Community Discussion Guide for Maternal and Newborn Health...

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COMMUNITY DISCUSSION GUIDE

Community Discussion Guide for Maternal and Newborn Health Care and Immunization

in Northern Nigeria

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Community Discussion Guide forMaternal and Newborn Health Care and

Immunization in Northern Nigeria

Partnership for Reviving RoutineImmunisation in Northern Nigeria;

Maternal Newborn and Child Health Initiative

The PRRINN-MNCH Programme is funded and supported by the Department for International Development (DFID/UKAid) and the State Department of the Norwegian Government. The programme is managed by Health Partners

International, Save the Children UK, and GRID Consulting Nigeria.

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CONTENTS

SECTION PAGE

Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Introduction to the Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

How the Approach Works . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

COMMUNITY FORUM AND DIALOGUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

MODULE 1: MATERNAL HEALTH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Session 1 Our Need and Right to Good Maternal Health Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Session 2 Maternal Danger Signs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

Session 3 Planning for Safe Pregnancy and Delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Session 4 Importance of Hospital Delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52

Session 5 Community Systems and Support for Maternal Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58

MODULE 2: NEWBORN HEALTH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70

Session 1 Immediate Newborn Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71

Session 2 Caring for the Newborn in the First 30 Days After Delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79

Session 3 Postnatal Care for Mother and Newborn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89

MODULE 3: ROUTINE IMMUNIZATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94

Session 1 Introduction to Routine Immunization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95

Session 2 How Vaccinations Protect Your Baby . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104

Session 3 Sharing Responsibility for Routine Immunization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114

Session 4 How Children Spread Polio . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119

Appendices

1. Clean Delivery and Lefen Haihuwa Song . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127

2. Eight Newborn Danger Signs: Say and Do . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130

3. Breastfeeding Problems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132

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PREFACE

The Community Discussion Guide for Maternal and Newborn Health Care and Immunization in Northern Nigeria sets out a process for engaging with communities to increase awareness of and social approval to act on maternal, newborn and child health (MNCH) issues, including routine immunization. The Discussion Guide was developed with the support of the Programme for Reviving Routine Immunisation in Northern Nigeria and Maternal, Newborn and Child Health Initiative (PRRINN-MNCH) and involved considerable input from various government line ministries, departments and agencies in Zamfara, Yobe, Katsina and Jigawa States. The topics contained in the Discussion Guide and the techniques used to introduce these at community level have been extensively ‘road-tested’, and many re!nements have been made along the way. The Community Discussion Guide therefore represents current best practice.

Putting communities at the centre of their own development, and empowering them to take action in support of improved health, is essential if improvements in health indicators are to be made. Communities also have a right to play a part in de!ning how health services should be provided. The community engagement approach outlined in the Community Discussion Guide is appropriate to the Northern Nigerian context, has proved to be an e"ective way of mobilising communities around a maternal, newborn and child health agenda, and has helped strengthen community voices on health issues.

We are currently working towards implementing at scale the community engagement approach outlined in this guide in our own states. We hereby recommend this Guide to other states in the Federation as a practical and e"ective example of how to operationalise policy commitments to demand creation and to community involvement in health.

Many ministries, departments and agencies have been involved in the design and !eld-testing of this Guide. Of particular note is the collaboration at state level between Ministries of Health, Women’s A"airs and Local Government, and State Primary Health Care Development Agency.

Signed

Alhaji Lawan Kawu IbrahimDirector GeneralYobe State Primary Health Care Management Board

Mohammed Kabir Janyau,Honourable Commissioner, State Ministry of Health Zamfara

Dr. Aliu Muawuya,Executive Secretary, State Primary Health Care Development Agency, Katsina

Pharm. Usman A TahirDirector GeneralGunduma Health System Board, Jigawa State

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ACKNOWLEDGEMENTS

The original version of this manual, which focused on maternal health, was developed under the auspices of the United Kingdom Department for International Development (DFID) supported Partnership for Transforming Health Systems in Nigeria Programme (PATHS1). The manual was later adapted and extended for use within the Partnership for Reviving Routine Immunization in Northern Nigeria and Maternal, Newborn and Child Health Initiative (PRRINN-MNCH) in Nigeria, supported by UKaid/DFID and the Government of Norway. New modules on routine immunization and newborn care were developed in participatory workshops involving a range of government and civil society stakeholders.

