Tropical Health Matters

Uduak, a community directed distributor (CDD) for Jhpiego’s malaria in pregnancy (MIP) prevention program in Akwa Ibom State, Nigeria, was involved with pregnant women long before the MIP program started in 2008. She normally works as a traditional birth attendant attached to one of the churches in Atiamkpat community in Onna Local Government Area (LGA).

So, when Jhpiego introduced the ExxonMobil Foundation funded program that required volunteers selected by the community members to deliver MIP services, Uduak volunteered along with 38 other women to serve the villages and kin groups in the catchment area of Atiamkpat Clinic. On their part, the community leaders were happy that she volunteered because, “Uduak has been resourceful in the past and always committed in whatever assignment given to her”

Jhpiego had formed a state training team, which trained LGA health team members who in turned trained staff at the front line health facilities to deliver malaria in pregnancy services and enable communities to provide community directed interventions. These health facility staff trained volunteers like Uduak.

During the training that followed, Uduak was elected by her colleagues to be the chairperson that coordinates the activities of these volunteers. Asked the colleagues why they selected Uduak as their leader, one of the CDDs responded that, “Uduak is responsible and one who respects other people’s opinion.” In addition to providing malaria prevention services such as insecticide treated nets (ITNs) and intermittent preventive treatment of malaria in pregnancy (IPTp) to pregnant women in her own local community, she supervises and coordinates the other women volunteers, ensuring that they do not run out of stock of anti-malarial drugs and update their community registers for accurate service provision.

Uduak also organized and mobilized the traditional birth attendants in her community to send their clients for antenatal care that is a platform for providing MIP prevention services. She accomplished this with the support of the nursing officer attached the Atiamkpat Clinic and the traditional ruler. Uduak also provides community counseling sessions on malaria to pregnant women in her community as well as health talk to women in her church.

One of the project beneficiaries who received nets from Uduak shared her profound gratitude to Uduak because according to her, “Without Uduak I would not have started using the net but her consistency and persistence in reminding me to use the net prompted and encouraged me to do so.”

Prior to the activities of Uduak and her colleagues, Atiamkpat health facility was not patronized by pregnant women. The community members complained that the staff were not usually on duty at the time pregnant women visited the facilities. Uduak and colleagues met with the health staff and got their commitment to be at the facilities. This coincided with Jhpiego’s training of health staff to improve the quality of ANC and malaria control services they provided.

Now the staff have started receiving antenatal care clients. This increased from just two pregnant women in the three months preceding the intervention to fifty pregnant women in the first three months of intervention. The clinic is now also taking delivery of babies. Because of the way Uduak has been able to organize her group of CDDs, the catchment area of Atiampat Clinic has achieved on average 43% better coverage of the required two doses IPTp relative to its population compared to the three other clinics/catchment areas in the LGA.

Uduak has been a source of encouragement to her follow volunteers, one of whom noted that, “We would have stopped this work since we are not paid, but Uduak as continued to encourage and motivate us.”

Uduak was once asked what motivates her to carry out this assignment in absence of any financial reward or personal gain. She responded that, “The life and survival of pregnant women is my concern and much more important than money.”

One of the women beneficiaries noted that, “Uduak is selfless and committed to helping people. Her life is a testimony and challenging to us.” Uduak on her own part has vowed to keep doing the CDD job even though she does not benefit financially, explaining that, “There is an inner joy in providing quality community service, and this motivates me.”

[This story was compiled with the help of Bright Orji of Jhpiego Nigeria and Eno Ndekhedehe of Community Partners for Development, Akwa Ibom State, respectively.]

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