Somalia ranks 6th globally, with one of the highest maternal mortality rate (MMR) of 692 per 100,000 live births in the world (Somalia Health Demographic Survey report, 2020). Most of these deaths are preventable. Many women suffer major complications due to pregnancy or child-related illnesses. Many die or suffer near misses due to lack of access or lack of knowledge of health services. Delay in seeking medical care is one of the most significant factors contributing to maternal deaths in Somalia. This is largely due to cultural beliefs and practices, lack of knowledge about complications and the benefits of modern health care services, and women's low status in society.
In Luuq district of Gedo region in South Central Somalia, we meet a healthy-looking Shukri, one of the project beneficiaries. She is nursing her 3-week-old baby whom she delivered at Luuq hospital. This was the first time Shukri delivered her baby at a health facility. Her other six children were all delivered at home and had never received any antenatal care for any of her previous pregnancies, and none of her children had been immunized.
"As a fulltime mother, I have always been very busy in the house and did not see how I could get time to go to the hospital. Besides, I could easily get medication from a nearby pharmacy if need be," she says when asked why she did not visit a health centre.
Shukri's perception of the health facility and knowledge about her health and that of her children was changed by two women who visited her in her home. These women, Female Community health Influencers (FCIs) working with Trocaire in a UK Aid supported health and nutrition demand creation program, say that Shukri was pregnant with her eighth child when they first visited her.
"She was in her third trimester, but had not visited the health facility for ANC," says one of the FCIs. "We took her through the maternal health component of the booklet we use, and we still could not convince her," adds the FCIs. She says that it took another visit and a candid conversation about child health and danger signs during pregnancy for Shukri to see value in visiting a health facility.
"I had no clue that I needed to go to hospital. I just did what those who have been there before me told me to do, and that's how I had all my children at home." Says a now convinced Shukri.
"When the women came back the second time”, she says, “I was bleeding and they mentioned that it was a danger sign during pregnancy". Upon being convinced to go to the hospital, Shukri was given a referral card. The women also called for the ambulance, as this was an obstetric emergency, and she was taken to Luuq District Hospital for further assessment and treatment.
At the hospital, the medical officer booked Shukri for an emergency cesarean section as the diagnosis revealed that the placenta had prematurely detached, causing the profuse bleeding. The operation was a success although Shukri was left weak and needed blood transfusion to regain her strength. She stayed at the hospital for five days and the FCIs kept on visiting her to see how she progressed.
‘’We visited Shukri every day until she was discharged. We are relieved that we visited her that second time even after she declined to visit the facility the first time. I don’t want to imagine what would have happened to her had she not visited the hospital and received the care that she received’’ says one of the FCIs.
Shukri and her child have both received postnatal care. The FCIs still visit to ensure that she is following the proper care schedule for her and her baby and to monitor their progress.
Shukri’s case is just one of the many that the FCIs have encountered in their health demand creation activities. Their persistence in visiting mothers to convince them to seek quality care in a nearby health facility is paying off as evidenced by notable increase in number of women visiting health facilities for ANC and PNC services.
Since the inception of the Somali Advocates for Health and Nutrition (SAHAN) project in February 2019, Trocaire’s 54 FCIs have managed to conduct over 80,000 home visits and referred over 14,000 women of reproductive age and under five children for quality health care services. Of this number, over 13,000 referrals were converted to effective referrals showing a 90% success rate of the mother-to-mother model for creating demand for health care services. Additionally, maternal and child health services’ utilization rates increased by 6.7%, skilled birth attendance by 15.5%, and ANC by 10.5%. The FCIs are working in Luuq, Belet Xaawa and Dollow Disticts in Gedo region for the SAHAN Programme, which is the Demand Creation component of the UK’s Department for International Development Somali Health and Nutrition Programme (SHINE).