Since its conception, the manual has undergone many revisions in line with implementation experience and many people, including government stakeholders and PRRINN-MNCH programme sta" and technical advisers have been involved in this process.1 The manual has since been adapted for use by other programmes, including the Mobilising Access to Maternal Health Services Programme (MAMaZ) in Zambia.

This version of the Guide is very much ‘work in progress’. Adaptations to the content of the Guide are being made all the time in line with implementation experience.

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INTRODUCTION TO THE GUIDE

Why is the Community Discussion Guide Needed?

Maternal and newborn mortality are signi!cantly higher in the Northern States of Nigeria than in the rest of the country. Innovative solutions that are appropriate to the Northern Nigerian context are therefore needed. The Partnership for Reviving Routine Immunization in Northern Nigeria and Maternal, Newborn and Child Health Initiative (PRRINN-MNCH), a UKaid and Norwegian government supported programme, is supporting the four Northern states of Jigawa, Katsina, Zamfara and Yobe to implement a community engagement approach which mobilises communities to overcome the barriers preventing timely use of maternal and newborn health services.

This Community Discussion Guide, which was developed by PRRINN-MNCH and its stakeholders, prepares trained Community Volunteers to lead participatory activities and discussions among groups of community members to encourage safe pregnancy planning and appropriate newborn care, including immunization. The community mobilisation process outlined in the Guide has proved to be both appropriate to the Northern Nigerian context, and highly e"ective.

What are the Objectives of the Discussion Guide?

The Community Discussion Guide is designed to empower people to adopt healthier and safer maternal and newborn care seeking behaviours. Innovative communication body tools empower community volunteers and participants to easily learn, recall, share and think about new health decision-making information together so that everyone agrees to adopt new behaviours that protect their families. The Guide promotes rapid infusion of new information in peer group discussion sessions led by community volunteers along with opportunities for shared re#ection about the need for and the bene!ts of new behaviours. The Guide generates ownership of the change process by providing participants with opportunities to engage with basic health information, evaluate it themselves and decide to take action.

The Discussion Guide also encourages communities to re#ect on who within the community is less likely to be able to act on their health-related needs and what can be done to promote their inclusion in the mobilisation process.

Why is a Focus on Inequality and Social Inclusion Important?

All citizens have the right to basic health promoting knowledge regardless of education and socio-economic status. Evidence suggests that infant and child deaths are clustered among relatively few households in the northern states of Nigeria. It is likely that women in these households also have poorer health status. Clustering happens in households where women perceive that they lack social support (from their husbands, families and the community in general). Questions on inequalities in health care access and outcomes and on social exclusion are raised for discussion throughout the sessions.

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Who Are the Audiences for the Discussion Guide?

This version of the Community Discussion Guide can be used as a resource or reference guide by the core group of trainers who are responsible for training and coaching the Community Volunteers. It can also be used as a reference guide by the teams that will mentor and coach the Community Volunteers. However, the aim is to train both core trainers and Community Volunteers in such a way that they do not have to rely on studying a paper version of the Community Discussion Guide before sessions.

What Topics Does this Discussion Guide Cover?

The Community Discussion Guide on Maternal and Newborn Health and Immunization (MNHI) is divided into three modules (maternal health, newborn health and routine immunization, including polio). The manual covers a range of health topics (see Box).

The mobilisation process begins with a focus on maternal health issues, and in particular, maternal emergencies. Experience has shown that this can be a very emotive issue due to the high number of maternal deaths and complications, and therefore one around which communities can be quickly mobilised. New health topics are added once communities have !nished the maternal health module.

Additional health topics (for example on malaria, child nutrition, HIV/AIDS, etc.) can be added to the Guide in future. However, the interactive, participatory methodology and the innovative communication body tools are key to the success of the approach outlined in this Guide (see below). If new health topics are developed in future and are to have the same impact, they will need to use the participatory methodology and adapt the communication body tools found throughout this Guide.

How Much Time Is Required to Implement the Approach?

The approach begins with a Community Forum and Dialogue. This is designed to obtain community ownership of the intervention and begin the process of putting in place community-wide supportive systems. The Forum lasts between 2-3 hours. Communities then participate in a number of facilitated discussion sessions. Most of the sessions last between 1.5 to 2 hours. There are 5 sessions in the maternal health module, 3 sessions in the newborn health module, and 4 sessions in the immunization module. Community groups completing the entire process will therefore participate in 12 discussion sessions. This translates into up to 28 hours of direct contact time.

