Naturum, Uganda—Two healthy babies born in one week — an exciting occasion for their mothers, Josephine Lomongin and Dakele Chegeni, and their village in the Karamoja region in northeastern Uganda, where maternal and newborn death rates are higher than in the rest of the country.
Here, childbirth is not always a sure, safe thing for mother and baby.
But nurses and midwives in districts across Karamoja are addressing complications at birth with new skills and vigor as part of a Jhpiego-led initiative of the Ministry of Health of Uganda to strengthen the quality of health services for women and families. With the support of the government and UNICEF, “champion” health workers like midwife Rebecca Okello Acech are leading efforts in rural health facilities to deliver skilled, lifesaving care.
While the number of health workers plays a critical role in improving maternal and newborn health in regions of the world with high mortality rates, “the quality of services delivered is of equal importance,” according to a review of the impact of health care provider champions in 26 countries, including Uganda. This review has been published in a special supplement of the International Journal of Gynecology & Obstetrics (June 2015).
“There is an apparent need for providers who possess not only up-to-date clinical skills but also strong leadership skills,” wrote the authors, a team of maternal health experts from Jhpiego.
The article, “Preparing the next generation of maternal and newborn health leaders: The maternal and newborn health champions initiatives,” describes two Jhpiego-led efforts to identify, train and develop mid-career health professionals who could lead their peers in high-impact, sustainable improvements in service delivery that could save lives.
These maternal health champions, the authors write, should engage with decision makers to advocate for the best evidence-based health practices, disseminate knowledge among their peers, build relationships broadly across the health field and between professional groups, and achieve consensus on critical issues.
Rebecca, head midwife at Rupa Health Center II, is just such a leader, whether in her workplace, in the community or as a vocal advocate across the district.
She’s greeted by name when she arrives in Naturum to visit Josephine and her five-day-old baby girl, who had a difficult birth. The young mother shares how Sister Rebecca, a term of respect in this part of Uganda, used her skills to revive her unresponsive newborn.
“The baby was not breathing,” Josephine recalls. “I watched how Sister Rebecca cared for the baby, covering her, giving her help. She slowly started breathing.”
Josephine is thankful for the respectful, high-quality care she says she received throughout labor, and the progress her baby continues to make.
“The midwife welcomed me, cleaned me, explained to me all of what was happening and taught me new things that I didn’t know, like how I needed to put the baby on my chest for warmth after delivery,” Josephine says, reflecting on the midwife’s confident demeanor and thoroughness.
Jhpiego is building the skills of health care providers in all of Karamoja’s seven districts to improve health outcomes for mothers like Josephine and their newborns. Rebecca recognizes the impact of these efforts: “The training is hands-on — what you do in the training is exactly what you would do in your facility. So I felt very prepared to help both mother and baby.”
Rebecca has helped drive similar improvements at health facilities. She is a champion trainer in the district, managing a variety of skills-building sessions for her fellow health care providers—interventions to manage prolonged and obstructed labor, pre-eclampsia/eclampsia, and newborn care complications like birth asphyxia.
A role model for quality, evidenced-based, respectful care, Rebecca also sits on the District Health Office’s Supervisory Committee as the technical lead for maternal and newborn health, engaging with decision-makers in her region and leading the charge on strengthening the health system. In this role, she visits health facilities throughout the district, mentors fellow health workers and makes policy recommendations based on her observations and experiences.
While visiting lower-level health facilities in the region, Rebecca noticed that many health workers didn’t know how to handle neonatal asphyxia in babies like Josephine’s, who couldn’t breathe. Without a mandate or funding, Rebecca helped organize a training for staff at those health centers. She wanted to pass on the knowledge and skills she had learned during a Jhpiego-supported training in newborn resuscitation, using the “Helping Babies Breathe” approach developed by the American Academy of Pediatrics and other partners, including the United States Agency for International Development and Save the Children. Rebecca has since trained 15 health workers from six health facilities in the district.
“It’s our duty to share what we have learned with others,” Rebecca says. “By sharing this, we are helping the mothers in all parts of our district and also encouraging the other midwives who are doing this difficult work on a daily basis.”
Mothers like Dakele recognize the impact of such care on their lives. “I am going to tell others that they need to deliver at the facility,” says the young mother. “The midwife has been very helpful to me, making sure me and my baby are doing well.”
Read more about efforts across the world to raise the next generation of maternal and newborn health champions in the International Journal of Gynecology & Obstetrics: bit.ly/MNHChampions
Photos by Jhpiego/Guido Dingemans