Archive for March, 2011
By Luciana Brondi
Maputo, Mozambique—Health care workers like Eleutéria Jaime face a dual challenge in the fight against tuberculosis. Their clients are often suffering from HIV, the virus that causes AIDS; of all TB patients in Mozambique, 61 percent test positive for HIV. And for HIV-positive patients, TB is a leading cause of death.
That means Jaime and her colleagues at the Rural Hospital of Chicumbane—located in an area of the country with the highest prevalence of HIV (25.1 percent)—must be ever-vigilant in making sure their patients take their medicines and stick to their treatment regimen, which takes at least six months. She also cares for patients who are difficult to treat because they have multidrug-resistant TB (MDR-TB), a particularly stubborn form of TB that is resistant to standard antibiotics.
Despite these challenges, the Government of Mozambique, with support from Jhpiego and the President’s Emergency Plan for AIDS Relief (PEPFAR), has embarked on a five-year national plan for TB infection control. As part of this initiative, Jhpiego helped lay the groundwork for the national program by reviewing standards of care and local infection control policies at 30 health care facilities in three provinces. Jhpiego’s assessment found that few facilities had TB infection control policies, and even where policies existed, health workers knew little about how to prevent or control TB. These findings helped inform guidelines and practices for the TB Infection Control National Policy, which was signed by the Minister of Health earlier this year.
Following that seminal work, Jhpiego and partners set out to help Mozambique implement its campaign to stop TB. Jhpiego has led efforts to prepare workers and facilities across the health system to carry out the national plan, improve detection of TB, address challenges associated with treating patients with MDR-TB and promote proper “cough etiquette” and other TB prevention behavior in clinics and health centers.
To build and strengthen a TB-competent work force, Jhpiego has helped educate more than 200 health care workers in infection control and prevention strategies. Jaime was among them, and, she says, she is now better able to serve her clients and to reinforce the often simple measures that help prevent the spread of TB—for example, covering one’s mouth when coughing and keeping windows open in patient areas to circulate the air.
“I did not have much idea about the issues relating to TB-MDR and TB transmission and infection control,” said Jaime. “I was really pleased to be able to learn more about these issues and how I could motivate my patients to keep fighting TB, how I could protect myself and the patients and their families from TB transmission. It helped me to provide better care and instructions to the patient on cough etiquette and infection control both while in the hospital and at home.”
Every year, more than 7,000 Mozambicans die as a result of TB. Residents who are HIV-positive are more vulnerable to the threat of TB, and in a country with an HIV prevalence rate of 11.5 percent among adults, the challenge of containing that threat is great. The Ministry of Health (MOH) is focused on strengthening health services to avert the spread of TB and provide improved care to its people. One of the key strategies to fight TB is the implementation of collaborative HIV/TB activities.
“The National [TBIC] Plan is crucial to guide the activities to be implemented to control TB transmission in Health Care Units and group settings,’’ said Dr. Alexandre Manguele, Mozambique’s Minister of Health. “We hope therefore to be able to guarantee safer and healthier health care facilities and services for all Mozambicans.”
From promoting cough etiquette in small rural health facilities to establishing strong TB and general infection control policies in hospitals, Jhpiego is partnering with Mozambican organizations to share evidence-based practices and strategies to strengthen health care and protect health care providers where they work.
Red Cross Mozambique is one of the front-line organizations working to prevent and control TB in the community, especially in remote areas where access to health facilities is more difficult. Red Cross volunteers play an active role in supporting the MOH with its community TB-DOTS (Directly Observed Therapy Short-Course) strategy, which includes a focus on having a friend or relative watch and support a TB patient in taking his or her medicine properly. But many volunteers did not know how to protect themselves and the community against TB infection. Nor were they fully confident about dealing with MDR-TB clients.
Last fall, at the request of the MOH and the World Health Organization, Jhpiego supported TB infection control training for 22 Red Cross medical officers. This training covered twin challenges—treating persons with HIV, or those with MDR-TB. A majority of these medical officers manage 139 field supervisors, who in turn train and oversee 1,404 volunteers working in the 11 provinces of Mozambique. Last year, these Red Cross volunteers reached 62,227 families with updated information on TB prevention and control.
“After the training, I was confident to teach the volunteers about TB/HIV issues, adherence to treatment importance and how to motivate clients, the risks of multidrug-resistant TB and how to protect themselves and their clients against TB transmission,” said Celeste Langa, a supervisor with the Red Cross. “I feel privileged and I am happy to hear that people in Jhpiego are concerned with the TB and TB-MDR challenge we face in our country, especially in my province Maputo.”
