Pịnye ka ịchọọ

Ọgụgụ ngwa ngwa Oge Ọgụgụ: 5 nkeji

Ịkwalite nlekọta ahụike nne site na mkpata obodo

The Case of Maper Village in Northern Bahr el Ghazal, South Sudan

The role of patriarchy in South Sudan was clear when Maper Village community chiefs and members resisted male midwives being deployed to Aweil Hospital’s Maternity Ward. Iji luso mkparị ahụ ọgụ, the South Sudan Nurses and Midwives Association (SSNAMA) piloted the “Safe Motherhood Campaign” for community engagement. They addressed misconceptions about maternal health care, helping to change attitudes about male midwives and nurses.

Traditionally, patriarchy has been a dominant force in South Sudan. Male family members have always played an overriding role in family matters, including finding necessities, providing security, and making decisions about livelihoods. While most caregiving roles fall to women, men are responsible for reproductive health decisions in the household. Ya mere, it was not surprising to encounter resistance from community chiefs and some members of Maper Village in Northern Bahr el Ghazal State to male midwives being deployed to Aweil Hospital’s Maternity Ward.

“Why is the South Sudan Nurses and Midwives Association and the Ministry of Health deploying male midwives in our hospital? This is not culturally acceptable.”

Akot Akot Dut, a chief of Maper Village

Safe Motherhood in South Sudan

South Sudan has registered significant improvements in its health indicators in the past 17 afọ. Mortality among mothers dropped from 2,054 per 100,000 live births in 2000 ka 789 per 100,000 live births in 2017 according to nke 2017 UN Maternal Mortality Inter-Agency Group estimates. The country had fewer than eight trained midwives in 2011 (SSHHS, 2011); today, it has over 1,436 trained midwives (765 nurses and 671 midwives), according to the South Sudan Ministry of Health 2018 SMS project II tracking report. As the gender mainstreaming effort in health education continues, more males are registering as midwives and nurses. As a result, some communities do not have sufficient professional female midwives available during deployment, resulting in women and mothers having to rely on male midwives for care.

Six pillars of family planning, antenatal, obstetric, post-natal, abortion, and STI/HIV/AIDS prevention and control compose safe motherhood. Every woman who has reached reproductive age will, at some point, require one of these services. Dị ka ọmụmaatụ, when she becomes pregnant, she will require antenatal care and, during delivery, obstetric care. In the event of an abortion, she will need post-abortion care, and she will need protection against sexually transmitted diseases. Ya mere, a break or alteration in this link can put a woman’s life at risk.

The World Health Organization launched the Safe Motherhood Initiative (SMI) n'ime 1987 as a way of improving ahụike nne and reducing maternal deaths by half by the year 2000. This would be achieved by improving the health of mothers through a comprehensive strategy of providing, preventing, promoting, curative, and rehabilitative health care.

Addressing Cultural Sensitivities

The South Sudan Nurses and Midwives Association (SSNAMA) piloted the “Safe motherhood campaign” for community engagement including an open maternity day dialogue at Aweil hospital. This was in recognition of the community’s strong resistance to male midwives providing reproductive and maternal health care to women and young girls in Maper Village. SSNAMA carried out the interventions in partnership with the Reproductive Health Association of South Sudan, Amref Health Africa, na UNFPA.

Community sensitization on safe motherhood.
Community sensitization on safe motherhood.

During the dialogue, myths and misconceptions about reproductive and maternal health care were addressed. The most worrying concern raised by the community chiefs and the Boma health workers during the dialogue was that of male persons performing midwifery functions at the hospital. This seemingly resulted in fewer women seeking maternal health care services at the hospital. Further, the community (especially men) felt that family planning practices promoted promiscuity. They did not know why mothers and their newborns spend time in the hospital after delivery. Na mgbakwunye, they did not appreciate how crucial antenatal care is to a pregnant woman and her unborn baby.

Community sensitization on safe motherhood.
Community sensitization on safe motherhood.

Community Leadership Sensitization

There was a need to sensitize the community on safe motherhood in general and, in particular, ensure that health workers across the gender divide are appreciated as critical health care service providers. To demystify misconceptions around male midwives, 10 community representatives, comprising the chief, village elders, and other Maper Village community members, participated in an experiential educational tour of the maternity section of the hospital. They were sensitized about each pillar of safe motherhood. At every station of the maternity ward, the midwife or nurse in charge explained the routine interventions that take place and how they were important for the wellbeing of the unborn baby and the mother.

