The objective of project is to empower women of child bearing age through increase in their income, to enhance their access to reproductive health knowledge, care and services, as contributory factors towards the attainment of the MDG targets on infants and maternal mortality reduction by 2015.
Following the development of the project concept with funding support from UNFPA, the commencement of project implementation was preceded by an assessment of the economic empowerment and reproductive health needs of the target communities through a base line survey enriched by findings of focus group discussions conducted in all the villages. The empowerment needs centered on the improvement of the economic and livelihood activities prevalent in the communities and facilitation of the initiation of other income generating activities of their preference.
The economic activities in the village cluster range from farming of food and cash crops, individual and community gardening, limited fisheries-related activities to the felling, collecting and sale of firewood. The needs identified to improve these activities included the provision of biological production inputs such as seeds and fertilizers, mechanical equipment such as tractors, sinehoes, power -tillers, seeders, weeders and harvesters, the construction of an access bridge to their farm land, a boat for transporting farm produce, the sinking of boreholes, fishing equipment and materials and market outlets for their produce. Other economic activities they expressed interest in venturing into included sewing, soap making, tie and dye, bakery operations, peanut butter manufacturing and small business operations in the form of village shops and canteens.
The RCH needs identified by the village communities included improvement of referral services through facilitation of access to horse carts, ambulance and commercial vehicles; the establishment of blood banks, equipping and improving service delivery in Kaif Health Center, which serves the entire village cluster, through the provision of water and electricity, medicaments and delivery sets. The needs to train and equip TBAs and promotion of positive attitude of staff of health facilities were also expressed. The solutions put forward entailed incerased knowledge and information, improved nutrition and food security, the provision of ambulance services, improvement of the physical conditions of the road network in the district as well as equipping and appropriately staffing of the health facilities.
The gender sensitiveness of reproductive health care and services was factored in the project design. The needs of the male population of the villages were assessed and the manner in which they could support their women partners explored in the quest for improved access to reproductive health services through economic empowerment. The village men were unequivocal in asserting support to their economic activities as strategic means for improving the collaborative reproductive health partnership with their women folk.
Using its model holistic/integrated approach, BAFROW responded to the identified needs by building on the strengths of the village communities and modest attempts at economic empowerment to alleviate their livelihood constraints. This has translated into a down-sized and scaled- down intervention working through the “Kabilo” system. The “Kabilo” is an occupational, task-oriented socio economic group with co incidental ethnic, locational and age affinities. Their relationship is one of positive rivalry and competition for excellence in task performance and hence members are highly motivated. Thus all “Kabilos” in the project area identified two representatives from each village for training as “Kabilo Bama” i.e. mother of the community, to serve as conduit of RCH information through counseling and encouragement of women to seek antenatal care from and deliver in the health facilities. The criteria for the selection of candidates for training and designation as ‘kabilo bama’ included demonstration of willingness to learn and be available, ability to keep secrets, respect of confidentiality and one’s right to privacy.
TRAINING OF COMMUNITY HEALTH COUNSELORS AND KABILO BAMAS:
Training has been conducted for “kabilo Bamas” using Participatory Rural Communication Appraisal (PRCA). This involve processes through which communities are able to discuss, identify, analyze and understand a given problems or issue that needs to be addressed and propose possible solutions. With the help of various tools, they are able to come up with qualitative as well as quantitative information and data on such issues, while at the same time increasing their awareness, and improving their knowledge on these issues.
There are 24 “kabilos” in the project area of seven villages and each Kabilo is served by two “kabilo bamas”. The “kabilo bamas” are trained in counseling in the area of reproductive health care to include required antenatal care and services, labour, delivery, post natal and infant care as well as sensitization on the advantages of delivering at the health facilities. This body of knowledge they are to impart to women on the individual basis during counseling and at community level during regular sensitization.
FUNCTIONAL LITERACY TRAINING
The “kabilo bamas” and some women in each village are engaged in functional literacy in the subjects of numeracy; book keeping and basic business management to enable them manage their income generated activities.
Through the functional literacy, women are also engaged in actions on behavior change interventions on sexual and reproductive health to empower then and their communities with knowledge and skills that will enable them to make their own decisions including the protection of their sexual and reproductive health and rights.