To ensure that participants can internalise the information discussed during each session, and to give participants time to discuss what they have learned with others in the community, the ideal scenario is that one discussion session is held per week. This may not be feasible in all cases, but what should be avoided are situations where Community Volunteers attempt to squeeze a large number of sessions (or all sessions) into a single day.

So as not to overwhelm communities with too much information, it makes sense to schedule a break of at least one month between the three modules.

Health topics covered in the MNHI Community Discussion Guide

• Emergency maternal health care • Antenatal care • Delivering with a skilled birth

attendant • Post-natal care • Essential newborn health care • Newborn emergencies • Routine immunization including polio

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HOW THE APPROACH WORKS

What is the Social Approval Community Engagement Approach?

This Community Discussion Guide is designed to support the social approval community engagement approach. This approach generates community ownership of communication about healthier behaviours thereby making it easier for each community member to adopt the healthier behaviours. The approach relies more on disseminating new health information and providing opportunities for group re#ection during peer group discussion sessions than on teaching new health messages. E"orts are made to include all segments of the community by training 30 Community Volunteers to lead discussions in di"erent parts of the community for several weeks on each topic while encouraging participants to share and discuss the new information at home. Innovative communication body tools empower community volunteers to easily remember and share the new information. Once the community discussion sessions have been completed, community members are supported by the Community Volunteers to establish community-based and other systems to address MNCH-related barriers. The social approval community engagement approach therefore supports the transition from awareness to action.

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What are Communication Body Tools?

Two main types of communication body tools are used: ‘Say and Do’ activities and narrated mimes. These ensure that new health information is easy to understand and remember. For Say and Do activities, participants’ bodies are used to help them recall the new health information easily. We SAY the information we want to recall while we DO an action to help us remember the information. For example, we say FEVER, while we fold our hands over our chest and pretend to shiver. We also say PROLONGED LABOUR while we kneel in the birthing position. Regardless of their gender, ethnicity, socio-economic status, experience, education and literacy, trainers and Community Volunteers can e"ectively use these Say and Do activities as an easy way to remember the information they want to communicate, even in sites lacking electricity, multimedia projectors or chalkboards.

Narrated mimes are similar to !ve minute dramas that make new information easy to remember. The discussion leader tells a short story while telling a few participants to act out the roles in the story without talking. For instance in a ‘Flies and Polio Virus’ mime, the discussion leader tells one participant to play a small child stooling behind the house, a second participant to play the mother preparing bowls of uncovered food, while a third participant plays a #y swooping down on the stool and then on the uncovered bowl of food. Finally, the fourth participant plays another small child who begins to enjoy the contaminated food. Following the mime, all participants discuss what will happen if the !rst child is infected with polio and what should be done to protect all the children. This mini drama using friends and relatives as the actors is memorable, fun to watch and easy to discuss and laugh about at home while passing on important messages.

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Why is a ‘Whole Community’ Approach Important?

Since most people are reluctant to initiate changes in their behaviour without the approval of their family, friends, peers, or community leaders, discussion group sessions are implemented simultaneously with many groups of people. All key decision-makers and actors within the community are reached through a community-wide approach, and discussion group participants are encouraged to share their new knowledge and attitudes with spouses, relatives and friends. This promotes shared responsibility for new lifesaving actions. The ultimate goal is to create a sense of collective responsibility in the community towards saving the lives of pregnant women and babies. The saying ceton mai nakuda farilla (saving women in labour is a religious obligation) is used to frame the discussions.

The whole community approach recognises the way in which decisions are made at household and community level. For instance, it is important to involve men as they play a key role in decision-making, particularly in the event of a maternal emergency. Likewise, it is important to involve senior women since grandmothers and mothers-in-law are traditionally responsible for the care of newborns and children in the compound. If senior women know the new behaviours for protecting their grandchildren, they will teach and encourage their married children to adopt the new healthier, newborn care practices. It will be much easier for parents to adopt the new practices if the senior women in their family approve and guide them thereby ensuring smooth intergenerational transfer of appropriate newborn health information.

What Does ‘Saturating’ the Community with New MNHI Knowledge Involve?

Community Volunteers recruit between 10-15 community members to their discussion group. Participants ‘graduate’ from the community discussions if they complete all sessions. Because the aim is to ‘saturate’ communities with new knowledge on MNHI issues, cycles of community discussions continue until at least 30 percent of the target population has been covered. The community is then ready to move on to new health-related issues.

