Investing in Creating Fistula Free Communities by Empowering Ethiopian Women

1. Investing in Creating Fistula Free Communities by Empowering Ethiopian Women

2. Safe Motherhood Ambassador, Kindehafiti, with Mehret and her new baby

3. Vision • To empower women who have suffered from childbirth injuries by training these women to bring basic maternal health services to their villages and providing opportunities to help them reintegrate back into their communities. 

4. Mission • To establish safe motherhood support networks around the Healing Hands of Joy Center and with the goal of preventing fistula and assisting those who have suffered from fistula to reintegrate successfully back into their communities as Safe Motherhood Ambassadors and self-sustaining members of their community.

5. OrganizationalHistory • In March 2009 HHOJ formed a Steering Committee with the Tigray Health Bureau, the Mekelle Fistula Hospital, the Tigray Women’s Association and the Tigray Women Affair’s Bureau. • In June 2010, the Pilot Project was established and the Safe Motherhood Ambassador Curriculum was created with the Tigray Health Bureau. • In November 2010, the HHOJ Mekelle Center opened.

6. The center

7. HHOJ Pilot project sites • Enderta Wereda/county • Saharti Samre Wereda/county • Mekelle

8. Programs • Safe Motherhood Ambassador Training • Community Engagement Campaign • Community Training

9. Safe Motherhood Ambassadors (SMAs) selection criteria: • Cured fistula patient • Desire to be an SMA and willing to teach her community by monitoring and mentoring • Available for month-long training • Desire for income-generating skills training and able to accept loan

10. Safe Motherhood Ambassador training curriculum • Maternal Health Care: • Cause of fistula and how it can be cured and prevented • Family planning • Different contraceptive measures • Maternal and child health • Pregnancy, ANC and safe institutional delivery • Hygiene and sanitation

11. SMA curriculum continued • Ambassador responsibility training: • Self-confidence building skills • Encourage participation in cultural community ceremonies, which help strengthen their reintegration process. • Communication skills • Identifying fistula patients and report to a near by health institutions. • Complete pregnant women registration lists • Making sure if the pregnant women are having ANC and delivery at the institution.

12. Curriculum continued • Spiritual guidance • Psychological Counseling • Literacy training • Uniform given • Income Generation Activity (IGA) training • Receive a revolving fund loan equivalent to 150 USD to help them lead a self sustainable life. • Sheep and goat breeding and fattening • Dairy farm • Buying and selling cereals, fruits and cereals. • Handicrafts • Poultry farm etc

13. SMAs graduating

14. Community Engagement Campaign • Community Engagement events are planned and held at the county and the village level to raise awareness about the importance of safe delivery as well as fistula prevention, identification and treatment: • Film screening “Fistula is Not a Curse” • Live drama performance “Fistula is Not a Curse” • A song is created about fistula. • SMAs introduced and present their testimonies. • Promotional materials distributed such as brochures with information about the treatment umbrellas, T-shirts and scarves to reinforce message • Advocacy workshop was conducted with the area leaders.

15. Community Engagement Campaign: Quiha

17. Community Training Components • To properly monitor and integrate our program activities in the pilot areas we conducted community training of Health Extension Workers, Women’s Association, religious leaders, Midwives and MCH experts for 2 days on Safe Motherhood Activities (including SMA responsibility), Fistula Prevention & identification.

18. Community Trainings

19. Community Training

20. Programs Implemented • 9 classes of SMA trainings were completed. • 71 SMAs graduate. • 4 CECs were performed (Samre town, Arato village, Mekelle and Quiha). • Two community training conducted (Samre and Enderta). • M&E of the pilot project with partners conducted (Samre and Enderta) • M&E data collection in process for Samre and Enderta.

21. Monitoring and Evaluation • Methodologies • Primary data • One on one interviews with SMAs (19 in Enderta & 18 in Samre) • Focus Group Discussions • Interviews with health workers • Secondary data • Gathered from the health offices

22. Focus Group Discussion

23. M&E Findings

24. Safe Motherhood Ambassador, Alem Weldebrhan, and Mother institutionally delivered

25. IGA activities

26. IGA activity

27. One SMA Testimony • Abadit Miruts, Ederta Woreda, 5th class of Safe Motherhood Ambassadors

28. Abadit delivering small advises

29. Abadit in her shop

30. Abadit with her daughter and sheep

31. M&E Findings CEC • In Aratu, out of 300 audience members 108 film questionnaires were distributed there was a significant difference in understanding the causes of fistula.

32. Key Lessons Learned • Incurable SMAs had greater difficulty approaching women in their community. • Health Extension Workers are key partners and will be provided with a form to quantify the impacts of SMAs in their community in all aspect. • Individual Impact of the SMA training was profound, the work within their communities needs support. • Economic Empowerment improves the status of a former fistula patient in her community which allows greater access. • Women’s Association needed to sustain the loan. • One-month seems to be a good timeframe for training.

33. Recommendations For Better Future Impact: • SMAs and pregnant women who deliver institutionally get some kind of incentives for their motivation which is sustainable. • 2-3 dollars each for one delivery. • Delivery kits for mothers. • 1% off from their loan • Safe Motherhood Ambassadors should form Associations to strengthen their impact • Workshops should be conducted with the SMAs every six months for experience sharing and follow-up

34. Recommendations • Monthly monitoring should be conducted for the SMAs through the Women’s Association. • Targeted approach to involving Wereda/ county administrators/ and Religious Leaders should be including to discuss fistula prevention and barriers to maternal health care. • Maternal Health Partners needed to provide transportation assistance for the community to improve the institutional delivery. • The community engagement campaign was found to be very important in raising the level of awareness among the community and hence should be scaled up to other communities of the counties.

35. Thank youwww.healinghandsofjoy.com