Neighbourhood health committees out to reduce maternal mortality

By MELUSE KAPATAMOYO

The day is September 25, 2012 and I am at Chaisa Health Centre to be part of a Focus Group Discussion (FGD) on Maternal and Child Health being held by Alliance for Community Action on HIV and AIDS in Zambia (Alliance Zambia), with Neighbourhood Health Committees (NHCs).

Despite it being a windy day, as soon as I step out of the vehicle, am greeted by a strong stench emanating from a nearby sewer. Fortunately my attention immediately shifts to a large crowd of women and children attending an Under-Five Clinic. What is even more striking is that the majority of these mothers are still children themselves.

Before my brain can process the situation and begin to ask the necessary questions, my focus is drawn to a screaming baby. I curiously watch as the young mother struggles to calm the child down.  Looking somewhat embarrassed and irritated by the child’s screaming, she starts to remove the baby’s clothing, signaling that perhaps the September heat could be the reason for her Childs discomfort.

But that doesn’t calm the child down, forcing one elderly woman to ask if the child is sick. Her response, ‘This is the way she cries. She will stop on her own. I am used to it.’  The woman suggests that she should perhaps try and breast feed the baby. Having drawn everyone’s attention already, the young mother reluctantly gets ready to feed but the young mother lamentably struggles to hold on to the breast and at the same time hold on to the child. It is clear that she is yet to grasp the art of breast feeding. 

Luckily for her, she gets a free lesson from the elderly woman who teaches her how to hold the baby’s head comfortably, while holding on to the breast to prevent chocking. In just a few minutes, the child’s screaming is replaced by the normal noise of other children, running around the clinic compound as the crying baby falls asleep.

“That is a daily occurrence around here. We have children, having children. And when these children have children, they have no idea of what it takes to be a mother. The situation is made worse because most of them miss out on ante-natal where they can be taught some of these things such as the importance of nutrition. Instead of attending ante-natal the girls try by all means to conceal their pregnancies,” says one NHC member when I shared the story of the young mother and her breast-feeding dilemma during the Focus Group Discussion. 

“About two months ago, an 18 year old girl gave birth just outside the clinic. She had kept the pregnancy hidden until she went into labour, by the time they got here, it was too late. They couldn’t get her inside the clinic. It’s a difficult situation, we are dealing with mothers who not long after delivery start to live the child in the care of younger siblings or old grandparents, depriving the baby of breast milk and motherly care,” added another NHC member. 

According to the NHCs, as high as the turn-up of mothers who bring their children for under-five clinic at Chaisa Health Centre may seem, the number of women that stay away was equally high.  The clinic covers three catchment areas; Marapodi, Chaisa and Mandevu.

Some of the reasons they absconded from accessing health care services at the clinic included; long queues caused by lack of adequate staff at the health centre and lack of family planning knowledge, which often leads to some mothers getting pregnant soon after delivery, making it difficult for them to live home and take all their children for under-five clinic. 

However, some women find taking a malnourished child to the clinic embarrassing. Instead they choose to keep the child hidden even from neighbours than admit they are unable to provide a proper diet for it. This is despite having knowing that through NHCs the clinic offers free nutritional supplements for malnourished children and also free cooking lessons.

While some of these challenges are being addressed by NHC’s in the area, others are beyond the committee’s capabilities and can only be handled by relevant authorities such as councilors, Member of Parliament (MPs), Ministers/Ministries.

Realising the important roles that NHC’s play in communities and the urgent need for these maternal health challenges to be addressed by authorities, a suggestion was born by Alliance Zambia, with support from Save the Children Sweden (SCS), to hold an  Advocacy training on Maternal and Child Health for Mungule and Chaisa NHCs. 

Together, and in collaboration with health centres in Mungule (Chibombo) and Mandevu (Lusaka) the two organisations are implementing a project that will see a two third reduction in morbidity rates for children under five years old in Zambia by 2014. The project is also promoting safe motherhood and is contributing towards improving maternal health in Zambia by 2014 and reducing maternal mortality by three quarters, thereby contributing to Millennium Development Goals (MDGs) 4 and 5.  

The two day training was held in Lusaka and attended by 10 participants from Chaisa and Mungule, an area where maternal health challenges are rampant and where two Focus Group Discussions were held prior to the training.  Each NHC was represented at the training by five participants.

Key points in the training included brainstorming major health challenges affecting women and under five children in Mungule and Chaisa and then depending on the particular issue, identifying targets they could advocate their problem to.