In order to maintain momentum, it is important to saturate the community as quickly as possible. The more trained Community Volunteers that are available to facilitate community discussion groups, the quicker saturation will be reached.

How are Women and Men Reached?

The forum for the discussion groups di"ers for men and women in the northern Nigerian context. While it is convenient for men to hold their discussions in a majalisa (a regular, informal meeting of men), this does not suit women because of the practice of seclusion and time constraints associated with the multiple demands on their time. A #exible approach is therefore required. Community Volunteers may choose to hold discussions with women in large compounds (extended family residences with large courtyards), Islamiyya schools, at health facilities, or at any other forum that is convenient for women and culturally acceptable. What is essential, however, is to involve women in community discussion sessions in a systematic way so that they complete all the sessions and graduate from the process on the same terms as male participants.

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What are the Training Methods?

A cascade training approach is used. First, a core group of trainers from the participating states and local governments is trained. This group goes on to train the Community Volunteers who will facilitate the community discussion sessions. An innovative training tool, the Rapid Imitation Method, is used to train the core trainers and the Community Volunteers to become competent facilitators of community health discussions regardless of prior experience. All activities in the Community Discussion Guide are expertly demonstrated by a senior trainer and then imitated by trainees. This enables the trainers and the Community Volunteers to memorise with relative ease both the content and the methodology of the Guide. This training tool has proved to be extremely e"ective in northern Nigeria, and very especially appropriate in a context where Community Volunteer literacy, knowledge of health topics and experience of leading peer group discussions is often low or non-existant. The Rapid Imitation Method also has the advantage of reducing preparation time for trainers and facilitators who are integrating the Community Engagement responsibilities into their busy schedules.

Volunteer’s Demonstration & Practice Method

1. Facilitator demonstrates a sign.

2. Facilitator says she will lead and asks participants to imitate her two times. • Participants imitate facilitator 2 or more times.

3. Participant demonstrates:

• Facilitator notes a participant who is doing a sign well and asks her/him to move one step into the circle and demonstrate the sign. • Facilitator asks participants to imitate the Participant Demonstrator 2 times. • Participant leads everyone 2 or more times.

4. Volunteers demonstrate each sign: • Facilitator asks for volunteers to demonstrate a sign. • Volunteer moves one step into the circle and demonstrates a sign. • Volunteer leads everyone 2 or more times.

5. Facilitator leads all the participants to demonstrate the key danger signs together. • Participants imitate her/him 2 or more times.

6. Practice each sign pose, one at a time. Continue using this rapid imitation method until all the sign poses have been learned.

How Are Community Discussion Sessions Facilitated?

Community discussion sessions are facilitated by Community Volunteers, sometimes with the support of Lead Community Volunteers who have more training. The Community Volunteers are trained to learn the discussion sessions by heart using the rapid imitation method.

Unlike other communication approaches that rely on use of written materials such as guidelines, picture cards, posters, or lea#ets in order to impart information, the approach in this Guide gives priority to the use of group discussions, song, mime, and demonstrations by trainers. Communication Body Tools such as the ‘knuckle and groove method’, which allows participants to count out and remember the various stages in a safe pregnancy plan, or the ‘vaccination hand’, which allows participants to remember a complex routine immunization vaccination schedule, are used. Song is also used to reinforce key issues. Facilitation approaches used throughout the Guide are outlined in the Box below.

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Facilitation Tools Used Throughout the Community Discussion Guide

• Participant Reviews: Participants feed back on the information from the previous session, thereby reinforcing their new knowledge and the importance of discussing it with their spouses, friends and relatives.

• Experiences: At the beginning of a new topic participants are asked to remember experiences related to the topic. This is meant to remind participants of what they already know.

• Presentation: Facilitators tell participants a small amount of information about a topic, usually using communication body tools.

• Discussion: All participants discuss a topic together, sharing all the information the group knows, thereby increasing their knowledge and building consensus.

• Small Groups Discuss: Groups of three or four participants discuss together and a representative of each small group shares the group’s thoughts with all the participants. This ensures that more people participate in the discussion.

• Say & Do Practice: Participants say the information to be remembered and do an action that helps them remember the information. This process is repeated many times so that participants remember the meaning of the action.

• Songs With Key Information: Participants learn and sing health songs for pleasure as well as for their content. For some of the songs, remembering the content is enhanced with the Do actions.

• Summary: Facilitators remind participants of the main points learned during an activity.

