Archive for June 8, 2010
By Molly O’Bryan
Bahati Sanga arrived at Iringa Regional Hospital with his teenage twin sons. He had noticed a poster in the market advertising free male circumcision (MC) services at the hospital clinic. Bahati had been waiting for just such an opportunity. As he had learned from his father, the consequences of not acting to protect his sons from HIV could be serious.
“Myself and all of my brothers were circumcised. Our father told us that being circumcised was good for our health, it was hygienic, and it helped us to avoid sexually transmitted infections,” said Bahati, 42, who sells fish at the local market to support his wife and eight children.
“Men need to be more involved in the health of their families,” he adds, enthusiastically.
For the past year, Jhpiego’s Tanzania team has been working closely with the Ministry of Health and Social Welfare, through the regional hospital, to establish MC services in the Iringa region. With the highest prevalence of HIV in Tanzania (15.7%) and only 29.1% of men circumcised, Iringa stands to benefit tremendously from an expansion of such services. Beginning in September 2009, with assistance from Jhpiego, Iringa hospital has been offering free MC services for all men and boys, 10 and above. Since that time, more than 1,500 have participated. Men who are circumcised are about 60% less likely to be infected during heterosexual sex than men who are not circumcised.
In addition to the surgical procedure, MC services for HIV prevention include group and individual counseling on the circumcision procedure and other HIV and male reproductive health issues, and HIV testing for those who are willing.
Bahati, who lives in a village on the outskirts of Iringa, wanted his sons to be circumcised, as he had been when he was eight years old.
But prior to Jhpiego’s work with Iringa hospital, it was difficult to access MC services. Bahati considered taking his sons to a traditional circumciser, but this was both expensive (about $15) and risky, given that infections are common and traditional circumcisers in the area do not provide any aftercare services. And when men and boys who suffer complications do seek help from health professionals, they often face discrimination from providers who do not approve of the traditional practice.
By Jaime Mungia
Throughout Qara Bagh District in northeast Afghanistan, tribal leaders have hung posters with illustrations that emphasize the importance of giving birth in a health facility and identify the warning signs of a newborn in distress. The community outreach is part of the work of the Qara Bagh health council, or shura, a locally selected group of tribal leaders who make decisions and resolve community conflicts. The shura promotes healthy behaviors and involves men in the health of their communities.
And their work is having an impact. In concert with the efforts of Qara Bagh District Hospital to increase use of health services, the number of women giving birth in the facility with a skilled health provider increased by 128% from 2008 to 2009.
Azimullah, the health shura’s chief, explains that a health shura is an appropriate way to engage leaders in improving their community’s health. Afghanistan has a long history of local tribal leadership.
“The community knows that we advocate for them and will help their problems. They trust us,” says Azimullah, who like many Afghans goes by only one name. “After all, this is our community…our country. We have the responsibility to make a difference if we want to improve conditions.”
The health shura gathers at Qara Bagh District Hospital monthly. The council serves as a link between the health facility and community, advocates on the community’s behalf, mobilizes the community and discusses priorities identified by community members. They give people in the community a voice—that might otherwise be unheard—and promote healthy behaviors.
Through the shura, the health facility relays educational messages and updates on health-related activities at Qara Bagh District Hospital, and jointly resolves concerns.
In recent months, the community health supervisor has provided the shura key points on preventive measures for tuberculosis, diarrhea and malaria transmission. In turn, the shura has shared these messages with residents in community meetings, or directly with the mullah or village religious leader who incorporates them into his sermons. The posters on display in the district were developed through the Jhpiego-led Health Services Support Project, funded by the U.S. Agency for International Development, which supports the Afghan Ministry of Public Health’s efforts to improve the quality of basic health services, including maternal and newborn care.
Health providers recognize the impact that health shuras can have on a health facility and community. Pashtoon Azfar, Afghan Midwives Association President, says midwives are being encouraged to reach out to health shuras and men in their communities to involve them in maternal and newborn health.
“In many parts of Afghanistan, the husband will make the decision when his wife should visit the health facility to receive care,” explains Azfar. “Midwives are educating health shuras, and men, on the importance of making timely decisions related to pregnancy and delivery to improve outcomes for the mother and baby. This has been a good way to involve men and educate the community.”
One of the Qara Bagh health shura’s proudest accomplishments is its role in increasing the number of deliveries assisted by skilled birth providers at the district hospital. Members described the many barriers that prevented women from going to the health facility, including sociocultural concerns regarding privacy, quality of care and lengthy waiting times. After sharing these concerns with the community health supervisor and health facility staff, the shura and facility hosted a regular “open day” at the facility for community members to visit the facility, tour the labor and delivery room and talk candidly with health providers.
As a result of the increased transparency at Qara Bagh District Hospital and heightened community awareness, health shura members and facility staff believe that the community is more willing to use the hospital for services.
These important efforts by the health shura, coupled with Jhpiego’s work to improve the quality of services in the facility, support the Ministry’s efforts toward meeting the Millennium Development Goals in saving the lives of women and children.