One midwife specifically spoke about anemia as one of the most common complications among pregnant mothers. This was because there was a general reluctance among community members to donate blood. Community members witnessed how hopeless and despairing the mothers were in the ward with such cases, and yet, there was no blood in the blood bank.

Impact on the Community

“Now I understand why you keep these mothers longer after delivery. Even in the old days, mothers had jaundice, anemia, but these were treated as cases of witchcraft, and many mothers succumbed to death. Taa, the same complications are managed from the hospital, and the mothers survive and live longer. Thank you for the great work! I will not anymore allow women with such a condition to go for witchcraft; they must all seek medical help as the best practice. I will also mobilize our community to donate blood to save our women.”

Deng Yak Yaxg, an elder of Aweil Village

At the end of the experiential tour, it was clear that the community’s resistance to male midwives or nurses was due to limited knowledge of what they offer at the health facilities. The tour was crucial in helping community leaders appreciate the fact that male midwives provided quality health care services just like their female counterparts.

As a result of this intervention, Aweil Hospital has experienced a 60% increase in women attending and seeking reproductive and maternal health care services at the hospital. From the radio talk shows facilitated by the chiefs and midwives, the hospital received positive comments and appreciation of the services being offered, and the community has positively responded to blood donation drives.

Ihe mmụta ndị a mụtara

We learned that understanding the role male health workers play in FP/RH uptake is important in improving family planning policy and service delivery programs. By identifying the barriers that male health workers face, appropriate strategies can be devised. Equally important is the need to identify how male partners at the community level facilitate and promote adherence and use of FP/RH services. It is important that decision-makers and policymakers consider how these positive strategies can be incorporated into policy to improve the uptake and use of FP/RH.

The FP/RH community intervention activity in Northern Bahr el Ghazal state established a social behavior change model. It promotes safe motherhood by sensitizing the community and providing practical information about hospital services. The model appears to be a viable method of generating demand and changing attitudes. “I want to become a midwife; I want to become one so that I can also support the delivery of babies,” remarked Akot Akot Dut, a chief of Aweil Village. Following this success, the South Sudan Nurses and Midwives Association plans to scale up this approach to the rest of the country.

Ndị nne South Sudan
Doris Lamunu

Onye njikwa mmemme, Ndị nọọsụ South Sudan na ndị Midwives Association

Doris Lamunu bụ onye njikwa mmemme na South Sudan Nurses and Midwives Association. Ọ na-arụ ọrụ dịka onye ọrụ na-ewuli ike na AMREF South Sudan. Doris nwere ahụmịhe karịrị afọ asatọ dịka onye ọrụ ahụike, kpọmkwem na ahụike mmekọahụ na ịmụ nwa, ike usoro ike, mmemme ahụike na mmejuputa iwu, ọgwụ clinical omume, nkuzi ahụike, na ndụmọdụ na nyocha HIV/AIDS. Ọ na-arụ ọrụ nke ọma na nkwado na nkwurịta okwu, Nhazi mmemme dabere na nsonaazụ, nnyefe na njikwa na-emesi ike karịsịa na mmepe nke ahụike mmekọahụ na ịmụ nwa (ASRH), na onye nkuzi ọzụzụ na ASRH na HIV/AIDS. Doris nwere nzere bachelọ na Health Public site na Clerk International University, nzere di elu na Health Community, diplọma na Clinical Medicine and Public Health, na diploma diploma na Mmekọahụ na Ahụike ịmụ nwa na ikike sitere na Mahadum Lund. Ọ bụ onye otu Global Academy, ma ọ na-achụ ugbu a nzere masta na Health Public na Texila University na Guyana.