• Commitment: The facilitator reminds participants about the existence of systems and services that have been established to increase access to and the affordability of MNCH services. Participants are encouraged to commit to supporting these schemes.

• Circular Review: To review the session content, participants take turns stating one thing they learned during the session.

• Share the New Information: Facilitators encourage participants to share the new information with family and friends so that more people will discuss and agree on healthier behaviours, thereby making it easier for everyone to adopt the new behaviours.

What is the Basic Pattern for Discussion Sessions?

Community discussions generally follow a set pattern, beginning with an opening prayer. Participants report the discussions they held at home on the previous session’s topic. Community Volunteers then introduce new topics using Say and Do, mime and other tools to demonstrate new ideas. The Community Volunteer closes each topic with a summary. At the end of each session, the participants each share one thing they learned, thereby reviewing the session content. Finally, the Community Volunteer reminds participants to go away and discuss what they have learned with other members of the community. The steps are outlined in the Box below. The preliminary and closing steps which are used in every session are essential for generating community ownership of the new health information.

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Basic Pattern for Community Discussion Sessions

Step 1: Opening: PrayerStep 2: Review

• Report back on discussions with others: Participants feed back on what they discussed with their spouses, friends and relatives since the last session.

• Discuss successes and challenges: Participants discuss examples of successes and challenges they and others in the community have faced since the last meeting (e.g. what happened when someone attempted to access a particular health service).

• Practice ‘Say and Do’ from previous discussion (where applicable).

Step 3: Introduce Topic for this Session

Step 4: Discuss Experiences/Share Knowledge: Participants re#ect on what they know about the new health issue.

Step 5: Use Say & Do/Mime/Demonstration/Song: Session facilitator uses one of these techniques to communicate new information in a memorable way.

Step 6: Summarise: Session facilitator reminds participants of the key points.

Step 7: Circular Review: Today I learned that……

Facilitator’s Note. Participants stand in a circle taking turns to recall the main points of the session.

-- “We will go around the circle sharing with each other what we learned today.”

• Facilitator demonstrates by announcing:

-- “Today, I learned that everyone, not just pregnant women, needs to know about how to support women to access maternal health care services.”

• Facilitator asks the participant to her/his right to imitate her/him by saying:

--Today, I learned that …”

• Facilitator asks the next person in the circle to follow the example.

• Each participant takes her/his turn.

Step 8: Closing - Promoting Discussion: Discussion Leader reminds participants to:

• Discuss what they have learned with their husband or wife

• Discuss what they have learned with two friends and family members

• Encourage people to use services

• Discuss inequalities in access to services within the community and think of potential solutions

• Make arrangements for next meeting: place, date and time

Step 9: Closing Prayer

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What Steps Need to be Taken Before the Community Discussions Begin?

What Ongoing Support is Provided to Participating Communities?

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Community Forum and Dialogue

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COMMUNITY FORUM AND DIALOGUE

Time: 2-3 Hours

A participatory Community Forum and Dialogue is held to begin the process of engagement with members of the community. This happens prior to the start of the community discussion sessions.

Objectives

By the end of the session, participants will have:

• Identi!ed maternal health as a serious problem in the community

• Identi!ed the root causes and e"ects of the problem in a ‘problem tree’

• Developed a ‘solution tree’ to address the identi!ed problems

• Developed an action plan for the community

TopicsCommunity Forum and Dialogue

Topic Method

1. Welcome and Introduction Presentation

2. Identifying and Prioritising Problems Presentation/Discussion

3. The Problem Tree Presentation/Discussion

4. The Solution Tree Presentation/Discussion

5. Community Action Planning Presentation/Discussion

Closing: encourage participants to discuss with friends and relatives Presentation

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Audience

This session will be hosted by the senior traditional leader and conducted in a community forum setting with the following categories of participants:

• Community leaders

• Religious leaders

• Members of community based organisations

• Male and female adult members of the community

A separate forum for women is recommended to solicit women’s voices on the main problems, solutions and actions. The outcomes from the women’s forum can be discussed in the men’s forum and utilised to develop a community action plan. Facilitators for the community forum are LGA members of the core group of community mobilisation trainers.

Topic 1: Welcome and Introduction

• Opening prayers

• Acknowledge dignitaries

• Introduce LGA team

• Introduce the community forum by reminding participants of the Hausa saying, “A pregnant woman has one foot on the ground and one foot in heaven” and telling participants the following facts:

– Doctors have proved that one out of every 15 pregnant woman will face a maternal emergency that requires emergency care in a hospital.

