At SOGH, we care passionately about health care for women and children. In 2014 we launched the Maama Project to provide effective support to women and infants during pregnancy and after childbirth. The project takes place in a rural area of southeastern Uganda, where one in 47 women die from pregnancy and childbirth-related causes and three out of every one hundred babies born die during their first month of life (World Bank, 2015). Research has shown that many of these deaths can be prevented by simple, low-cost interventions (Bhutta et al., 2008).
Our project takes place in southeastern Uganda where the health care resources are limited and the challenges are many. Working in collaboration with local leaders and in partnership with Uganda Development and Health Associates, the Maama Project has harnessed the power of communities by training community health workers to address many of the difficulties facing mothers and their newborn infants.
Improving maternal and newborn health
Delay in seeking health care is the single largest reason of newborn deaths in our project area. Our community health workers (CHWs) are trained to conduct home visits to pregnant women and women who have recently given birth. The women are provided with information on birth preparedness, safe childbirth, and newborn care. To date, our CHWs have made over 2,200 home visits to women in local villages. After an infant’s birth, the CHWs continue to make visits to ensure the safety of both the mother and the child.
Working with the local community
“The best part of being a CHW is that you gain respect from the community if you help the people. The community has benefited from the project, especially mothers, because before they had no access to information or encouragement to go to health care facilities.”
~ Scovia Wandera, CHW
With the help of local community health workers, we are able to conduct home visits to all pregnant women in our project area. During a home visit, the community health worker offers the mother information on birth preparedness, the importance of attending antenatal care and giving birth in a health facility. After birth, the community health worker equips the mother with information on her reproductive rights, family planning and newborn care. In addition to training and supporting the community health workers, we work closely with the local leaders and health care staff in the area and organise community dialogues in project villages. The dialogues allow us to provide information about pregnancy care, newborn health and family planning to all community members, including men and adolescent girls.
“The best part of being a CHW is that you learn to solve your own problems… I learned that human health at home is everyone’s responsibility.”
~ Zaina Naigaga, CHW
Birth kits – Reducing infections and increasing antenatal attendance
SOGH sponsored birth kits are given free of charge to expectant mothers. These kits provide sterile bandages, sheets, soap and other supplies to expectant mothers. The birth kits are given to the mothers on their fourth antenatal visit, incentivising women to complete all visits. The kits also play a large role in ensuring clean birth practices, which have been linked with infection-related neonatal mortality reduction of up to 40% (Blencowe et al., 2011).
The birth kit also encourages women to give birth at a health facility. Health facilities often ask women to purchase and bring items such as sheets, gloves and soap with them when they come to deliver, a financial burden that can be the decisive factor between a facility and a home delivery. The birth kit lifts the financial stress of obtaining the items, allowing women to use the money for transport and other supplies.
“Before, you could find a mother who had just given birth and then covered the baby in a bed sheet that they use at home. But now you can find a woman who shows you a full bag of things that she has prepared for the birth.”
~ Rose Nangobi, CHW
We at SOGH are passionate about data and evidence. We conduct yearly evaluations and monitor the project continuously in order to improve all aspects of our programming. We have witnessed several tangible results after the launch of the Maama Project in July 2014:
- All pregnant women surveyed during our program evaluation in June 2015 reported attending antenatal care and receiving at least one home visit from a community health worker
- The percentage of women giving birth in a health care facility increased from 63% to 86%
- Antenatal visits to the project clinic increased by 122%
- The proportion of women who attended an antenatal clinic four times increased from 29% to 82%
“The Maama Project has done a lot for our parish. Mothers now know the importance of coming for antenatal care and delivery. Thanks to the birth kits, the number of mothers who complete all four antenatal visits has increased. Some health centres can get three or even zero fourth visits, whereas we got 22 last month.”
~ Margret, nurse at Maina health centre
Our Maama Project is deeply rooted in research findings, most of them originating from research done at the Iganga-Mayuge Demographic Surveillance Site, close to our project area in Maina Parish. This ensures interventions specifically tailored to the local context. Our project development has been guided by the following findings:
- Neonatal mortality can be reduced up to 40% with prenatal and postnatal community health worker home visits, community mobilisation and improved linkage of families to health facilities (Lassi et al., 2010)
- A combination of clean birth and postnatal care practices can reduce neonatal deaths from sepsis and tetanus by 40% (Blencowe et al., 2011)
- With a short training and effective supervision, community health workers are competent in identifying and referring sick newborns in poor resource settings (Kayemba Nalwadda et al., 2013).
- 50% of newborn deaths in eastern Uganda were related to a delay in caretaker’s problem recognition or decision to seek care. On average, the decision to seek care was taken three days after the onset of illness. (Waiswa et al., 2010)
- Providing mothers five home visits during and after pregnancy increased the uptake of immediate and exclusive breastfeeding, hygienic cord care, and thermal protection – practices associated with reduced neonatal mortality (Waiswa et al., 2015).
- The uptake of safe newborn care practices in eastern Uganda is low: 46% of newborns had a facility delivery, 38% were judged to have had good cord care, 42% optimal thermal care, and 57% were considered to have had adequate neonatal feeding (Waiswa et al., 2010).
- Prenatal care provided by skilled providers and at least four prenatal visits were associated with decreased neonatal mortality in Sub-Saharan African countries (McCurdy et al., 2011).
- Attending ANC four times, starting ANC visits before the third trimester and education about pregnancy danger signs are significantly associated with birth preparedness (Timša et al., 2015).