What is in this session?
This session describes what you can do as an individual health worker. However, active participationof non-health actors and community representatives in planning maternal and newborn services should be adressed by the programme manager.
What skills will I develop?
Forming an alliance with the community
Establishing links with other health care providers and leaders
Practical skills for efficiently planning and organizing productive meetings.
What am I going to learn?
By the end of this session you should be able to:
Outline the benefits and problems of team work/working with others
Identify the relevant groups, organizations and providers that you can establish links with
Facilitate joint action.
Working with the community
Ideally, everyone within the community should be aware of the specific needs of a woman and her newborn, and informed about the situation of women and neonates in the community. The health services together with the community can find different ways to solve problems, thus becoming jointly involved in the processes of improving health.
Advantages of health services and communities working together
Collaboration, or forming community partnerships, is a difficult challenge, particularly between parties who may not be used to working together. However, it can bring many benefits:
It allows for increased knowledge and understanding of what different groups can contribute.
It helps to clarify roles and avoid duplication of effort and work.
It leads to a more effective use of resources.
It supports groups who would not normally see themselves as having a role in maternal and newborn health understand how they might contribute.
It allows for a more comprehensive analysis of health problems and for the identification of realistic solutions.
It helps to minimize gaps in the provision of care and provides better coverage of services.
It co-ordinates information and advice among different providers, assuring uniformity rather than conflicting information. Information can also be formulated with the community so that it is more easily accepted and more pertinent to the reality.
It helps the health services and personnel learn more about local traditions and practices, and whether they present barriers to health service use, and if so, how these can be overcome.
Ways for health services and communities to work together
Additional skills which can help to improve working with other groups include communication, facilitation in meetings, and institutional strengthening of partners in management processes.
The different groups you work with have different roles and responsibilities which they currently fulfil, and different ways of working to meet their objectives. It is important to work out how you can reach a shared vision of what you want to achieve.
For example, if you have all agreed on a skilled attendant at birth for all pregnant women and newborns as a common objective, you could follow the steps described below:
You would need to work with the other groups and providers to define what you mean by birth with a skilled attendant - make sure you have a good measure of what the current use is and a target of what level of use you want to achieve over a defined time period.
The next step would be to assure that all parties understand who the women are who are currently seeking care (as you have defined) and why these women are not using the services. You may need to gather additional information, through exit interviews, focus groups or in-depth interviews, and not just rely on what the groups think they know. It is important you find ways to hear from women themselves.
After there is a good understanding of the problem, together you can discuss possible solutions and elaborate a plan to overcome the barriers to use of care and to increase the use of services with a skilled attendant.
Together you can map out all the different resources you have in your community to see how they fit together e.g. see who currently provides which services, who would best be suited for the different tasks in the plans, what other groups you may need to involve, and how to divide roles and the responsibilities to achieve the plan.
You also need to work out how you will liaise and communicate with one another and which group or organization or even individual will take the lead and responsibility for coordinating the work together.
Different actors in the community
It may not be possible to work with the whole community, but you can work with certain groups or key individuals in the community. A community is made up of different groups and individuals:
Community leaders: e.g. political, religious or informal
Community groups: e.g. women's groups, youth groups, income generating groups
Community health volunteers
TBAs, traditional healers.
Since our focus is maternal and newborn health, it is important that you hear from women directly and include groups who work with women and who can best represent them.
Link with community leaders
Every community has a number of different community leaders. Some of these will be religious leaders, some political, some tribal or natural leaders, or people in positions of authority. These leaders can have many roles, for example, they can be influential on social norms, beliefs and attitudes. They can be influential decision-makers and planners, so that they are important for organizing transport for referrals or may be important for the provision of information. We often refer to leaders in the community as the ‘gate keepers’, they are the key people who have access to the wider community as a whole. As it is often not possible to work with the whole community, it is important to identify those leaders who can provide access to and represent the whole community. These are the key people that we need to work with. Do you know who the key community leaders are in your community? How can you find out who these people are? Consider making a resource list with the names and contact details of all the key community leaders in your area. Often these lists have already been put together by another group – find out what exists in your area.
Working with community groups
Different community groups exist either health related or non-health related, e.g. breastfeeding groups, agricultural groups, etc. The dynamics of these groups can be used to mobilize their members on maternal and newborn health issues as you have examined throughout this Handbook. For example, you have looked at:
cultural and gender practices in your community
seeking community support and engaging the community in birth and emergency plans such as village transport plans
knowledge of danger signs and when to seek care
ways to support women during pregnancy, after an abortion and after birth
healthy and harmful practices
strengthening and supporting mother's groups and support groups.
What other ways can you work with the community? For example, you can also have an input into changing gender and cultural norms which have a negative effect on women's health. You could consider getting feedback from the community about the quality of the services which are provided to them. You can also work with the community to get feedback on health information you provide and what they understand by this information. Consider including the community in developing practical action plans on how they can support women during pregnancy and after birth, for example, by looking after other children, helping the woman with household chores, or support for payments that need to be made.
GOOD TEAM WORK INVOLVES
a common task or purpose
clear definition of roles and responsibilities of the different players
different expertise for different functions/tasks
supporting one another in different tasks
skills and personalities complementing one another
commitment to achieving functions/tasks
a leader to take responsibility and coordinate.
