What impact have you had?
Thus far this project has only involved on of the results the lack of maternal health services. We have spent time in the community working on the issue of obstetric fistulas. Most recently, we had a community meeting discussing the problems with maternal mortality and discussed the possibility of a birthing center. We have also discussed this with the local community council, all of whom are enthusiastic about such a center.
By providing a self-sustaining maternal waiting home, women can plan in advance to come towards the end of their last trimester of pregnancy. The advantage of time will allow families to save funds and work out their transportation in a non-emergent manner. The first cohort of women who choose to come to the center can have their transportation costs provided for in order to kick-start the MWH. This group can return to the community and encourage others to use the center.
The center will provide a friendly environment for traditional birth attendants (TBA's) and hospital personnel to work together. If TBA's feel comfortable, they can learn more midwifery skills and eventually contribute to the workforce of the maternal health services. Using midwifery courses brought in from the mainland, and provided by the ministry of health, TBA's could learn more advanced techniques, improving their skill. In order to encourage them to work at the center, they will be compensated by the ministry of health only if they work at the MWH. This would lighten the burden of the staff at the hospital and hopefully improve the quality of care for all women who come to birth at the center.
In time, positive experiences would encourage more women and TBA's to participate in the center. Eventually families in the community will also see the benefit of personalized care at the center. When the need for emergency backup arises, the hospital and staff will be readily available and both maternal mortality and morbidity will decrease. Having women near the hospital and in a comfortable and yet safe environment will reduce both maternal and infant mortality and morbidity in Ukerewe.
What will it take for your project to be successful over the next three years? Please address each year separately, if possible.
-Research the birthing culture and patterns of women in Ukerewe, asking women specifically what elements of a birth center would appeal to them or convince them to make use of it.
-Research also the work of TBA's and discuss their willingness to utilize the center and receive increased training in recognizing and handling obstructed labor.
-Collect baseline data on birth rates, mortality, and morbidity for accurate evaluation of the MWH.
-Arrange to purchase the land and building equipment for the center.
-Establish partnership with the Ministry of Health and other local NGO's.
-Launch a public awareness campaign primarily through the radio highlighting reasons the center could improve birth outcomes and reasons families should make arrangements to come.
-Arrange with the Ministry of Health to post an additional nurse midwife at the center or recruit TBA's already in Ukerewe to receive midwifery training.
-Build the center and set up the facility.
-Continue public campaign to raise awareness in community of the MWH.
-Invite guest midwives to work with local midwives to share experiences from similar birth centers.
-Invite women to begin coming to the center .
-Maintain meticulous records on women who come, birth experiences and outcomes.
-Begin training programs for TBA's.
-Continue running the center and keeping records.
-Continue training programs for TBA's.
-Evaluate overall outcomes.
-Continue advertising to the community and share outcomes.
What would prevent your project from being a success?
All the issues that would prevent the project from being a success are socio-cultural in nature. For example, if the women do not choose to use the center or do not perceive a benefit in its use, the project will not work.
We could hold community meetings (a common way to disseminate information in Ukerewe) and explain to the community how the center would work and how it could provide a safe place to deliver. We could ask some of the women we know there who have experienced childbirth injuries to share their experiences with the women if they agree with us that a birth center would be helpful.
Additionally, if the TBA's do not feel comfortable and welcome at the center or discourage women from going there, the project will have limited success.
We will have to meet with them individually to learn what we could offer specifically that would interest them enough to travel to the center.
The relationship between the TBA's and nurse-midwives will also be important in the smooth functioning of the center. All of these examples are why it is critical to begin the project by assessing the interest and willingness of as many women, families, and TBA's.
A firm commitment from the Ministry of Health is also critical in the success of the project. This is why I would like to work quickly to follow the enthusiasm of the Member of Parliament who has expressed interest in this project. She could rally the support of the government and establish a partnership that would be needed to support the staff of the center and to keep it running smoothly.