INTERVENTIONS TO PROMOTE DIGNITY IN CHILDBIRTH- HESHIMA PROJECT Charity Ndwiga, Charlotte Warren, Lucy Kanya, Timothy Abuya, George Odhiambo and Alice.

INTERVENTIONS TO PROMOTE DIGNITY IN CHILDBIRTH- HESHIMA PROJECT

Charity Ndwiga, Charlotte Warren, Lucy Kanya, Timothy Abuya, George Odhiambo and Alice Maranga

RMC meeting 24th June, 2014

Heshima Project

Objectives

1. Specify types and prevalence of D&A

2. Develop and validate tools for assessing D&A

3. Identify potential drivers of D&A

4. Design, implement and evaluate interventions to reduce D&A

5. Generate lessons for replication and scale up

Stakeholder engagement Intervention suggestions

Package of interventions to promote dignity in childbirth

Policy

Engagement with MOHIn depth interviews with DHMTSteering committeemeetings

Facility

In depth interviews with facility staffService statistics NNAK reportsProject staff observations

Community

FGDs with men and women previously empowered their rights and obligation during childbirthCHEWS/ CHWsFIDA reportsProject staff observations

Endline Survey

Scale up plan

Observations, Exit interviewsProvider interviewsIDIs FGDs

Intervention design

Stakeholder Engagemen

t

Baseline

Survey

Formative

Research

Definition of

Disrespect and Abuse

Landscape analysis

Planning and development

Implementation research Quarterly Measure Analyze Improve

Sustain

Heshima Project

Policy level activities • Developed the intervention package-

provider and community- draft RMC Tool Kit in place

• Participate in Maternal Health Bill process

• Working with professional bodies, MOH and policy makers, parliamentarians to establish mechanisms for transparency and accountability at all levels- on going

• Supporting MOH and Partners in scale up

Facility level interventions Elements Focus

Values clarification and attitude transformation (VCAT)

Improve knowledge on RMC, D&A and health as a human right for both clients and providers

Improve self awareness on how socio norms, values, attitudes and behavior affect care

Support individuals and facilities to cultivate professionalism & mutual respect among themselves, clients/relatives and communities

Quality ImprovementsTeams (QITs)

Improve individual and team accountability at providers and managers levels

Maternity Open Days/ Caring for carers

Mechanisms to strengthen interpersonal interactions, discuss ways to deal with drivers of D&A and improve care and working conditions

Values clarification and attitude transformation (VCAT)

• VCAT training helps individuals to explore and honestly acknowledge what one truly values at a point in time in life in order to enrich their awareness of their own values

• Our values are shaped by beliefs and attitudes.

• Everyone has a right to her or his own beliefs

• Health providers have a professional obligation to give care in a respectful and nonjudgmental manner

• VCAT training is aimed at helping maternity providers adapt caring behaviors and professionalism

Results and lessons learnt • 132 maternity providers from 13 study sites

trained

• VCAT is a good tool for attitude change but requires individuals to take personal responsibility and commitment in aspiring to change

• Providers’ attitude and teamwork improved:

“…since the VCAT training some providers have become good role models in attitude and behavior change” (Hospital Manager)

• Community members reported reduction in both physical and verbal abuse in almost all sites

Caring for the Carers• Maternity providers experience work related

stress due to high workload, lack of professional support and poor teamwork

“..when you report on duty you work without a break... there is no way you can leave a mother in a critical time of need you just continue working” (a hospital midwife)

• Caring of the carers is an approach that was tested to support group and individual counseling sessions for health facility staff

• Aimed at preventing development of adverse reaction and reduces unnecessary psychological after effects work related stress

• Individuals who require more counseling are offered additional opportunities for one–on-one sessions

Results and lessons learnt

• Over 130 maternity care providers met to discuss traumatic events or critical incidents - work related stressors

• Caring of the carers is most appreciated among activities aimed to address D&A at providers level

“These debriefing sessions make us feel that it is not about achieving targets for skilled birth attendants but someone also cares for us”

(provider in maternity unit)• Can easily be adapted and replicated within the

existing MOH structures

Maternity open days • Maternity open days are one of the tested

interventions aimed at promoting dignity in childbirth

• Community members visit maternity units to get information on labor and delivery procedures and demystify common myths and perceptions

• A suitable date for the open day is identified and invitations sent through the existing community information systems

• Privacy and confidentiality for mothers in labor during the visits is maintained

Results and lessons learnt

• Maternity open days improve knowledge on labour and delivery

• A promising intervention in clarifying misconceptions and myths associated with facility based childbirth“... I have seen... there no ropes to tie one to the

delivery bed during childbirth...” (primigravida after maternity open day)

Alternative Dispute Resolution: Mediation

• A dispute resolution mechanism process where an independent and impartial third party (mediator) facilitates a negotiation process between disputing parties

• Decisions are made by the parties themselves with facilitation from the mediator

• Adapted from FIDA –mainly used for land disputes and family cases

• FIDA trained CHWs and society leaders on mediation; managers and providers also orientated  

Key observations • VCAT training increases providers’

responsiveness to dignity of care

• Providers need knowledge on client’s rights and professional ethics for improved accountability

• Maternity Open Days - a promising intervention to demystify labor and delivery procedures

• Caring of the carers is good approach to support providers with work related stress and therefore deals with drivers of D&A

• Intervention could be attributed to increased SBA and a supportive working environment for providers

Acknowledgments • USAID through TRAction Project/ URC

• MOH: DFH, RMHSU, Research Unit, Nursing and Midwifery Unit Standards and Regulatory Services Unit

• National Nursing Association of Kenya – Midwifery Chapter

• Federation of Women’s Lawyers Kenya (FIDA)

• Nursing Council of Kenya, KMA, COC

• Kenya Obstetric and Gynecological Society

• UON, OBGYN, Schools of PH, and Nursing

• Practicing private and public representatives

• White Ribbon Alliance – Kenya

• Health Rights Advocacy Forum (HERAF)

•Study site communities, providers and managers

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