Links with Traditional Birth Attendants and Traditional Healers
Traditional healers and TBAs are two groups involved in the provision of health care and who are often well respected and trusted members of the community. WHO recommends that you invite them to the health facility so that you can share with them the work, knowledge and advice that you have. Health services should make real efforts to establish relations with the TBAs as they can offer insight into local pregnancy and childbirth traditions and highlight areas for concern. They are also often the only ones who have confidential insight into the needs of women and their fears. Sexuality issues may sometimes only have been discussed between the woman and her TBA. Encouraging the TBAs to ‘come on board’ with any new pregnancy and childbirth practices is an effective means of developing the trust that women and the community will place in the new practices.
There are several practical ways that you can establish links with TBAs and traditional healers:
Include them in your referral system: encourage them to refer women to you. and provide them with feedback on women they have referred to you.
Clarify together what constitutes harmful, harmless or helpful practices.
Examine what resources you could share, e.g. leaflets, posters or condoms or disposable gloves.
Share with them your knowledge and expertise. Discuss points where you differ, respecting each other's right to express their views, but each presenting the statements to support their opinion.
Work with them to explain the key information of the PCPNC related to pregnancy, birth and postnatal care for women and newborns including family planning, STIs, breastfeeding and care of the newborn.
Invite them to participate in meetings that you hold for community groups and providers.
Ask for their help in identifying women who may be at risk.
Encourage them to persuade all women to give birth with a skilled birth attendant.
Encourage them to ensure each woman has a birth and emergency plan.
Encourage TBAs to act as labour companions for women and provide support immediately after birth.
Consider using them as a valuable source of feedback about the services you provide.
Encourage them to work through this Handbook.
Activity 1
Variable (you may need to carry this activity out over several weeks).
To help you establish links with other health care providers, community groups and leaders and to establish ways of working with them.
If you are working in a group, then divide up the activities so you each have responsibility for a different area of preparation and follow-up.
Make a list of providers and groups that work in your community.
Find out what each of the different groups/providers currently do with respect to the care of the woman and newborn during pregnancy birth and after birth. Collate this information into a document to be used as a future resource.
Identify the most common health problems related to pregnancy childbirth and postpartum/postnatal periods in your community. Use local morbidity (illness) and mortality (maternal and newborn deaths) data to help you. You may be able to get this information from health service or district annual reports or from your health information registers in the maternity wards.
Work out a way to co-ordinate and unify information on these common health problems related to the care of the woman and newborn during pregnancy, birth and the postpartum/postnatal period.
Think about how you might be able to do this in advance of setting up a meeting:
You could consider generating key information together.
You could provide a list in advance that you discuss at the meeting.
Try to keep it simple and focused on the most important information relevant for the community.
Organize a meeting/meetings where representatives and leaders from these providers or groups can attend. Remember to prepare an agenda in advance.
At the meetings define the roles and responsibilities different people and groups can make with respect to maternal and newborn health. Try to come up with ideas for things that you can do to improve maternal and newborn health.
During or after the meeting, prepare an action plan defining responsibilities and activities (including a timeline) that each of you have to do and circulate it to all participants.
Decide upon a person or group who will be responsible for monitoring how the implementation of the action is occurring according to the action plan.
Tips for planning a meeting
Make a list of all the people who need to be invited.
Ensure you have a place to meet, which is big enough to take the whole group. You may need to think about transport and ease of access.
Make sure you send out invitations to the meeting well in advance to make sure people are free. One way is to find out available dates in advance and then pick the day that most people can attend; it is unlikely you will get a day when everyone is free to come. Another way is to see if it is possible to add some points of your agenda to a meeting that is already organized for another purpose.
Plan what you want to cover in the meeting in advance – write down some aims and objectives. Use these to come up with an agenda and send this out with the invitation. If you have any other supporting materials you may want to send these in advance so people can prepare for the meeting.
On the day of the meeting organize the space so that everyone is comfortable and can see one another – if you can, organize the space so you are sitting in a circle or round a group of tables.
Consider whether you can provide refreshments, especially for those who have had to travel a long way.
Choose someone to chair the meeting, and someone to take minutes, which is a way of recording what has been discussed, and any plans or action that you come up with, and dates for future meetings.
Remember to also remind people of the aims and objectives of the meeting before you start going through the agenda items.
Sometimes it can be helpful to set ground rules for the meeting – suggestions might be things like addressing questions through the chair, not talking over one another, respecting different points of view.
Have an item ‘any other business’ on your agenda so people can raise other issues that you might not have thought about.
Our View
This activity is to help you unify the information, care and advice that is given to women for pregnancy, childbirth and after birth in your community and to identify the most pressing problems and possible solutions for women and newborn. It is important that women are not given conflicting advice and that you can advise women where to go for additional support and advice within the community. As health care providers you are part of a network of wider care and support and it will help you to be able to utilize the resources of this network. Health problems can be tackled from many different angles. By working in partnership you may be able to achieve far more than by working in isolation.
What did I learn?
You should be aware of the usefulness of establishing links with different providers and groups within the community. Are you more confident about how to work with them as partners? It should be a long-term goal of the health service to develop and maintain partnerships.
