In many villages, community leaders — chiefs, religious leaders, leaders of grassroots organizations, employers — play an important role in reinforcing social and cultural traditions and practices, and can play an equally critical part in changing them. In a range of programs that comprise our Missing Partner Initiative, FCI engages these leaders and groups in efforts to improve the quality of maternal health care and to remove the barriers that dissuade women from using the services that are available. We work with communities as partners, rather than as mere client populations or targets for informational campaigns. All of our projects are designed with full community participation at all stages.
FCI's community engagement projects
In developing the Missing Partner Initiative, FCI engages communities in a variety of projects aimed at improving the quality and increasing women’s utilization of maternal and reproductive health services. Recent examples include:
In the northern Sahel region of Burkina Faso —a landlocked, desperately poor country in West Africa where FCI has been selected as a core strategic partner of the Ministry of Health — FCI has
helped residents of nearly 700 rural villages, most of which lack even basic health clinics, arrange transportation so that women with obstetric complications can get lifesaving care they need
worked to gain community leaders’ support for skilled care attendance at delivery
trained 1,000 community outreach agents to encourage women to give birth in facilities with skilled staff
provided more than 300 women with surgical treatment for obstetric fistula, a childbirth injury that often leads to a lifetime of illness and social ostracism
taught grassroots organizations to identify obstetric fistula survivors and help them access care and reintegrate into society
In the cities of Bamako and Mopti in nearby Mali, a distinctive feature of FCI’s work to increase the knowledge of out-of-school young people about their reproductive health and rights has been our focus on influential adults in the community, including religious leaders and employers. Experience has shown that raising authority figures’ awareness of sexual and reproductive health issues, and improving their ability to communicate with young workers, can help increase the impact of education programs on hard-to-reach youth.
work with community-based management committees at rural health centers to enable them to better understand their roles and responsibilities and the management skills needed to fulfill them; to be more knowledgeable and sensitive about maternal health; and to better represent community needs when interacting with the facility staff
engage committee members and community leaders in exploring the human rights dimensions of maternal health, addressing the barriers that limit women’s access to life-saving maternal health care, including lack of health care autonomy, unavailability of transport, and lack of emergency loan funds
conduct workshops to train and motivate community leaders to encourage women to prepare in advance for delivery, involve husbands in planning and decision-making, deliver at a health facility, and return for postpartum checkups
FCI also prioritizes community engagement in all our work in Latin America. In many countries of Central America and the Andean region, indigenous women are likely to have the least access to reproductive health services and are most likely to suffer a maternal death or disability. They face discrimination at health facilities and cultural barriers when seeking care. FCI addresses these gaps by:
bringing local health care providers together with community leaders and local women in innovative partnerships to make health services more culturally relevant and responsive
working with technical partners to develop basic standards for monitoring the “cultural responsiveness” of maternal health services throughout the Andean region
working with indigenous communities in two rural areas of Bolivia to build bridges between health care providers and users by promoting community wide dialogue
working with indigenous health promoters to heighten awareness about the causes of violence against women and its impact on individuals, families and communities, and to strengthen linkages with judicial and health services for victims of domestic violence
building the capacity of indigenous organizations to conduct community outreach about HIV and AIDS, strengthening efforts to prevent HIV infection and combating the stigma that often affects people who are already infected
Watch a video (in French) about FCI's work in Burkina Faso to provide care for survivors of obstetric fistula
Read Ann Starrs' blog on the importance of communities: "Clean, accessible, professionally-staffed health centers can only save the lives of women who use them… Communities — and the respected, influential local leaders who can be such powerful agents of change at the grassroots level — need... to help change the social and cultural norms that stand between women and the skilled care that they need.”
With less than five years left before the Millennium Development Goal deadline of 2015, MDG 5 — Improve maternal health — remains furthest off track. There is now a consensus that access to a set of basic health services — family planning and other reproductive health services; skilled care before, during and after childbirth; emergency obstetric care when complications arise; and postnatal care after delivery — are the keys to saving women's lives.
But health services can only save lives when women actually use them. When care is of poor quality, or service providers are insensitive to human rights and cultural sensitivities, many women choose not to use the services that are offered. In many villages, social and cultural barriers — traditional health practices, taboos, and gender inequities — also keep women away from clinics. And when communities don't care about and take ownership of their local health services, the quality of care often suffers. That’s why many of FCI’s programs focus on what we call community engagement, a strategy that approaches communities as the “missing partner” in efforts to improve the availability, quality, and utilization of services.
Origins of the FCI approach
FCI's Missing Partner approach builds upon work that we have implemented for more than a decade in Africa and Latin America, including our multi-year Skilled Care Initiative, which explored the individual, household, community, and health systems factors that influence women’s use of maternal and reproductive health care. Our results highlighted the importance of community leadership in encouraging women to seek skilled care:
In Burkina Faso, when village leaders actively promoted the use of skilled maternity care, maternity care-seeking during delivery more than doubled.
In Kenya, when community leaders responsible for overseeing the local clinic worked with medical staff to review maternity caseloads, mobilize and inform community members, and raise funds, services improved and more women came in and used them.
In Ecuador and Bolivia, when communities were informed about women's right to maternal health and empowered to hold facilities accountable, health services and medical staff became more responsive to local values and cultural preferences, and service quality and utilization improved.
FCI co-sponsors UN event on indigenous women
FCI, together with partners UNFPA, the Continental Network of Indigenous Women of the Americas, the International Indigenous Women’s Forum—FIMI, and the Spanish International Development Cooperation Agency—AECID, organized a side event as part of the 10th Session of the UN Permanent Forum on Indigenous Issues in May 2011. The side event — Indigenous Women, Health & Rights: Strengthening indigenous women to realize their right to reproductive health — featured presentations by indigenous women leaders from Ecuador, Bolivia, and Peru. Speakers discussed ways in which the “Indigenous Women, Health & Rights” initiative, launched by UNFPA and AECID in 2008, has strengthened the capacity of indigenous women’s organizations to advocate for safe motherhood, and discussed advances, challenges, and plans for the future.
Community leaders are crucial to increasing use of maternity services
In rural African villages, community leaders — chiefs, religious leaders, women's group leaders, and others — can have a major influence on how local people manage health issues, including pregnancy and childbirth. They also provide an important link between communities and health facilities, and can help mobilize communities to demand better health services. Many such leaders, however, have little if any information about maternal health. In 2009, FCI trained over 200 community leaders in three districts in Tanzania to encourage greater use of maternal health services. "If women in our community experience safer pregnancy and childbirth, they will have a healthier family," said one participant. During the training, community leaders developed messages tailored to their unique social and cultural environment to encourage women to seek skilled maternity care, as well as action plans for sharing these messages with members of the community.