By Ann LoLordo
Nairobi, Kenya—During a visit to Jhpiego-supported programs in a slum outside Nairobi, Melinda Gates heard the same message from dozens of residents—women want to plan their families so they can provide for their children and give them opportunities they never had.
“I talked to more than 50 women about family planning when I was in Kenya, and all but one told me how desperately they wanted to plan their families and space their children…,” said Gates, whose family foundation recently chose Jhpiego, the Baltimore-based international health non-profit and Johns Hopkins affiliate, to lead its $23 million urban reproductive health program in Kenya called Tupange.
“The women I met talked a lot about how important it was to make sure their daughters learned about family planning. One woman said she had six children before she knew anything about family planning, and she told me she must not let the same thing happen to her daughter. Her direct quote: ‘My daughter will be more informed about family planning than I was. I will teach her everything.’”
Whether speaking through a Swahili translator or finding their voice in English, the women who met Gates recognized that spacing their children in a healthy manner would enable them to better care for their families so all would thrive.
“I asked a group of women why they wanted to practice family planning. One woman summed it all up when she said, ‘I want to bring every good thing to one before I have another,’” said Gates. “It just reinforced what I always come away from these conversations realizing—that mothers everywhere want the same things for their children, that we all want to set our children up for a successful future.”
Jhpiego, whose urban health program has been recognized for its innovative strategies to increase access to quality health care and services for Kenyans, hosted Gates during a day-long visit that included meeting with women from a Nairobi area slum. The organization’s work in Korogocho and Viwandani slums led to a significant increase in family planning use by women.
As Gates walked through the communities and talked with Kenyan wives and mothers, women shared the challenges they faced in getting adequate family planning services that include disapproving husbands, physical infirmities and inadequately supplied health clinics.
“One woman had been trying to plan her family for years, but her husband wouldn’t hear of it. Then, because she had so many children in the same room where she was cooking their food, there was an accident and her child got burned. They had to go to Kenyatta Hospital, and the dad finally understood the importance of child spacing. The woman was at the clinic to finally start the process of planning her family.”
But Gates also learned about new family planning methods that were being offered to Kenyan women living in these crowded, impoverished areas of the city.
“I visited a health clinic in Kariobangi, and I happened to be there on the day they set aside for long-term family planning, including tubal ligation, IUCDs and implants,” recalled Gates. “The women I talked to were really excited about the implants. They called them batteries, because they work for four years. I got to see a woman having the procedure done, and it was just amazing to me how easy, quick and relatively painless the procedure is.
“It’s such a cost-effective and effective way to give women the ability to plan. I thought to myself, that little procedure can make such a huge difference in the lives of women, their families and their communities. That’s why there was a line out the door and a four-hour wait to have the procedure done.”
Throughout her visit, Gates was heartened by women’s concerns for one another and the network of support that had developed among many to access family planning services.
“The sad truth is they don’t get much support from the men, but they make sacrifices for one another. At the health clinic, two women told me they’d already gotten implants, but they had come because they wanted to encourage other women who were scared or uncertain,” said Gates. “Seeing that there were women who had come to give advice and another who had come seeking advice made me realize that tools and technology are only part of the equation.”
Gates recalled her meeting with a courageous, determined volunteer health worker named Maureen.
“She was an HIV-positive mother, and one of her five children also had HIV,” said Gates. “Now, she is running a program where HIV-positive mothers counsel pregnant women with HIV about preventing mother-to-child transmission. The most important thing, she said, was helping the women realize that others just like them had overcome the same obstacles. In her words this was ‘Living Positively.’ Maureen told me that in her program, they haven’t had a baby born with HIV since August—and that’s more than 30 healthy children!”
Access to family planning services can have a profound impact on the lives of women and their families. A woman named Mary told Gates about a savings club—called a “merry-go-round”—in which members contribute to a pool from which they can get loans to start a small, home business.
“Mary took a loan to buy a sewing machine, and she had a thriving business selling backpacks out of denim. She sold them at the local market for 50 shillings apiece, and she was supporting her family and paying back her loan,” said Gates. “When I visited Mary’s workshop, she was caring for her youngest child while the other two were off at school. I just kept thinking that the futures of those children were so much brighter because their mother had been able to plan her family and band together with other women in the community to grow a business.”