– Special skills and equipment can save the lives of women. We no longer need to accept that many mothers have to die or su"er in order to give birth.

– Government has improved the maternal emergency services. The doctors and nurses have received special training and they have better equipment at . . . . . . . . . . . . . . . . . . . . . . . . . . . . (Name the hospital).

• Explain that the community forum will provide an opportunity to:

– Identify the problems that pregnant or newly delivered women encounter, and the underlying reasons for these problems

– Identify solutions to these problems and develop a plan of action.

Topic 2: Identifying and Prioritising Problems

Facilitator’s Note: Research and experience have demonstrated that the major cause of maternal death within the community is the delay in making the decision and the delay in transporting women with a maternal emergency to the hospital for emergency care. Assist participants to recognize that women with complications require specialised hospital medical care to save their lives and the lives of their newborns. Also assist participants to go beyond formulating the most serious problem as ‘death from complications’ to formulating the most serious problem as ‘rushing women with maternal complications to the hospital too late.’ This will ensure that the roots of the problem tree more directly address the delays in getting hospital emergency care.

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Ask participants to identify the problems experienced by women who are pregnant, delivering a baby or in the !rst 40 days after delivery.

• Encourage participants to discuss and mention many complications.

• Ensure that participants mention cases of women who were taken to the hospital for emergency care and survived (if any) and died (if any). Ask questions that encourage participants to realise that the women who died had reached the hospital too late.

• List the problems mentioned by participants.

• Keep the list for future reference and documentation.

• Encourage participants to prioritize and identify the most serious problem that is a"ecting pregnant or newly delivered women.

• Ask the following questions:

- “So what is the worst thing that can happen to a mother who is pregnant, delivering or in the !rst 40 days after delivery?”

- “How could her/their deaths have been prevented?”

- “If she had been in the hospital when her emergency started, could she have been saved?”

- “If there had been no delays in getting to the hospital when her emergency started, could she have been saved?”

• “Can we say that the most serious problem pregnant, delivering and post delivery mothers face is the possibility of a maternal complication and being rushed to the hospital too late?”

• Tell participants that from now on we will focus on the most serious problem that they identi!ed

Topic 3: The Problem Tree

Introduction

Facilitator’s Note: Use the concept of the PROBLEM and SOLUTION TREES to help participants think about how their own actions contribute to the underlying causes of their most serious problem. Support them to recognise that they have the responsibility and power to change these underlying causes. Refer to the problem tree and guide the community members to use the parts of the tree to think about the relationship between the most serious problem (the trunk), the underlying reasons/causes of this problem (the roots) and the results of this problem (the branches). To ensure that the discussion !ows well and since the words to be "lled in on the trees cannot be read by the majority of the participants, a co-facilitator should draw and "ll in the tree during the discussion.

Introduce the concept of the tree

• Ask

- “When you are looking at a tree, what do you see?” (trunk and branches)

- “Is that the entire tree? What part of the tree is not visible?” (roots)

• Draw a large tree trunk on a chalkboard or a large piece of paper or cardboard.

• Write the most serious problem across the trunk.

• Say out loud:

- “We have agreed that our most serious problem is (mention the problem they identi!ed; the possibility of having a maternal complication and being rushed to the hospital too late.)”

- “The trunk represents the most serious problem (again mention the identi!ed problem).”

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Develop the roots of the tree – the reasons or underlying causes for the most serious problem

• Tell participants that you will now begin to discuss the roots or the underlying causes of the most serious problem (mention the identi!ed problem).

• Ask participants to think about the underlying causes of the problem. Ask:

- “What are the reasons why women in our community get hospital care too late when they are in danger during pregnancy, delivery and the !rst 40 days following delivery?”

• As participants to identify a cause/reason, draw a root and write the cause/reason in the root.

• Guide participants to get to the bottom of the causes by asking for each root:

- “But why does this happen?”

Facilitator’s Note: To avoid confusing participants with the complicated image of the roots and contributory roots, the co-facilitator continues drawing the tree roots and contributory roots. The facilitator does not slow the discussion to watch the co-facilitator’s work. Instead, the facilitator keeps asking and encouraging participants to discuss their responses. This process engages the participants in group re!ection on the underlying causes and the complexity of the underlying causes.

