWs, clan leaders and other leading community members, TBAs have also been engaged in mobilizing the community of their respective sub districts to participate in the Community Conversations; and the performance of each partner and stakeholder especially the government officials in addressing MCH issues has been increased.
This Conference and the CCs being conducted have brought results such as: building the sense of ownership and belongingness among key partners and stakeholders; enhancing the capacity of individual actors and partners; filling the gap of the information flow among each stakeholder; strengthening social network system; and increasing the collaboration and coordination of key partners and stakeholders.
In this conference, there was also a detailed discussion on the roles and responsibilities and ways of integration/relationships of the project key stakeholders and government partners towards taking over the project and sustaining it. The participants, as a result, decided that the district and sub district level administration and the HEWs should take the commitment to keep the CCs continue. The biggest responsibility was given to the district Health, Women, Children and Youth Affair and the Islamic affair offices to support and encourage the grass root level community mobilization activities. It was also decided to integrate the project activities with the government's health plan.
2. Strengthen and support task force through training
Anti-FGM task forces are key community health development agents who have been playing a prominent role in mobilizing the community and facilitating the project implementation at the grass-roots level.
AISDA has targeted 30 (13 Female) Anti-FGM task force members in the district through AWC-HSP. Out of them, 25 are working at the grass root level and the remaining 5 are working at the district level.
Enhancing the performance and capacity of these key health promoters through training was vital to enable them more effective in the maternal and child health promotion intervention. In cognizant of this, it was planned to address all the task force members through manageable training and it has been able to achieve the plan.
A locally suit approach- teaching by the respected religious leader was one of the methods employed in the training for better convincing of participants, especially for those who couldn't distinguish the cultural and religious perspective towards FGM.
These trainings were found to be vital in clearing up Participants’ confusion about FGM from Islamic perspective and inspired them to distinguish culture from religion. Similarly, it also helped the trainees to be acquainted with their roles and responsibilities in addressing the MCH, SRH and FGM issues.
During this quarter, major of the Awash Women and Children Health Support Project activities implemented in the district are providing a capacity building training for Traditional Birth Attendants (TBAs) that are used as a local health prompter, provision of training on Community Conversation for Health Extension Workers (HEWs), conducting Community Conversation at village level, conducting public education on market places and Provision of Drugs for rural health institutions.
1. Organize Capacity Building Training for Traditional Birth Attendants (UTBAs)
During labor, pregnant pastoral women often prefer to be assisted by TBAs even in places where there are a nearby intuitional health facilities because it makes them feel secure in the child delivery.
Through a range of training methodologies employed, and using a training manual which was prepared and presented based on the national health policy, it was able to train 15 TBAs.
TBAs were able to learn about the types of mal- presentation, prolonged labor, obstructed labor and excessive blood loss, how to refer patients to the nearby health facilities before complications, how to identify danger labor signs.
2. Training for Exiting Health Extension Workers (HEW)on Community Conversation
Health Extension Workers (HEW) are permanent government employees working in the rural Ethiopia with the tasks of accomplishing seventeen health package designed under the health strategic plan of the country. The government has employed and is trying to implement the health extension program at grass-roots level. For very remote areas like Afar and particularly Awash, the number of HEWs is less than the demand because of lack of educated people and the insufficient monthly payment compared to the tasks given to them. AISDA is using these community health actors with additional incentive on top of their salary to actively work in the facilitation of Community Conversations. As CC facilitators, these potential actors of the project needed to be capacitated through refresher training so as to improve their practical skills. Hence, seven days of CC facilitation training was provided for 11 HEWs (all women).
The concept, objectives, principles, & outcomes of CC; Framework of the strategic direction of CC; Reproductive Health & Harmful Traditional Practices: Definition of traditions & Common HTPs prevailing in the glob; FGM: definition & facts and figures about FGM; The historical & cultural context of FGM; and The practice of FGM: Health risks and complications of FGM were the topics covered.
3. Community conversation (CC)
As part of the community mobilization campaign, Community Conversation (CC) is a very important tool that served as a main vehicle for bringing key sexual reproductive and maternal & child health interventions to the community. It was also important to bring key stakeholders like HEWs, TTBAs, Religious leaders, clan leaders and other influential bodies together in one place and enabled to discuss common problems and find solutions using their own capacity and resources. As CCs resulted in a significant improvement in the community's awareness during the first phase of this project, similar activities were planned as part of the project to facilitate village level community discussions through attracting as many people as possible. Hence, through covering the essential expenses of the CC s, constant facilitation and technical supports, it has been able to support the local people to come together and discuss their major concerns in relation to the consequences of FGM , early marriage, child health, pregnancy and ante natal cares and HIV/AIDS in a regular manner.
4. Public Education on Market Places
A megaphone supported announcement against female genital mutilation and other related cross cutting issues that threaten the lives of communities were conducted in market places (Awash town and Sabore) where too large community members from different social back ground come together. It has been able to conduct 16 rounds of announcements in both market places at Awash town and Sabore.
5. Provision of Drugs for rural health institutions
Availing basic medical equipment and drugs to rural health institutions is crucial to improve the quality of their health service provision, which in turn enhances the health service utilization of the community.
In cognizant of this, and with the request of the district health office, drugs like Amoxicillin syrups, Amoxicillin tabs, cloxacilling sodium, mebndazol and chromophnicals were distributed to five rural health institutions.
It is common that Pastoralist women of Afar very often prefer to deliver a child with the support of Traditional Birth Attendants (TBAs) even in places where there is access of health facilities and delivery services. Valuing the significant role of TBAs in promoting maternal and child health (MCH) issues and in referring pregnant women to health institutions, twenty days of capacity building training is provided on MCH, referral systems, Harmful Traditional Practices (HTPs) with a special emphasis on Female Genital Mutilation (FGM), Family planning, The roles and responsibilities of TBAs as a local health promoter etc. is delivered to 15 TBAS. Similarly, a community conversation (CC) facilitation skill training is also delivered to 15 health extension workers (HEWs) and subsequently, with these HEWs' voluntary base facilitation, CC participants are organized and the CCs are been conducted in each of the five sub districts of Awash.
Through these CCs, it has been able to bring key stakeholders like Religious leaders, HEWs, youths and children, Community health workers or TBAs, clan leaders and other influential bodies together in one place and enable them find out their common problems and threats in relation to MCH to find solution by themselves through participating in the cycle from the planning stage all the way to action and evaluation.
Women Group Dialogue is used as a platform to enable women community members critically discuss on the cultural norms, values, traditions and individual behaviors affecting the health of women and children. Hence, to enhance the capacity of marginalized rural pastoral women, a group dialogue is being conducted among the Traditional Birth Attendants and those marginalized women having different background at all sub districts of Awash.
AISDA's community mobilizes are facilitating these dialogues following the steps in the methodological frameworks of Community Capacity Enhancement - Through Dialogue and Action. This has helped the discussion participant women to easily identify and explore problems and concerns related with MCH and HTPs with a special emphasis on FGM. It also helped them to make decisions and plan as to how the identified concerns to be solved by their own capacity and recourses. Similarly, consequences of FGM and relevant issues like early marriage, child health, pregnancy and ante natal cares, and issues related with HIV/AIDS and gender were some of the agendas discussed in their dialogues.
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