Although both areas faced similar problems, they chose different issues as the ones needing advocacy.



NHC Members Stanely Banda (R) and Leonard Mwewa during the
Alliance Zambia training.



“For a long time we have had major issues in our communities needing urgent and serious attention from our leaders, but didn’t know how to approach them. It was difficult to find ways of tackling these issues. The training has indeed opened my eyes to the many different methods we can use to air our views and most importantly get the attention of our leaders,” said Chaisa NHC member, Stanley Banda, enthusiastically, at the end of the training.

And Mungule’s Catherine Himoonga said, “Advocacy used to be such a strange and complicated word to me, now I understand it and how to go about it. I can’t claim to be an expert but it’s good that the team from Alliance Zambia have committed themselves to be available when we need help. We have always been silent and do nothing when things go wrong in our community but with this training, we now have an idea of how to go about it.” PYM. 

Be a good neighbour, stop GBV

By MELUSE KAPATAMOYO

At only 12, the life of Brilliant Muyuwa was brought to an abrupt and brutal end when she was defiled and strangled early this year.

Brilliant's death made headlines in the media and also attracted the attention of high profile people like First lady Dr Christine Kaseba, who travelled to Masupelo village in Chibombo to attend her funeral.

Since then Chibombo has remained in the spotlight and many more cases of Gender Based Violence (GBV) have surfaced. However, civil society organisations are keen to see a reduction and eradication of GBV cases in the area.

Recently, the Zambia Social Forum (ZAMSOF) and its partners; Alliance for Community Action on HIV and AIDS in Zambia (Alliance Zambia), Action Aid, Sight Savers and Oxfam in Zambia held a National Forum aimed at making known the new Anti- Gender Based Violence Act  and raising awareness on GBV to people in Chibombo and neighbouring areas.

ZAMSOF is a network of civil society organisations which is part of the World Social Forum of Civil Society Organisations (CSOs), an open space for reflective thinking, democratic debate of ideas, free exchange of experiences and interests for effective action.

The national forum was flagged off with a march past led by the vice-presidents wife, Charlotte Scott, ministers spouses, representatives from the first lady’s office, members from various civil society organisations and community members. It was held under the theme ‘Gender Based Violence, Child Rights and Abuses.’

Issues on the agenda included, HIV & AIDS, maternal neonatal, children health and voluntary medical male circumcision, climate and environment, youth and labour, governance, human rights, including the right to land and women’s rights.

Mrs Scott said it was impossible to achieve any meaningful development amid a society which experiences injustice and violation of human rights due to GBV

“More police posts should therefore be equipped with facilities to ensure this is a reality. Distance should not be a barrier to the course of justice and recourse in our communities so that women and children are adequately protected. As Zambia celebrates its 49^th year of independence, the commemorations need to move the country to another level of social justice and wellbeing should lead to reduced GBV cases,” said Mrs Scott.

For children who are victims of abuse and violence, which includes witnessing violence that is inflicted on other members of the household, this affects their mental, physical, and emotional development. It also affects their capacity to realise their aspirations and contribute to the development of the country.

Mrs Scott added that, “We know the role that women play in the country, not only in social but also economic development and if we are taking the people who are leading that process and we put them into lives of anxiety, of fear, of pain, of rights abuse then the country can’t go anywhere.”

Recent statistics from the Young Women Christian Association (YWCA) indicate that cases of GBV are still on the upswing. About 3, 733 cases were reported between January and June 2012.

NGOCC Executive Director, Engwase Mwale noted that “It is an undeniable fact that GBV reinforces the inequalities and iniquities between women and men and therefore compromises, not just the health of the victims, but also the dignity, the security and autonomy of the victims.”

She said because women and children had continued to be victims of brutal killings, rape, defilement, incest and other forms of abuse, the fight against the vice needed commitment and concerted efforts from different stakeholders if Zambia was to see a reduction in such cases.

“We are here (Chibombo) to be able to commit to work with the traditional leaders that their voice is important to end the negative cultural practices if we are to win the fight against GBV. And as a women’s movement, we are requesting the traditional leadership to ban early marriages in their chiefdoms. Early marriages have repurcations on the girl-children because it keeps them away from schooling,” pleaded Mwale.

She called on government to allocate adequate resources in the 2013 national budget so as to address the issue of shelter for survivors of GBV and also resources that will go towards putting together a gender based violence fund that will cushion the survivors of GBV.

