Reducing Maternal Deaths Through Home Health Promoters

Only 40% of people in South Sudan are within reach of health facilities and have consistent access to primary health care services. The Boma Health Initiative seeks to provide sustainable delivery of essential health care and public health programmes at the community level. Less than half of the population can access health facilities due to a shortage of skilled birth attendants, increasing the maternal death rate.

50-year-old Rebecca Yomo, one of the few trained mid-wives in South Sudan currently working at Ayong Chong Primary Health Care Unit (PHCU) in Wau that provides Ante Natal Care (ANC) services. Rebecca notes that the ANC normally hosts up to 70 pregnant women given awareness raised by the home health promoters (HHP) about this service.

This number however goes down because of cultural beliefs within the community associated with hospital deliveries. Such as when a woman delivers at home she can reveal the number of lovers she has had, but if she delivers at the hospital it is believed that she is given medication which conceals this revelation. Because of these archaic beliefs, most women prefer to deliver at home. Rebecca explains that she can go for a month with only one delivery taking place at the unit.

The Primary Health Care Unit (PHCU) is one of the facilities receiving renovation support through HPF. Initially, before the rehabilitation and renovation of the hospital buildings, the community used to receive health care services under a tree. The only other alternative was to walk close to 66km to seek medical help from the Wau teaching hospital. This was time consuming and most patients would die along the way. The construction of hospital buildings has been of great assistance and enhanced quality service delivery.

Incentives such as provision of a mama kit which includes a mosquito net, soap and a towel and the provision of porridge during ANC visits encourages women to attend ANC services. A mother notes that, the facility has transformed their lives and now women have access to drugs for free, before they had to sell livestock to get drugs from Wau.

HPF is currently training more home health promoters (HHPs) to create awareness about ANC in the community. The HHPs are the entry point in the community and comprise six men who will run the awareness campaign. It is important to note that men are chosen because they are more educated, and the area’s cultural beliefs favour them. It is very highly unlikely for a woman in this village to participate in outreach activities because the community believes that women’s duties revolve around household chores. It is a patriarchal society. HPF hopes to challenge some of these stereotypes held by men and refer more women to seek delivery services at the hospital to reduce maternal deaths.

Many maternal deaths are preventable when women have access to quality ante- natal and post-natal care, along with a safe delivery environment where skilled personnel are available, and emergency obstetric care is provided. Ending preventable maternal deaths within a generation is achievable but progress is still a bit slow.