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Promoting Safe Delivery in Health Units through Male Engagement and Community Participation

When Emmanuel Epou won the UNICEF scholarship to train as a Comprehensive Nurse, he was like any other trainee; ‘I just wanted to help people’. However, by the time he completed his course he knew something had changed, ‘I have the skills and confidence to follow my passion of helping mothers and babies’.

In February 2014, Emmanuel was posted to Natirae Health Center II, as a Health in Charge. Located more than 370 kilometres from Kampala, in the Lolachat Sub County, Nakapiripirit district, this health centre, presented many challenges to him.

Emmanuel explained that, ‘in Natirae parish the expected deliveries are around 31 per month, however when I joined there were absolutely no deliveries being conducted in the Centre.  There was not a single qualified health worker in the unit until my arrival’. As a result, the expectant mothers had no choice but to deliver with the Traditional Birth Attendants (TBAs).

Soon after taking charge, Emmanuel and his team (two nursing assistants and 2 support staff) engaged the community, especially the male members, including the cultural and religious leaders and TBAs.

The main purpose was to encourage uptake of maternity and other services at the health centre. As a result, Emmanuel was able to build trust with the community and gradually there has been an increase and acceptance of deliveries by male health workers. “We are only males in the health unit and the community are comfortable having me deliver them. I have engaged with TBAs through dialogue and encouraged them to bring the women to the facility.” “We have since seen a gradual increase in deliveries,” says Emmanuel.

Around the same time, as part of ‘A Promise Renewed Reproductive Maternal Newborn and Child Health Sharpened plan’ roll out, UNICEF intensified its activities in high burden districts for maternal and new-born mortality, including the Karamoja region. 

This entailed, in addition to other interventions, an initial assessment of various health centres to ascertain their ability to offer maternity services by UNICEF in partnership with CUAMM. According to estimates for 2013/2014, the expected deliveries for Natirae Parish were around 376 for a population of 7,749. This meant that Natirae HC II had to be equipped to provide quality maternity services to reduce maternal and new born mortality.

At the health centre, a room was allocated for maternity services where equipment for delivery and mama kits were provided as incentives to boost delivery under skilled care. This was enriched with the introduction of the transport voucher system.

For community participation and commitment, UNICEF supported Emmanuel to organize community dialogue meetings with the various stakeholders including TBAs on the benefits of delivering under skilled attendants. The session created awareness among the communities regarding the services available at the health unit and involving the TBAs in the transport voucher system, boosted demand. The TBAs henceforth committed to taking part in the transportation of mothers to the health centres in order to improve maternal health.

The unit started conducting deliveries starting with 13 in February to 26 in May.  In July, UNICEF introduced the birth cushion which enabled mothers to feel more comfortable delivering in the modified squatting position.

Emmanuel believes that with consistent community engagement and upgrading of the Health Centre maternity services, maternal mortality can be drastically improved in Natirae.




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