Two of Jhpiego’s community participatory interventions in Nigeria were featured in the Keynote address at the 8th International Scientific Conference of the Society of Gyneacology and Obstetrics of Nigeria (SOGON) in Abuja today.
William Brieger, Jhpiego’s Senior Malaria Advisor, who was introduced by SOGON member and Jhpiego Country Director, Emmanuel Dipo Otolorin, explained that communities have cared for their pregnant women and mothers since time immemorial. Simply building a modern service does not mean women will come. Ultimately the community and the health system need to be partners so that the best of ideas and resources from both can be pooled, making for stronger services for women.
Jhpiego has tested two successful interventions that involve the community in improving maternal health in Nigeria. Community Directed Intervention in Malaria in Pregnancy Control is being sponsored by Sponsored by the ExxonMobil Foundation and based in Akwa Ibom State. The Household-to-Hospital Continuum of Care approach to saving mothers’ lives is sponsored by USAIDâ€™s ACCESS and MCHIP programs AND IS Based in Kano, Zamfara and Katsina States.
Prior to intervention in Akwa Ibom State in 2007 only 17% of pregnant women had slept under an insecticie treated bednet. Only 6% had received the recommended minimum of two doses of intermittent preventive treatment. Therefore a two-pronged intevention was implemented that improved performance standards at local goverment antenatal clinics and also enabled clinic staff to organize a community directed approach with local volunteers to the distribution of IPT and nets in catchment areas surrounding the intervention health facilities.
After two years ANC attendance improved. Coverage of two doses of IPT rose to 65% in the intervention communities, and 27% in the control areas where IPT was provided only through the health center.
The program demonstrated that a linked community-clinic delivery system for preventing MIP increases coverage of pregnant women with lifesaving interventions. Strengthening both the health system and the community is intended as a way to sustain MIP prevention. Community Directed Interventions in MIP can be scaled up through support from Global Fund and World Bank Grants and links with other public health efforts.
SOGON members were challenged to think of other life saving interventions that could be delivered through community directed intervention such as misoprostol. The Minister of Health, who opened the conference, declared that misoprostol had been added to Nigeria’s essential drug list at the meeting.
Five key community intervention were included in the USAID Sponsored ACCESS program: Community Mobilization Teams, Community Core Groups around health facilities, Household counselors to educate women and their families, Male Birth Spacing Motivators, and Mothersâ€™ Savings and Loans Clubs.
This combination of community action and planning, advocacy, social support and health information provided by the community resulted in an increased knowledge among women of danger signs in pregnancy from 53% to 80%.Â The number of women who actually made a birth preparedness plan rose from 32% to 68%. One-third of the women who made use of the microfinance loans used the funds to access emergency health services they would have otherwise foregone. Antenatal clinic attendance nearly doubled.
In conclusion, communities offer valuable human, social and economic resources to improving health care. Our formal health services cannot go it alone and succeed. A true partnership will bring together the best of what communities and clinics, households and hospitals have to offer in order to save the lives of mothers and children.