By Adolfo Sampaio and Reena Sethi
Benguela City, Angola—With few pregnant women in Benguela province accessing malaria prevention services, staff at the Fronteira Health Center decided to launch an outreach effort to get women to the facility early and often.
As part of the ExxonMobil-funded program, health workers visited markets and churches, held community education sessions and persuaded local leaders to encourage pregnant women to visit the health center. That effort and other activities, supported by a Jhpiego-led quality assurance program, helped lead to a significant increase in the number of pregnant women receiving critically important malaria prevention services and prenatal care at the health center—56.3 percent of women received the first dose of intermittent preventive treatment for the prevention of malaria in pregnancy (IPTp1) in 2010, compared to only 13.1 percent in 2009. Similarly, 17.9 percent of women received IPTp2 in 2010, compared to 4.6 percent in 2009.
Since April 2009, Angolans at the Fronteira Health Center have been working to increase use of antenatal care (ANC) and improve quality of services to prevent malaria in pregnancy (MIP) through the generosity of ExxonMobil and in conjunction with the Angolan Ministry of Health. The center serves an area of about 36,000 people in which 22 percent or 7,920 are women of reproductive age and 5.2 percent or 1,872 are pregnant. According to the 2006 Angola Malaria Indicator Survey, only 2.5 percent of women received two or more doses of IPTp during their last pregnancy and 20% of pregnant women sleep under insecticide-treated bed nets to protect against malaria-transmitting mosquitoes. The Ministry of Health of Angola reports that malaria accounts for a quarter of maternal deaths in the country.
To protect women more effectively against the risk of malaria in pregnancy, project leaders at Fronteira recognized that more women had to access ANC services during their first trimester. In 2009, staff, the head of the ANC unit there, an ANC nurse and provincial and municipal supervisors participated in an educational seminar designed to improve the capacity of health providers in prevention and control of MIP.
“I think it was a very good process because it really improved the way we work. The clients also say that our services have improved a lot since this process began,” said Odeth da Glória Jamba, the ANC nurse at the Fronteira Health Center.
Employing Jhpiego’s pioneering Standards-Based Management and Recognition (SBM-R) approach, project leaders assessed health providers’ performance in delivering ANC, including MIP services, and found that services were improving. At each assessment, the Fronteira Health Center showed improvement, and by December 2009 the center met all 17 performance standards for ANC as defined by the Ministry of Health.
“I really enjoyed it because I learned a lot . . . and now I can do my supervision work better and teach others how to improve their work and be more organized,” said Josefina Samuel Tiago, Municipal Supervisor for Reproductive Health/ANC, Benguela.
The SBM-R method also helped the Fronteira staff identify gaps in service and develop ways to address them.
Problems included: pregnant women not coming to the health center for a consultation in their first trimester, lack of HIV tests for women and no telephone listings for health facilities that deal with serious cases. The center staff proposed ways to improve conditions: conduct community awareness campaigns, set aside an office to perform HIV tests, document the number of women who attend ANC services. As a result, health providers are continuing outreach activities to increase use of the facility by pregnant women; HIV testing is available at Fronteira; and a phone list for higher-level health facilities is now posted at the center.
Other best practices implemented by the center include:
• Established an appointment system for clients’ follow-up ANC visits, which led to women using services more routinely
• Provided materials so providers can directly observe clients taking Fansidar, an antimalaria drug, during eligible ANC visits
• Introduced a system for recording and tracking client education sessions.
Since 2009, the program supported by ExxonMobil has been implemented in 13 health facilities in Benguela province.
“We have plans to continue the process at the health centers that were supported this year and we would like to apply the process to other health centers,” said Algemira Belarmina, Provincial Supervisor for Reproductive Health/ANC, Benguela. With the continued support of the ExxonMobil Foundation and Esso-Angola (Block 15), a local subsidiary of ExxonMobil Corporation, women are receiving critical MIP services at the health facility and reducing their risk of contracting malaria.
By Nasir Bashir, Samaila Yusuf and Ann LoLordo
With each pregnancy, Malam Abubakar Maikudi worried about the health of his wife, Hadiza. The father of three children, Maikudi feared that another baby, born too soon, would further weaken her and make it harder for her to care for the children. But what could he do? A visit by a community health counselor helped this Nigerian father attend to the needs of his family.
