Benguela City, Angola—With few pregnant women in Benguela province accessing malaria prevention services, staff at the Fronteira Health Center decided to launch an outreach effort to get women to the facility early and often.
As part of the ExxonMobil-funded program, health workers visited markets and churches, held community education sessions and persuaded local leaders to encourage pregnant women to visit the health center. That effort and other activities, supported by a Jhpiego-led quality assurance program, helped lead to a significant increase in the number of pregnant women receiving critically important malaria prevention services and prenatal care at the health center—56.3 percent of women received the first dose of intermittent preventive treatment for the prevention of malaria in pregnancy (IPTp1) in 2010, compared to only 13.1 percent in 2009. Similarly, 17.9 percent of women received IPTp2 in 2010, compared to 4.6 percent in 2009.
Since April 2009, Angolans at the Fronteira Health Center have been working to increase use of antenatal care (ANC) and improve quality of services to prevent malaria in pregnancy (MIP) through the generosity of ExxonMobil and in conjunction with the Angolan Ministry of Health. The center serves an area of about 36,000 people in which 22 percent or 7,920 are women of reproductive age and 5.2 percent or 1,872 are pregnant. According to the 2006 Angola Malaria Indicator Survey, only 2.5 percent of women received two or more doses of IPTp during their last pregnancy and 20% of pregnant women sleep under insecticide-treated bed nets to protect against malaria-transmitting mosquitoes. The Ministry of Health of Angola reports that malaria accounts for a quarter of maternal deaths in the country.
To protect women more effectively against the risk of malaria in pregnancy, project leaders at Fronteira recognized that more women had to access ANC services during their first trimester. In 2009, staff, the head of the ANC unit there, an ANC nurse and provincial and municipal supervisors participated in an educational seminar designed to improve the capacity of health providers in prevention and control of MIP.
“I think it was a very good process because it really improved the way we work. The clients also say that our services have improved a lot since this process began,” said Odeth da Glória Jamba, the ANC nurse at the Fronteira Health Center.
Employing Jhpiego’s pioneering Standards-Based Management and Recognition (SBM-R) approach, project leaders assessed health providers’ performance in delivering ANC, including MIP services, and found that services were improving. At each assessment, the Fronteira Health Center showed improvement, and by December 2009 the center met all 17 performance standards for ANC as defined by the Ministry of Health.
“I really enjoyed it because I learned a lot . . . and now I can do my supervision work better and teach others how to improve their work and be more organized,” said Josefina Samuel Tiago, Municipal Supervisor for Reproductive Health/ANC, Benguela.
The SBM-R method also helped the Fronteira staff identify gaps in service and develop ways to address them.
Problems included: pregnant women not coming to the health center for a consultation in their first trimester, lack of HIV tests for women and no telephone listings for health facilities that deal with serious cases. The center staff proposed ways to improve conditions: conduct community awareness campaigns, set aside an office to perform HIV tests, document the number of women who attend ANC services. As a result, health providers are continuing outreach activities to increase use of the facility by pregnant women; HIV testing is available at Fronteira; and a phone list for higher-level health facilities is now posted at the center.
Other best practices implemented by the center include:
- Established an appointment system for clients’ follow-up ANC visits, which led to women using services more routinely
- Provided materials so providers can directly observe clients taking Fansidar, an antimalaria drug, during eligible ANC visits
- Introduced a system for recording and tracking client education sessions.
Since 2009, the program supported by ExxonMobil has been implemented in 13 health facilities in Benguela province.
“We have plans to continue the process at the health centers that were supported this year and we would like to apply the process to other health centers,” said Algemira Belarmina, Provincial Supervisor for Reproductive Health/ANC, Benguela. With the continued support of the ExxonMobil Foundation and Esso-Angola (Block 15), a local subsidiary of ExxonMobil Corporation, women are receiving critical MIP services at the health facility and reducing their risk of contracting malaria.