The Chronicle Newspaper (Lilongwe)
Pushpa Jamieson
4 September 2007
Lilongwe — .... Given the information; they can make a difference "Health of individuals and communities is largely dependant on their own actions or inactions. People do what they do based on their existing knowledge, beliefs, social norms and expectations.. The key therefore is to build on what people know and provide them with appropriate information and skills," - Paper by Dr. Raj. Arole and Mabelle Arole
The Comprehensive Rural Health Project (CRHP) situated in Jamkhed, a community development block in the Ahmednagar District of Maharashtra, India is the brainchild of Doctor Raj and his wife, the late Doctor Mabele Arole that started in the year 1970.
The project goal was to develop a health programme relevant to the needs and resources of a specific rural area and, amongst their objectives to be achieved in five years were; reducing maternal morbidity and mortality, reducing infant mortality by 50% and reducing the crude birth rate by at least 10 points.
Getting trusted and influential women from within the village who understood the culture and problems of the people to be involved in training programmes on health education, antenatal care, safe maternal delivery, family planning services and other health related issues has changed the health of people living in the village. By involving and working with the community to bring about positive change in health issues, CRHP has been able to reach and far surpass its goals.
A workable and secure network within the community for referrals to the hospital within Jamkhed was set up and serviced by the Arole family who handle any delivery complications and other medical needs of the people in the area. CRHP can now boast about the involvement of the community being one of the reasons why there is a better awareness about health and a very considerable drop in maternal mortality in the project's catchment areas.
Health issues, especially in the developing world are still of concern as indicated by the Millennium Development Goals (MDGs). The health problems that the Jemkhed community experiences are cross cutting and common to many other developing countries, Malawi included.
By involving trusted and influential people in the community, greater awareness about health issues can also be achieved in the rural areas of Malawi. One of the most concerning health issues at present is the number of maternal mortality incidences being recorded in the country.
Well informed community members will gain the trust of expectant mothers and their spouses and can be very useful in bringing about change in the way women view delivery of their babies in the rural settings in Malawi. Informed community members who can explain to both men and women some of the dangers of cultural and traditional practices that greatly impact on maternal mortality will significantly reduce the deaths currently experienced in the country.
Although recent statistics reveal that over 90% of pregnant women visit an antenatal clinic at least once during their pregnancy, the percentage of clinical visits of pregnant women does not correspond to the number of women who deliver with skilled attendants.
There are still a large number of women in the rural areas who deliver with the assistance of a Traditional Birth Attendant (TBA) and follow traditional and cultural practices that can have negative and fatal results.
Malawi is reported to have one of the highest maternal mortality ratios in the world. According to the Road Map for Accelerating the reduction of Maternal and Neonatal Mortality and Morbidity in Malawi - second version for July 2006, statistics are estimated at 1,120 per 100,000 live births, this is an increase in from 620 per 100,000 live births in the year 1992.
A recent report from the Ministry of Health (MoH) also reveals that some of the main contributing factors of high maternal mortality are issues like limited utilization and availability of maternal health care services, shortage of staff, a weak referral system and weak community participation and involvement.
The MoH has taken an aggressive approach to deal with the maternal mortality rates by introducing programmes that are working directly with the communities in the rural areas.
Results from the programmes have made it possible for the Reproductive Health Unit (RHU) of the MoH to identified some of the reason why women continue to use unskilled attendants to deliver their babies. The programmes have also helped by providing a platform for discussion between communities and officials.
Activities done at national level and those done at district level have so far been successful and yielded positive results.
By holding meetings with the people in authority and influence, Safe Motherhood and Neonatal Officer in the RHU Diana Khonje says the meetings within the community have made it possible for relevant departments to address some of the crucial issues concerning maternal delivery.
"Meetings with some of the influential leaders in the community have been helpful to find out what they need to ensure that women have a safe delivery," she says adding: "After meetings with some communities, we have been able to provide shelter nearer to the hospital facilities for expectant mothers to live while waiting for delivery. In one case an ambulance has been provided to the community to transport women in labour to a facility for delivery," she says
Khonje says the participation of the community has had a positive impact on the number of deliveries by skilled attendants. "The number of skilled attendant deliveries have gone up and is currently at 52%. Skilled attendants are Registered Nurses, Clinical Officers, Doctors or a professional," she explains.
MoH is currently looking into providing a delivery kit for those women who choose to deliver with a TBA or are not able to get to a facility in time. "We are hoping to give women on their first visit to the clinic for antenatal a kit, just in case she is unable to reach a clinic or other facility and has to deliver at home. We are still talking to our partners about it." According to Khonje, the kit will consist of gloves, soap, string, a razor blade, a piece of gauze, a plastic mat and a towel.
The number of maternal mortality incidences is unacceptable she says and working with people in the community is one way to stop the numbers rising. "We are involving men in fighting the morality - husbands must be involved. We are now talking to women about choices when they are delivering at the health facility."
Breaking all cultural and traditional taboos about the presence of a man during delivery Khonji says women are given the choice to have their spouses present at delivery. "Women are even told that they can have their spouses present when they come to deliver at a health facility. The interest shown by the men to be involved in the delivery has been encouraging."
By communities taking on the responsibility of safe maternal delivery themselves, maternal mortality can be successfully addressed and, as stated by Dr Aroles paper; "Essentially primary health care is about empowering individuals and communities to ultimately take responsibility and work in partnership with health programmes and the government systems to achieve the goals of health for all."
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