Ali Ibrahim, a male counselor who is part of a U.S. Agency for International Development (USAID)-supported program to enhance reproductive health services in northern Nigeria, explained to Maikudi the benefits of properly spacing future pregnancies. He discussed several family planning methods for the couple and referred them to the Kiru Comprehensive Health Centre.
“Your visit to my house has taken a big burden out of my life,” Maikudi told the counselor. “I am very much satisfied with the information you have given me on how to plan my family and where to get services.”
After meeting with a health provider at the center, Hadiza and Maikudi decided that an intrauterine contraceptive device (IUD) was their preferred method of family planning.
The couple is just one of thousands of families who have been helped through a comprehensive program supported by USAID’s flagship Maternal and Child Health Integrated Program (MCHIP), managed by Jhpiego and partners to strengthen reproductive, maternal and family planning services in three states in northern Nigeria. An estimated 30,000 women die annually from complications of childbirth in Nigeria. The program began under the ACCESS Program and is being continued by MCHIP.
Through its cooperation with the Nigerian Ministry of Health over the past four years, MCHIP in Kano, Katsina and Zamfara States has achieved steady and significant gains in women’s visits to antenatal care clinics, skilled birth attendance, active management of third stage of labor, essential newborn care and use of long-term family planning. Through this initiative, 164,040 women have received family planning and reproductive health counseling.
“We are partners in progress because from the time when they came and started the activities in this state, we have made a tremendous progress,” said Dr. Bello Buzu, the chairman of the Health Services Management Board in Zamfara State.
The goal of the program has been to strengthen health systems and improve the quality of care in the community and health facilities to reduce the deaths of women and newborns. In northern Nigeria, women have an average of five to seven children. Program partners launched a multi-tiered approach that targeted 57 health facilities in more than two dozen local government areas, and relied on community health counselors and mobilizers to reach women in their homes and villages. The program focused on strengthening emergency obstetric and newborn care and family planning services.
Key accomplishments of the program have included:
- Health facilities using active management of third stage of labor increased from about 30 percent to more than 60 percent in the three states in northwest Nigeria;
- The number of facilities performing newborn resuscitation nearly doubled;
- Use of family planning among postpartum women in the areas served by the program increased from one percent to 15 percent of households; and
- More than 8,000 women chose injectables as the preferred form of contraceptive during a one-year period, an increase over the estimated 6,000 women seen at the start of the program.
As part of the project, health care providers were educated in emergency obstetric and newborn care skills, and family planning methods and e-learning opportunities were strengthened to build capacity in these areas. Beyond community education and facility improvement, a key strategy was to integrate health screenings with immunizations, newborn care and well-baby visits so as not to miss an opportunity to address women’s health and family planning needs.
“We have a reason for being in northern Nigeria. If you look at the demographic characteristics, many indicators are very poor in northern Nigeria compared to southern Nigeria,’’ said Prof. Emmanuel Otolorin, Jhpiego’s Country Director. “Our household-to-hospital continuum of care approach aimed to eliminate the delays to accessing health care delivery such as ignorance of the danger signs in pregnancy and childbirth and/or inappropriate customs. It also aimed to address delays in reaching the point of care due to lack of appropriate transport or poor roads and geographic terrain, as well as delays in receiving care after arriving at the health facility because of weak health systems—including a shortage of skilled birth attendants or lack of equipment and supplies.”
A network of community health volunteers taught pregnant women and mothers basic health care skills to prepare for childbirth and encouraged them to access health care services before and after delivery. Men were recruited to participate in outreach efforts to discuss the importance of pregnancy spacing and family planning with husbands, fathers and other male relatives. Savings clubs were organized for women, giving them the financial means to contribute to their families and develop leadership skills.
A Jhpiego-pioneered quality assurance approach, Standards-Based Management and Recognition, was shared with health care providers and administrators in an effort to improve services at facilities; measurable progress was made. In addition, health facilities were renovated and equipment upgraded.
“In terms of capacity building, systems strengthening and physical infrastructure, ACCESS, followed by MCHIP, has really supported Kano State government,” added Dr. Ashiru Rajab, Deputy Director of Primary Health at the Ministry of Health in Kano State.
But there’s more work that can be done.
“While there is an increase trend in the uptake of family planning services in Kano, a large number of women still have an unmet need for family planning,” said Dr. Yusuf Munkaila, Medical Director of the Sir Muhammad Sanusi Specialist Hospital. “There is a need to step up engagement of the religious and traditional leaders to understand the health benefits of family planning so that they can actively participate in advocacy efforts and disseminating messages that promote family planning as a means to improve maternal and newborn health.”