Irene Alenga

Ijikwa ihe ọmụma na ntinye aka obodo, Onye na-akwado ngwa ngwa

Irene bụ ọkachamara n'ihe gbasara akụ na ụba na-elekọta mmadụ nwere ihe karịrị ya 13 ahụmịhe afọ na nyocha, nyocha amụma, njikwa ihe ọmụma, na njikọ aka. Dị ka onye nyocha, o tinyela aka na nhazi na mmejuputa ya 20 Ọrụ nyocha gbasara akụ na ụba mmadụ na ngalaba dị iche iche n'ime mpaghara Eastern Africa. N'ọrụ ya dị ka onye ndụmọdụ njikwa ihe ọmụma, Irene etinyela aka na ọmụmụ gbasara ahụike site n'ịrụ ọrụ ahụike ọha na ụlọ ọrụ lekwasịrị anya teknụzụ na Tanzania, Kenya, Uganda na Malawi ebe o nweworo nke ọma njakịrị akụkọ mmetụta yana mmụba nhụta nke ntinye aka. Ọkachamara ya n'ịzụlite na ịkwado usoro nchịkwa, nkuzi mụtara, a na-egosipụtakwa omume kachasị mma na nhazi mgbanwe nhazi afọ atọ na usoro mmechi nke USAID| Sistemụ njikwa ihe nnyefe na ntinye (SCMS) 10-afọ oru ngo na Tanzania. Na omume na-apụta nke Human Centered Design, Irene emeela nke ọma na njedebe dị mma iji kwụsị ahụmịhe ngwaahịa site na-eduzi ọmụmụ ahụmịhe onye ọrụ mgbe ọ na-emejuputa USAID| DREAMS Project n'etiti ụmụ agbọghọ na ụmụ agbọghọ na-eto eto (Ndị AGYW) na Kenya, Uganda, na Tanzania. Irene maara nke ọma n'ịchịkọta akụrụngwa na njikwa ndị na-enye onyinye, karịsịa na USAID, DFID, na EU.

Sarah Kosgei

Onye njikwa netwọkụ na mmekọrịta, Amref Health Africa

Sarah bụ onye njikwa netwọkụ na mmekọrịta mmekọrịta na Institute of Capacity Development. O nwechaala 10 Ahụmahụ afọ nke na-enye nduzi na mmemme mba dị iche iche na-akwalite ike nke usoro ahụike maka ahụike na-adịgide adịgide na Eastern., Central, na South Africa. Ọ bụkwa akụkụ nke Women in Global Health – Africa Hub Secretary nke bi na Amref Health Africa, Isi mpaghara nke na-enye ikpo okwu maka mkparịta ụka na ohere imekọ ihe ọnụ maka iduzi mgbanwe nwoke na nwanyị n'ime Africa. Sarah bụkwa onye otu mkpuchi ahụike Universal (UHC) Ọrụ ndị mmadụ maka ahụike (HRH) sub-kọmitii na Kenya. O nwere akara ugo mmụta na Ahụike Ọha na Masters Executive na nchịkwa azụmahịa (Ahụike zuru ụwa ọnụ, Nduzi na njikwa). Sarah bụ onye na-anụ ọkụ n'obi na-akwado maka nlekọta ahụike nke mbụ na nha anya nwoke na nwanyị na Sub-Saharan Africa.

Alex Omari

Onye isi ala East Africa KM, Ọmụma ihe ịga nke ọma, Amref Health Africa

Alex bụ onye na-ahụ maka atụmatụ ezinaụlọ na nka na ahụike Amref Health nke Africa Institute of Capacity Development.. Ọ na-arụ ọrụ dị ka onye isi nchịkwa ihe ọmụma mpaghara (East Africa) maka oru ngo ihe omuma. Alex agafeela 8 ahụmahụ afọ na-eto eto na ndị ntorobịa mmekọahụ na ike ịmụ nwa (AYSRH) imewe mmemme, mmejuputa iwu, nyocha, na nkwado. Ugbu a ọ bụ onye otu ndị ọrụ nka nka maka mmemme AYSRH na Ministry of Health na Kenya. Alex bụ onye a họpụtara ahọpụta nke Royal Society for Public Health (FRSPH) na onye bụbu onye nhazi obodo Kenya maka International Youth Alliance for Family Planning (IYAFP). Ọ nwere nzere bachelọ sayensị (Ahụ Ike Ndị Mmadụ) na Master of Public Health (Ahụike ọmụmụ) sitere na Mahadum Kenyatta, Kenya. Ugbu a, ọ na-agbaso nzere nke abụọ Master's na Public Policy na School of Government and Public Policy (SGPP) na Indonesia ebe ọ bụkwa onye ọkachamara ahụike ọha na ahụike na-ede akwụkwọ na onye na-enye aka na webụsaịtị maka Strategic Review Journal.

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