Helping Hibo Reach Mothers and Children in Her Community
Understanding a community’s needs is essential to improving the usage, quality, and availability of maternal and child healthcare services. Community health workers can make a huge difference in increasing the number of people accessing services.
Hibo, a 28-year-old healthcare provider in the Somali region of Ethiopia, knows this from experience. She works in the Togochale Health Center, where there is low attendance for maternal and child healthcare services. Hibo sees firsthand how most women in the community do not use family planning, attend antenatal care, or deliver in facilities. In fact, over half of the births in Ethiopia are not attended by skilled birth personnel, and in the Somali region, that number is over 70%. The contraceptive prevalence rate for all women in the region is only 2.8%.
She understands that service quality, accessibility, and cultural acceptance are barriers to the care so many need. Many people in her region live in hard-to-reach areas or are part of pastoralist communities. Patriarchal ideals are deeply embedded in Ethiopian society. These harmful social norms prevent girls and women from fulfilling their sexual and reproductive rights, particularly in pastoralist and agrarian communities.
Hibo is frustrated that mothers and children are dying from preventable causes, and she wants to help more of the community—they’re just not coming in for services. But she is determined to change that.
EngenderHealth’s approach to supporting Hibo consists of improving the quality of care, adapting tools for pastoralist regions, integrating a Gender, Youth, and Social Inclusion approach for service delivery, creating unique service delivery and strengthening referrals within communities and healthcare facilities, ultimately improving the ability to deliver culturally acceptable, accessible, and high-quality health services. We provide training, mentoring, and supportive supervision adapted from EngenderHealth’s previous experience and success in helping the Ethiopian Ministry of Health roll out clinical mentorship in more than 1,000 primary healthcare facilities. Building on the experience of a local partner, we support local health systems to deploy health promotion, mobile, and outreach services at marketplaces, water points, and in hard-to-reach pastoral areas, specifically focusing on services for women, children, and youth.
Healthcare providers like Hibo have a lot working against them. They must navigate incredibly challenging situations—from struggling health systems, emergencies, and conflict to deeply embedded harmful social norms—that hamper progress in improving reproductive, maternal, newborn, child, and adolescent health services in their communities. But together, we can ensure they are able to best serve their communities.
EngenderHealth’s Family Planning by Choice (FPbC) program was built on the Ethiopian government’s existing three-tier health service delivery system. FPbC established, operationalized, and institutionalized a system of clinical mentoring and supportive supervision focusing on comprehensive contraceptive and abortion care. FPbC strengthened the system and enhanced the capacity for in-service clinical training, including establishing training centers at the six centers of excellence and learning zones. FPbC also strengthened clinical quality audit and quality improvement systems. This included revising or developing national tools for clinical auditing, establishing and revitalizing clinical quality teams at health facilities, providing orientations to clinical audit teams, and working alongside existing government clinical quality structures. Based on capacity needs assessments and gap analyses, EngenderHealth’s FPbC staff also developed and implemented comprehensive capacity-building packages for health systems in partnership with the MoH.
Through the Family Planning by Choice program, Hibo was trained, mentored, and participated in gender and youth sensitization activities and now better understands her community’s needs. Because of this, she has been able to tailor her services to be culturally appropriate and responsive to the needs of the women and youth she wants to serve. Lately, she has noticed an increase in the number of people coming to the Togochale Health Center for reproductive, maternal, adolescent, and child health services, which she credits, in part, to the improved referral system and the increased quality and responsiveness of services they can offer. Despite the many challenges Hibo faces, she is committed to providing high-quality, holistic care for her patients and now has the tools to do that.