INCOME GENERATING ACTIVITIES:
Each kabilo has been provided with D20,000 as seed resources for the commencement of the income generating activity of their choice. This was preceded by training on the development of a business plan to factor repayment, contribution towards a revolving fund for access to loans of higher amount as well as profits that would be earmarked for reproductive health care expenses. “Kabilos” have purchased jerry cans to store water, battery lamps as well as bed sheets and curtains for use to hedge against lack of water, electricity and household materials at the health center at the time of delivery. Arrangements have been made with taxi drivers for emergency evacuation to the health facility. Villages have established a micro community health insurance scheme from which they could borrow for referral facilitation. There are also plans to provide a mother’s kit for use at the time of delivery. The kit is to contain needed items such as soap, sanitary pads, spirits, mackintosh and wrapping cloth etc. during delivery.
MALE ACTION GROUP
One of the landmarks of the Empowerment Project is the formation, capacity building and support of Male Action Groups to support women and girls sexual and reproductive health and rights. Work with men revolves around the concept that partnership with women can bring greater success in the home, at the community and within the state. That masculinity is manifested in positive ways including supporting partnerships between man and women, respect for women’s views and ideas, creating space for dialogue between partners and taking informed decisions, and sharing responsibilities particularly with respect to issues of sexuality, child bearing and child rearing, empathy and support during pregnancy, and prevention of gender-based violence. These principles guide all discussions and interventions with the Male Action Groups on family and reproductive health issues. Each group has formulated activities on how to collaborate with their partners in family planning, how to support them during pregnancy and how to improve the referral system in accordance with their means. The two focal persons identified in each of the seven villages meet monthly to share information and experiences. Blood donation activities have been initiated in all of the villages. Each male action group runs a register with the name of each donor as well as his blood group
SETTING UP OF BAFROW’s model INFORMATION and Empowerment CENTER-“MUSU BUNGO” (HOUSE OF WOMEN):
The operation of information and empowerment centers are effective strategies of empowering women. This has been piloted in the village of Madina Sancha and equipped with television and furniture for sensitization and group meetings. Such facilities will be replicated in all the seven villages.
MONITORING AND REPORTING TOOLS
Each community health counselor and “Kabilo Bama” has been provided with activity forms for use for each pregnant women counseled and a form for the summary of monthly activities. The activity form facilities the collection of data enhanced by pictorial expression of the danger signs during pregnancy and the use of the flip book, fact sheets, the apron and the video recording of the various IEC tools. Danger signs graphically demonstrated include high blood pressure, excessive vomiting, severe head ache, bleeding, draining water early (liquor) and anemia.
DEVELOPMENT OF IEC MATERIAL:
The IEC tools developed include a flip book, the maggi apron, fact sheets,audio visual recording of the tools and their use, promotional T-Shirts, Caps etc.
- The flip book on maternal care is for use by community health counselors, “kabilo bamas”, TBAs and health extension workers. Contents cover antenatal care as well as information on labour, delivery and post natal care.
- The maggi apron is a pictorial depiction of the reproductive organs, various stages of the reproductive cycle and process, positions of the foetus to include both the ideal and the inappropriate.
- The fact sheets also pictorially promote care at the antenatal clinic, proper nutrition during pregnancy and the post natal period, the different types of contraceptives, birth plan to include expected date, place and mode of delivery, importance of post natal care and family planning as well as infant care to include breastfeeding, immunization, follow up and registration at birth.
- The audio visual recording of the sensitization tools and their use is done in English,
Mandinka, Wollof and Fula. Each village is provided with video equipment and a generator.
- Promotional t- shirts have been produced with messages such as;
- Taking control of our economic and reproductive health
- Supporting women sexual and reproductive health and rights
- My sexual and reproductive health in my own hands
Some Major achievement
- Number of deliveries at the health center has increased by 74.1% as against 41.3%, hence a reduction in home delivery by 25.9% as against the 58.7%
- Early booking and Antenatal attendance has increased
- Clean water and light is now available in the health centre due to innovative community initiatives such as the purchase of battery lamps and water containers
- Male support and participation has increased
- Micro community health insurance scheme established from income generating activities has to some extent eased referral challenges.