And Alliance for Community Action on HIV and AIDS in Zambia (Alliance Zambia) Policy and Advocacy Manager, Reverand Malawo Matyola directly called on women not to live in fear but report cases of Gender Based Violence to relevant authorities.



Charlotte Scott folds the Maternal and Child Health Poster presented to her by Alliance for Community Action on HIV and AIDS in Zambia (Alliance Zambia) Policy and Advocacy Manager, Reverand Malawo Matyola, as ZAMSOF chairperson, Mary Tembo-Mhango looks on/Picture by Nkandu Chikonde from Alliance Zambia



“In our African setting, your neighbour’s child is yours too. Because that is your child too, if you notice that child is showing signs of abuse, it is your duty to report the case to authorities and if possible take the victim to the hospital,” Matyola advised.

However, he also urged health workers to be tolerant and patient with victims of GBV.

Matyola condemned an incidence where a young girl was harassed by police on her way to the hospital to collect Ante-retro viral drugs (ARVs) when she was accused of promiscuity.

“Because of the long distance to the centre, this young girl started off to the clinic as early as 04:00 but was stopped by police who accused her of being promiscuous. Such situations should not be allowed to happen. The girls’ only response was ‘I wish I was the causer of this disease, but I was born with it.’ Colleagues in the police force and clinics, let’s be friendly and render the help these victims need,” he added.

Recognising the importance for Civil Society to address GBV, Child Rights and abuses in communities, Alliance Zambia places great importance on the rights of pregnant women and children under the age of 5, to ensure they are not abused.

With support from Save the Children Sweden (SCS) the organisation is currently contributing to Millennium Development Goals (MDGs) 4 and 5; to reduce mortality and morbidity rates for children under five years old in Zambia by 2014 by two thirds and to promote safe motherhood and improve maternal health in Zambia by 2014 and reduce maternal mortality by three quarters respectively. This project is being implemented in Mungule (Chibombo) and Mandevu (Lusaka) through close collaboration with the healthcentres in the respective sites.

In Zambia, cases of mothers miscarrying due to GBV and others who die while pregnant due to the same vice are common.

The National forum which was organised by Zambia Social Forum, under the secretariat of NGOCC, Women for Change (WfC) and Zambia Council for Social Development (ZCSD) also provided eye screening checkups, Voluntary Counseling and Testing (VCT) and testing, Sexually Transmitted Infections (STIs), Male Medical Circumcision and information on Economic Empowerment.

ZAMSOF has been successfully organizing the annual National Social fora in towns and communities of Lusaka, Choma, Kapiri-Mposhi, Monze, Mansa and Chipata since 2003.

One of its many objectives includes improving participation of the general citizenry in the policy making processes of the area Members of Parliament by ensuring those peoples’ voices are registered at the national, regional and continental levels.

“Our mission is to promote and facilitate sustainable, socio-economic Development through collaboration and networking among NGOs, Community Based Organisations (CBO’s) and other stakeholders,” explained ZAMSOF chairperson, Mary-Tembo Mhango. PYM

 

Male involvement in ante-natal care equals healthy babies

By MELUSE KAPATAMOYO

Enedi Malambo, 38, is a mother of seven and is currently carrying another pregnancy due in three months.

Enedi

During all the previous seven pregnancies, her husband has never accompanied her to the Ante-Natal Care (ANC) clinic. But the eighth one is exceptional in more ways than one.

“Since my first ante-natal appointment (during this pregnancy), my husband has been coming with me to the clinic. Before, he used to refuse,” says Enedi of Kembe area, some 70km off the Great North Road in Chibombo district.

She smiles and adds that “not once did he escort me to the clinic when I was pregnant with my other (seven) children. But now that nurses insist on pregnant women coming with their husbands, he had no choice but to come with me to the clinic.”

Enedi is happy over the involvement of her husband in her current pregnancy. She says it has given him extra insight into the intricacies of pregnancy care and as such they  are now able to communicate better about her health needs.

In the past men were not obliged to accompany their pregnant wives for ante-natal check-ups. Currently most public health institutions are asking men to be fully involved in the affairs of their expecting wives. 

Pregnant women and their husbands undergo couple HIV Counseling and Testing services. In the event of both or either of them being found HIV positive, the couple can then be counseled on how to manage the infection and ensure they protect themselves from re-infection.

Where both of them are HIV negative, they are still encouraged to discuss their status and ways of ensuring they remain free from HIV infection and other sexually transmitted infections. PYM