1. FBO’s and Women’s, Maternal, and Neonatal Health Care A Review of Faith Based Models of Community Based PNMCH

2. Overview of Presentation ► Background of Initiative to Review FBO Work in Community Based PMNCH Programming ► Indicators Reviewed ► Review of Community Based Programs  World Relief  Jamkhed  Church of Central Africa Presbyterian ► Conclusions/Recommendations

3. Background ► Role of FBOs in Women’s Maternal, and Neonatal Health under recognized ► Presence of Faith Based organizations, churches and hospitals ► JHPIEGO and IMA World Health Collaboration on ACCESS Project

4. Indicators Reviewed ► Infant Mortality ► Immunization uptake ► Use of Antenatal Care ► Exclusive Breastfeeding ► Uptake of Family Planning Services ► Rates of Malnutrition

5. MCH Programming in Mozambique

6. Situation in Mozambique ► 4 out of 10 Mozambicans live on less than $1 per day ► 3 in 10 children in Mozambique die before they reach the age of five ► Ten years ago, when a child got sick or died—mothers blamed witchcraft because they did not know the truth about disease.

7. WORLD RELIEF Vurhonga Projects I, II, III ► World Relief’s “Care Group Model” trains volunteer health promoters in Mozambique:  Every household in five health districts learns the truth about hygiene, nutrition, immunizations, diarrhea, malaria control, etc.  Every household in five health districts learns the truth about hygiene, nutrition, immunizations, diarrhea, malaria control, etc.  The result—communities change as families protect and care for their health

8. Care Group Model ► 5 Supervisors ► 26 Promoters ► 220 Care Groups of 10-15 Volunteers ► 10 Households per Volunteer

9. Care Group Model cont’d ► Goal: Achieve sustainable impact by engaging a network of community health volunteers and training them in “Care Groups” as behavior change agents.

10. Care Group Model Cont’d  Each volunteer commits to sharing knowledge with 10 neighbors. Knowledge transferred mother to mother. Combat Dehydration ► Facilitate Practice of Birth Spacing ► Follow Good Nutrition and Hygiene Habits ► Learn Importance of Breastfeeding, Vitamins, Iron Supplements, and Immunization

11. Care Group Model Results Project Results from Chokwe 1999-2003 INDICATORBASELINEENDLINE ANC Visits 30%90% Delivery by trained provider 66%85% Increased food consumption during pregnancy 45%82% Exclusive Breastfeeding 10%79% Knowledge of STI Prevention 0%53% Family Planning use 7%29% ITN Use for under 5’s >1%85%

12. Community Rural Health Project: Jamkhed

13. CRHP Model ► The Village Health Worker (VHW) acts as the local agent of positive health and social change. She is selected by her community and receives training in health, community development and organization, communication skills, and personal development from CRHP.

14. Village Health Workers cont’d ► VHW training was designed to empower these often oppressed women by increasing their knowledge, building skills, and demystifying medicine so as to truly put health in the people’s hands. The initially high rates of diseases and premature deaths in the area were primarily linked to malnutrition, water-borne diseases resulting in diarrhea and infections, untreated communicable diseases, lack of family planning, and harmful superstitious beliefs and practices. The training these women received opened a doorway for effective, locally-managed and relatively simple interventions to halt this vicious cycle that was causing so much pain and suffering.

15. VHW Delivering Basic Care

16. CRHP Model Cont’d ► What Do Village Health Workers Do?  Visit households and share information  Work directly with women’s, youth, and farmer’s groups,  Teach about harmful cultural practices such as discrimination against women  Refer severe health conditions to the hospital

17. VHWs in Action

18. CRHP Model ► To Improve PNMCH, Jamkhed has:  Promoted a comprehensive approach to health and empowered the community to improve infrastructure, water quality, hygiene, etc through multi-sector approaches.  Introduced participatory decision making at the community level by encouraging community meetings and working with women’s and youth groups on skill development  Mobilized the community to emphasize beneficial traditional practices and eliminate harmful ones.

19. Outcomes for CRHP Villages Indicators19712004 India (2004) Crude Birth Rate 4018.623.9 Infant Mortality Rate 1762462 Access to ANC 5%99%64% Safe Delivery <5%99%64% Use of Family Planning <1%68%41% Immunization (<5) 5%99%70% Malnutrition (<5) 40%5%47%

20. Additional CRHP Outcomes ► People now willingly accept family planning since they no longer expect their children to die from communicable diseases. ► Most health problems are effectively taken care of and monitored at the villages themselves by well-trained and confident VHWs. ► The impact of CRHP’s training activities has led to a true grassroots movement for health and social justice, shaping public health policy as well as the direction taken by health conscious NGOs involved in development work.

21. Church of Central Africa Presbyterian ► Operating in areas with traditionally low coverage in terms of availability of services ► Local Congregations promote women’s and children’s health through their women’s groups. ► Engages religious leaders in delivering health messages. ► Provides health messages through youth groups

22. CCAP cont’d ► Malaria Prevention Program provides the following:  Health Education about prevention and early treatment of malaria  Insecticide Treated Nets at subsidized prices to pregnant women and children five and under  Re-treatment of nets  Follow up services for pregnant women and children who have malaria

23. Insecticide Treated Net

24. CCAP Program Impact ► High percentage (81%) of respondents aware of benefits of sleeping under a mosquito net. ► Significant increase in the percentage of respondents reporting having nets in their homes

25. Conclusions and Recommendations ► Community, and congregation based FBO health programs are a valuable national asset and provide a critical link to ensuring access to health care, especially for rural and marginalized populations ► FBO led community based programming is one of the most effective and sustainable avenues for ensuring health women, mothers, and babies and should receive political support from governments, as well as financial support from donors.

26. Thank You Sarla Chand, MD IMA World Health sarlachand@imaworldhealth.org 410-635-8720 Jacqui Patterson MSW, MPH ActionAid International USA Jacqui.Patterson@actionaid.org 202-370-9916 To DOWNLOAD a copy of this report- www.accesstohealth.org www.accesstohealth.org