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.