By Ann LoLordo
Women’s accounts of giving birth in community health centers and local hospitals in three districts in Indonesia revealed a series of problems with the care and service they received. The women’s stories, told to a team of visiting health professionals, detailed improper assessments, lack of monitoring, questionable management of labor and birth, difficult emergency transport, poor attitudes among providers and numerous out-of-pocket expenses.
The interviews with 45 women offer a unique perspective on conditions that may discourage pregnant women from choosing to give birth in a health facility with skilled attendants, a key contributor to reducing the deaths of mothers and newborns. These first-person accounts provide an opportunity for Indonesian health care providers—with the support of the U.S. Agency for International Development’s Maternal and Child Health Integrated Program (MCHIP)—to strengthen hospital referral services through a Jhpiego-pioneered quality assurance program that has been successfully implemented in Indonesia and 30 other countries with demonstrable results.
For more than 25 years, Jhpiego has worked collaboratively with the Indonesian government and other partners to help improve health care access and delivery in this nation of islands. This work has included building capacity among midwives, developing a model program for cervical cancer screening and prevention, and preparing health workers in prevention and treatment of avian influenza.
In two recent Jhpiego-supported programs, efforts to improve quality of care at health centers and clinics attended by midwives delivered substantive results. Health providers increased their competency in nine areas, ranging from antenatal care to infection prevention, and women received a higher quality of maternal and newborn services.
For example, when Jhpiego received support from British Petroleum and Rio Tinto in 2007 to improve maternal and newborn health care services in the district of Kutai Timur (pop. 250,000), many small, local health facilities were below standard, village midwives lacked basic emergency and newborn care skills, and poor infrastructure impeded women’s efforts to reach health centers to give birth.
Jhpiego’s pioneering Standards-Based Management and Recognition (SBM-R) approach helped administrators and staff at two community health centers identify problems and gaps in service, propose solutions and assess outcomes. The SBM-R approach gives health providers the means to develop and implement their own self-improvement program. It builds capacity by both motivating and rewarding employees who participate and encourages a sense of ownership in maintaining compliance with performance standards.
In Kutai Timur, to address gaps in knowledge and skills, an on-the-job mentoring program was devised for village and hospital midwives in basic and emergency obstetric care, infection prevention, and family planning counseling and services. Subsequent assessments showed steady improvement in antenatal care, labor and birth, newborn care, postpartum care, family planning, child immunization and infection prevention over the two years of the program, improving from an average of 69.4 percent to 87.9 percent in normal delivery care and from an average of 76 percent to 91 percent in infection prevention. Through the SBM-R approach, the midwives working in health clinics improved their level of care, meeting 90 percent of evidence-based standards, up from 50 percent.
MCHIP, which is led by Jhpiego, is presently working with six hospitals and 17 community health centers in the districts of Kutai Timur, Bireuen and Serang. SBM-R has been introduced in these facilities to identify problem areas and improve care and services. In just six months, the facilities have shown improvement, with some increasing their performance from 22 percent to 61 percent of the standards achieved.
A report from a midwife working in a small village health clinic in Teluk Pandan illustrates the impact of the program in helping to save lives. In May of 2010, the staff had their first complicated delivery since participating in the Jhpiego-supported training. A woman with prolonged labor had a breech birth and the umbilical cord was wrapped around the baby’s neck.
“We managed to deliver the baby, but it did not breathe,” wrote one midwife. “BEONC (basic emergency obstetric and newborn care) team consisted of me and two new midwives. After two minutes of using a resuscitation bag and mask, the baby finally breathes… . If there was no knowledge update from Jhpiego we might have failed to keep the baby alive.”
By Gaudiosa Tibaijuka and Katie Caiola
Iringa, Tanzania – Tatu doesn’t know how she became infected with the virus that causes AIDS, but the 18-year-old is doing all she can to protect her unborn baby from becoming infected too. On a cool day in the southern highlands of Tanzania’s Iringa region, Tatu stood with nine other pregnant women to await her appointment at the antenatal care (ANC) clinic at a Health Centre in Makete District.
