South Sudan faces huge challenges. After four decades of war and just five years of peace there is still much to do to develop the country’s infrastructure, not least its health services.
Most vulnerable in this fragile state are women and children. For every 50 children born a mother dies. HIV increases this risk between 4-8 times.
To improve this situation, in September 2010 UK aid funded a project to increase the numbers of women attending health services, particularly those living with HIV, and to develop policies on maternal and newborn healthcare.
Increasing referrals to health services
Edward Bepo is the National Partnership Platform Coordinator (NPP), which is hosted by Alliance South Sudan. He has been tasked with galvanising civil society to implement the project.
He says transport is a huge barrier to increasing referrals of pregnant women and children from remote areas to health facilities. Ever resourceful, Action for Rights Relief and Development (ARRD), one of the scheme’s partners, piloted the use of a Raksha (tuktuk) as a community ambulance to carry pregnant women.
“When it’s not involved in referrals it is used by the local community to carry goods to market. It’s the income that helps to keep it running and pays the driver. Our idea is that the other community based partners will also receive vehicles,” says Edward.
Edward says a lack of knowledge is another barrier.
“Cultural beliefs and traditional practices continue to stop women from attending health services and many are unaware of the risk of delivering at home… HIV testing is rare; many women fear the stigma of being HIV positive and don’t understand the importance of PMTCT.
“There are a lot of maternal health and HIV issues emerging in the communities but people don’t know how to identify them. So we document them through Key Correspondents, local citizen journalists we have trained, then we share these stories. Storytelling helps people realise maternal health and HIV integration is important and something they can understand and do something about.”
Community based organisations are running training in remote communities to improve awareness of the issues.
Their efforts resulted in 2752 women being reffered during the project.
The community in action
Action for Rights Relief and Development (ARRD) is a community-based organisation in Pageri Payam district, Eastern Equatoria and a partner on the UKAid project. The organisation serves around 23,000 people.
ARRD raises awareness through peer educator talks at villages about maternal health and HIV, and supports PMTCT referrals. Since the beginning of 2011, ARRD has completed 164 referrals and followed each one up.
Margaret Oleyo, 30, has six children. Her youngest, Juma, is 3-weeks-old. “I always have complications giving birth. I have received peer education from ARRD and I know how important it is to be properly attended to for me and my baby. Thanks to ARRD I could deliver in Juma in hospital. Before, I had to pay for and find transportation to go to hospital. I don’t think I could have afforded it this time. Many families don’t even think about delivering in the clinic, even if it is close, because the clinic makes them pay for the maternity kit.”
Cisarena Yeli,38, has seven children. “I delivered my first three children at home and the rest in hospital. I almost bled to death delivering my third baby at home…That’s why I tell women here they must deliver in a clinic… ARRD is so important in giving us education on safe maternity here in the village and helping us to go to the clinic.”
Advocacy in communities
Key to galvanising civil society was the establishment of a 15-member NPP. The NPP has been able to combine advocacy and social campaigning, holding authorities accountable locally and nationally. It has used different approaches including community dialogues, church and radio.
“We encourage our partners to target those who are influential because once women leaders, traditional leaders and those in institutional leadership roles have something to say, people follow,” says Edward.
“It’s the first time South Sudan’s national and community based organisations have come together and are working in this coordinated approach on one issue.”
Raising the profile of maternal health nationally
More than 15,000 women were reached with information, education and communication activities during the project through a number of profile raising activities.
“We felt the Independence day celebration on 9 July this year was an important opportunity…We had several thousand journalists come to the country and people were attentive to the TV and radio. We wanted to utilise this opportunity…We held a march with messages about newborn and maternal health and rights for people living with HIV. We also realised that many hotels and lodges would be full so we distributed more than 200,000 condoms along with health messages in the hotels,” says Edward.
Using the media
To develop advocacy skills training for 20 KCs was organised by the NPP. KCs write about the realities faced by those affected by HIV and maternal and newborn health issue.
Training participant Duku Evance Charles says: “I became a KC to speak on behalf of the voiceless people such as those people living with HIV/AIDS.”
KC work is published at www.keycorrespondents.org and in the local press. A training of trainers means KCs are able to operate in all 13 states in which the project operates.
Radio is also an important medium. The NPP commissioned a jingle, which is being aired six-times-a-day for one month in Arabic and English, communicating messages about supporting pregnant women and the need for more health resources for people living with HIV, women and children.
Making a difference
NPP campaigning has led to a commitment of the Upper Nile state government to dedicate 5% of its budget to maternal health and PMTCT.
“Community based organisations have heard about the NPP and what it is achieving and they like the concept. They’re talking to us about replicating this at state level as they can see it increases people’s voice….Its early days but we’re seeing exciting developments,” says Edward.
“Our challenge now is funding the NPP and the maternal health work that has started. We really appreciate the support from UKAid for this initiative. Though the funding is for just one yearwe have managed to see the value of that money. This project is saving a lot of lives.”