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Promoção da atenção à saúde materna por meio da sensibilização da comunidade

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. Para combater o estigma, 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. Therefore, 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 anos. Mortality among mothers dropped from 2,054 per 100,000 live births in 2000 para 789 per 100,000 live births in 2017 according to a 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. Como resultado, 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. Por exemplo, 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. Therefore, 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) dentro 1987 as a way of improving maternal health 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 Saúde África, e 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. Além disso, 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. Hoje, 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.

Lições aprendidas

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.

Mães do Sudão do Sul
Doris Lamunu

Program Manager, South Sudan Nurses and Midwives Association

Doris Lamunu is a program manager at South Sudan Nurses and Midwives Association. She works as a capacity-building officer at AMREF South Sudan. Doris has over eight years of experience as a health officer, specifically on sexual and reproductive health, health system strengthening, health programming and implementation, medicine clinical practice, health tutorship, and HIV/AIDS counseling and testing. She is effective at advocacy and communication, result-oriented program design, delivery and management with particular emphasis on development of adolescent sexual and reproductive health (ASRH), and a trainer of trainees in ASRH and HIV/AIDS. Doris holds a bachelor’s degree in Public Health from Clerk International University, an advanced diploma in Community Health, a diploma in Clinical Medicine and Public Health, and a postgraduate diploma in Sexual and Reproductive Health and Rights from the Lund University. She is a member of the Global Academy, and she is currently pursuing a master’s degree in Public Health at Texila University in Guyana.

Irene Alenga

Líder de Gestão do Conhecimento e Engajamento Comunitário, Acelerador de Advocacia

Irene é uma economista social estabelecida com mais de 13 anos de experiência em pesquisa, análise de política, Gestão do conhecimento, e engajamento de parcerias. Como pesquisador, esteve envolvida na coordenação e implementação de mais de 20 projectos de investigação económica social em várias disciplinas na Região da África Oriental. Em seu trabalho como Consultora de Gestão do Conhecimento, Irene esteve envolvida em estudos relacionados à saúde através do trabalho com instituições de saúde pública e focadas em tecnologia na Tanzânia, Quênia, Uganda e Malawi, onde ela trouxe com sucesso histórias de impacto e aumentou a visibilidade das intervenções do projeto. Sua experiência no desenvolvimento e suporte a processos de gestão, lições aprendidas, e melhores práticas é exemplificado no processo de gerenciamento de mudança organizacional e encerramento de projetos de três anos da USAID| DELIVER e Sistemas de Gestão da Cadeia de Suprimentos (SCMS) 10-projeto anual na Tanzânia. Na prática emergente do Design Centrado no Humano, Irene facilitou com sucesso uma experiência positiva de ponta a ponta do produto através da realização de estudos de experiência do usuário durante a implementação da USAID| Projeto DREAMS entre meninas adolescentes e mulheres jovens (AGYWs) no Quênia, Uganda, e Tanzânia. Irene é bem versada em mobilização de recursos e gestão de doadores, especialmente com a USAID, DFID, e UE.

Sarah Kosgei

Gerente de Redes e Parcerias, Amref Saúde África

Sarah é Gerente de Redes e Parcerias do Institute of Capacity Development. Ela acabou 10 anos de experiência na liderança de programas multipaíses voltados para o fortalecimento da capacidade do sistema de saúde para uma saúde sustentável no Leste, Central, e África Austral. Ela também faz parte do secretariado Women in Global Health – Africa Hub domiciliado na Amref Health Africa, um Capítulo Regional que fornece uma plataforma para discussões e um espaço colaborativo para liderança transformadora de gênero na África. Sarah também é membro da Cobertura Universal de Saúde (UHC) Recursos Humanos para a Saúde (RH) subcomitê no Quênia. Ela é formada em Saúde Pública e tem um Mestrado Executivo em Administração de Empresas (Saúde global, Liderança e gestão). Sarah é uma defensora apaixonada dos cuidados de saúde primários e da igualdade de gênero na África Subsaariana.

Alex Omari

Oficial de KM da África Oriental, Conhecimento SUCESSO, Amref Saúde África

Alex é o Responsável Técnico de Planeamento Familiar/Saúde Reprodutiva no Instituto de Desenvolvimento de Capacidades da Amref Health Africa. Ele trabalha como o Diretor Regional de Gestão do Conhecimento (este de África) para o projeto Knowledge SUCCESS. Alex acabou 8 anos de experiência em saúde sexual e reprodutiva de adolescentes e jovens (AYSRH) projeto do programa, implementação, pesquisar, e advocacia. Ele é atualmente um membro do Grupo de Trabalho Técnico para o programa AYSRH no Ministério da Saúde no Quênia. Alex é membro eleito da Royal Society for Public Health (FRSPH) e um ex-coordenador de país do Quênia para a International Youth Alliance for Family Planning (IYAFP). Ele é bacharel em ciências (Saúde da população) e Mestre em Saúde Pública (Saúde reprodutiva) da Universidade Kenyatta, Quênia. Atualmente cursa seu segundo mestrado em Políticas Públicas na Escola de Governo e Políticas Públicas (SGPP) na Indonésia, onde também é estudioso de redação de políticas de saúde pública e saúde e contribuidor do site para o Strategic Review Journal.

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