ANC services help women, including those living with HIV, maintain normal pregnancies by preventing and detecting health problems and complications, and addressing them promptly. As part of this care, health providers use a “focused antenatal care” (FANC) approach, which tailors care to a woman’s individual needs. This integrated, innovative approach, advocated by Jhpiego, is particularly important for HIV-positive women, as it ensures that mothers have access to a comprehensive package of HIV services. These strengthened services include ongoing counseling, identification and management of common illnesses, such as tuberculosis, and distribution of antiretrovirals. A woman may need to take antiretroviral therapy (three drugs) for life, which reduces the risk of transmission of the virus to her baby, or a combination of drugs used in the short term to prevent her baby from becoming infected.
In Tanzania, Jhpiego has helped establish FANC services in 3,293 health facilities—69 percent of all facilities in the country—and educated 6,426 health care workers on how best to provide these vital services. This work has been supported by the U.S. Agency for International Development’s Mothers and Infants, Safe, Healthy and Alive (MAISHA) Program, with funding from the President’s Malaria Initiative. Other partners that support implementation of FANC include the Ministry of Health and Social Welfare, the National AIDS Control Program, UNICEF, UNFPA, the African Development Bank and local government entities.
Tatu’s initial visit to the ANC clinic provided her with information critical to the health of her unborn child: “I knew I was infected the first day I attended the clinic for my pregnancy,” says Tatu, as she waited to be seen by a health care professional. “I wouldn’t have known my status if I hadn’t attended the ANC clinic and would have gotten AIDS faster. I am benefiting from this facility.”
In Makete District, FANC services began in 2004, with the support of the U.S. Agency for International Development through Jhpiego Tanzania’s Primary Health Care Institute and regional and district health teams. The aim of the intervention was to strengthen and improve antenatal services at the Makete District Council’s 33 health facilities, which offer reproductive and child health services to more than 31,000 women of childbearing age.
Like all pregnant women who come to the ANC clinic, Tatu received counselling on how to prevent malaria and sexually transmitted infections, and on how to prepare for a clean and safe delivery. She is also monitored for serious complications like anemia and pre-eclampsia. During each ANC visit, Tatu learns the status of her HIV infection and is screened for possible opportunistic infections like tuberculosis. She is also linked to a Care and Treatment Centre to assess her need for antiretroviral drugs. To help Tatu financially, she has been referred to a support group for HIV-positive women that undertakes income-generating activities with the help of a nongovernmental organization.
Health facilities have seen vast improvements in the quality of care since FANC was introduced, according to Esther Mary Ngogo, the District Reproductive and Child Health Coordinator of Makete District Council. “Most women and their family members are aware that HIV, malaria and anemia are rampant in the area, and can contribute to deaths of women and newborns if advice from the ANC clinics is not considered adequately,” said Ngogo. “I have seen that Makete District health care providers are increasingly emphasizing what are the danger signs in pregnancy, labor and postnatal periods for both mother and newborn and advocating immediate reporting to nearest health facility.”
All 33 health facilities in Makete now have one or more service providers trained in FANC. These health care providers have helped pregnant women organize birth plans that include identifying a specific health facility and arranging for money and transport at the time of the baby’s birth. Services for the prevention of mother-to-child transmission of HIV (PMTCT) are also available at all health facilities where preventive care and treatment are being provided to mothers with HIV.
Like many HIV-positive women, Tatu isn’t sure how she contracted the virus. Her husband has delayed being tested. “He sometimes claims he tested and he is negative but I do not believe that…,” Tatu says warily. Despite these difficulties, she has been very pleased with the care and support she has received through the MAISHA program. “I feel cheerful whenever I come for my pregnancy check-up,” she says. “I get time to talk about my progress; providers give me options in addressing problems in addition to getting medicines and estimating my immunity [CD4 count].”
The encouraging experiences of pregnant women, such as Tatu, have encouraged health care providers to strengthen their outreach to families living in rural areas. As a result, more and more mothers-to-be are seeking out clinics with staff who have been trained in the FANC approach. With higher-quality care accessible, communities have come together to mobilize and help develop and furnish clinic space as well as provide transportation to clinics for pregnant women and mothers, especially during emergencies.
In some villages, young men have organized efforts to ensure that mothers get to health facilities, using a locally made wheelchair or stretcher if no other means of transport is available.
Ngogo says an increase in male involvement in other reproductive and child health services is becoming evident. For example, some men are now escorting their wives to ANC clinics and taking a more active role in the health of their families. With more support from community members, as well as family members, expectant mothers no longer have to bear the burden of pregnancy care alone.