Only 40% of people in South Sudan are within reach of health facilities and have consistent access to primary health care services. The Boma Health Initiative seeks to provide sustainable delivery of essential health care and public health programmes at the community level.With less than half the population able to access health facilities and a shortage of skilled birth attendants, the maternal death rate is high. 50 year old Rebecca Yomo is one among the few trained mid-wives in South Sudan currently working at Ayong Chong Primary Health Care Unit (PHCU) in Wau.
Ayong Chong PHCU provides Ante Natal Care (ANC) services. Rebecca notes that the ANC normally hosts up to 70 pregnant women given awareness raised by the home health promoters (HHP) about this service. This number however goes down because of cultural beliefs within the community associated with hospital deliveries. Some of these include that when a woman delivers at home she is able to reveal the number of lovers she has had but if she delivers at the hospital it is believed that she is given medication which conceals this revelation. As a result of these archaic beliefs most women prefer to deliver at home. Rebecca explains that she can go for a month with only one delivery taking place at the unit.
The Primary Health Care Unit (PHCU) is one of the facilities receiving renovation support through HPF. Initially, before the rehabilitation and renovation of the hospital buildings, the community used to receive health care services under a tree. The only other alternative was to walk close to 66Km to seek medical help from the Wau teaching hospital. This was time consuming and most patients would die along the way. The construction of hospital buildings has been of great assistance and has enhanced quality service delivery.
Incentives such as provision of a mama kit which includes a mosquito net, soap and a towel and the provision of porridge during ANC visits encourages women to attend ANC services. A mother notes that, “This facility has transformed our lives. We now get drugs for free; before we had to sell livestock in order to obtain drugs from Wau.”
Health Pooled Fund is currently training more home health promoters to create awareness about ANC in the community. The HHPs are the entry point in the community and comprise six men who will run the awareness campaign. It is important to note that men are chosen because they are more educated and the area’s cultural beliefs favour them. It is very highly unlikely for a woman in this village to participate in outreach activities because the community gives that women’s duties revolve around household chores. It is a patriarchal society. HPF hopes to challenge some of these stereotypes held by men and refer more women to seek delivery services at the hospital so as to reduce maternal deaths.
The vast majority of maternal deaths are preventable when women have access to quality ante- and post-natal care, along with a safe delivery environment where skilled personnel are present and where emergency obstetric care is provided. Bringing an end to preventable maternal death within a generation is doable but progress is still a bit slow.