In Burkina Faso, the Skilled Care Initiative was implemented in the Ouargaye District in the Tenkodogo Region in the eastern part of the country. Burkina Faso has one of the highest maternal mortality rates in Africa, and only one in four births take place in a health facility.
FCI and the Ministry of Health implemented a set of health systems interventions, which included working closely with district health officials in Ouargaye to improve the quality and availability of maternity care. Extensive training was conducted to strengthen the clinical skills of maternity care providers, and a quality assurance approach, COPE® for Maternal Health Services, was introduced at a number of health facilities to engage staff in identifying and addressing quality of care problems. Other activities included strengthening of the health infrastructure by installing solar panels at selected facilities and staff quarters, constructing of a new maternity at the district hospital and improving client privacy in examination rooms. FCI also supported the purchase of two-way radios and an ambulance which is stationed at the district hospital for emergencies.
Complementing these interventions at health facilities, FCI worked with local partners to implement a broad-based behavior change and community mobilization campaign. These interventions included antenatal counseling birth preparedness and a community-level behavior change communication (BCC) campaign on the benefits of skilled maternity care before, during and after childbirth. The campaign included theatrical and musical performances by local performing artists and community outreach agents trained to conduct health education sessions with local residents. Similarly, community leaders were sensitized to maternal health issues and encouraged to promote skilled delivery care to their communities.
A substantial increase in the percentage of births in health facilities was noted; 25% at baseline to 57% at endline. A significant increase was also seen in the percentage of poor women with complications delivering at a health facility.
Important improvements were observed in the capacity to provide high quality maternal health services, especially at the lower-level health centers, which were a major emphasis of the project, given their greater accessibility to women in rural communities.
There was a significant increase in the use of antenatal care (ANC) during pregnancy and the proportion of women with more than two ANC visits during pregnancy almost doubled.
The study found a considerable increase in the number of women who were counseled on danger signs of problems during pregnancy and childbirth.
A full report (French) and summary on the key findings and recommendations are available for download.
In Ouargaye Province, the Skilled Care staff met a traditional leader, whose family always used a traditional birth attendant and delivered at home. As he learned more about the initiative, he came to appreciate the importance for women to deliver at the health facility, and committed himself to advocating for institutional delivery. He began meeting with pregnant women in his community to urge them to deliver at the newly upgraded health facility. Within two months, his brother's wife, his uncle's wife, and his own wife delivered at the health facility. As soon as his baby was born, he called FCI to say proudly "The little Prince is born at the health facility!"
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While visiting families in his village, a Skilled Care Initiative community outreach agent met a couple who encountered severe financial difficulties during two previous deliveries. In both of these deliveries, the woman unexpectedly had to go to the health facility with serious complications. The couple was forced to borrow money from neighbors in their community to pay for the services. When they encountered difficulties repaying these loans, they faced public humiliation.
Following advice from the trained community outreach agent, when the woman became pregnant a third time, the couple decided to prepare for delivery. Starting in the second month of pregnancy, they put money aside every month to be held by a trusted elderly person. This time, when the woman delivered at the health facility, the couple was prepared to pay for the associated costs. Since then, the couple has been sharing their experience with all the families in their village, encouraging others to follow the same path.
Skilled Care Initiative Delivers Impressive Results
Between 2003 and 2005, FCI worked with Ministries of Health in Burkina Faso, Kenya, and Tanzania to improve the quality and availability of maternity care, improving services for thousands of women. Through an ambitious research effort, FCI evaluated and documented key strategies for increasing skilled care during childbirth. Click here to download an overview of the results from all three countries.
Safe Motherhood In The Community: A Flipchart This flipchart focuses on care during pregnancy, delivery, and the post-partum period.
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