Develop the branches of the tree – the outcome of the most serious problem

• Tell participants that they will now discuss the branches – the main e"ects of the problem (mention the most serious problem). Ask participants:

- “What are the main e"ects of the problem?”

• Draw each main e"ect as a branch of the tree.

• For each main e"ect encourage participants to identify a further e"ect by asking the question:

- “What could happen?”

Summarise

• Summarise the discussion so far using the tree to point out the most serious problem, causes and e"ects.

• Tell participants:

- “We have used this tree to show the maternal health problems of women in our community.”

- “The trunk of the tree shows the most serious problem. The roots show the causes, the reasons for - the identi!ed problem (mention some of the causes).”

- “The branches show the e"ects (mention some of the e"ects).”

• Use examples from the roots and branches to summarise how the cause and e"ects relate to each other. For example: “The absence of a husband from the home prevented a decision being made about transferring the wife to the hospital when a complication was identi!ed. The woman died.”

Topic 4: The Solution Tree

Introduction

• Tell participants that they will now turn their problem tree into a solution tree. That is, they will use the tree to think about and discuss solutions for helping their women to get access to maternal health care services, including emergency maternal health services.

• Take participants back to the trunk of the problem tree.

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• Ask participants to think about the most serious problem. Ask:

- “What solutions do you want to have in place?”

- “What do we want for our women to replace the most serious health problem we have identi!ed (mention the problem)?”

• Tell participants:

- “You can change the negative (bad statement) to a positive (good statement).”

• Ask participants to think about the most serious problem”

- “What solutions do you want to have in place?”

• Tell them”

- “You can change the negative (bad statement) to a positive (good statement).”

The Co-facilitator now draws another large trunk on another chalkboard or piece of cardboard/paper and writes down the solution identi!ed by participants (the solution is the positive statement) across the trunk of the tree.

Identify solutions to the causes of the most serious health problem

• Refer participants to each of the large roots and ask:

! “What would you like to see in place of the negative issues?”

• Guide participants to identify solutions for each large root, also linking it to the smaller roots.

• Guide participants to arrive at answers by referring them to the root causes.

! “What is underlying cause of this root?”

! “What can we do to change this root cause?”

• Draw in each answer as one of the branches.

• Repeat again for the other root causes.

• For each root cause, generate discussion on many aspects of the causes. Keep on asking the question:

! How can this be achieved?

Facilitator’s Note: Although the answers are like smaller branches, do not draw in the answers to avoid making the tree so complicated people miss the main idea that there are causes and they can change these causes into positive actions to solve the most serious problem.

Summarise the solution tree

•

! “This is the tree that we have used to show what we need to do in our community so that when women are in danger during pregnancy, delivery and the !rst 40 days following delivery they can get hospital emergency services without delay.”

! “Through our discussion we have identi!ed the solutions we would like to put in place to address the causes of our most serious problem (mention the 5-6 solutions).”

! “We will now talk about the actions needed to achieve our desired solutio

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Topic 5: Community Action Planning

Introduction

• Tell participants that they have identi!ed the solutions that are needed to help ensure that their women will no longer die needlessly from pregnancy-related complications. They will now put together an action plan.

• Mention the key solutions agreed from the solution tree.

• The solutions should not be more than six, and they should focus on issues for increasing access to emergency maternal care.

Turning solutions into actions and identifying activities

• Ask participants: “What do we need to do/what actions should we take to achieve the things we would like to see in place in our community so that our women will no longer die needlessly from pregnancy related complications?”

• Guide participants to turn the solutions into actions for example:

- Women should have permission to go to the hospital/health facility. The action for this statement is Husbands give their wives standing permission to go to the hospital/health facility.

- What activities would you carry out to achieve these actions? What speci!c activities would you carry out so that husbands give their wives standing permission?

• Guide participants to decide on activities they can carry out to achieve the desired actions. For example, the activities could include a) village head calls a meeting of all community men and discusses standing permission; or b) community volunteers visit pregnant women and discuss standing permission with them.

• Write the action down on the action plan matrix (see below).

• Guide participants to agree on priority and practical actions so that they will not have an unending list.

Agree by whom, when and where

Ask participants: “Who should do the actions and by when should the actions be done?”

• For each action, guide participants to agree on who should do the actions and by when.

• Explain to participants that responsibility for implementing the actions belongs to the community. They should therefore focus on the things they want to do as a community, or as individuals belonging to the community.

• Responsibility for implementing the actions should be grouped into the following: individuals and the community.

• The community can identify actions that they want the government to take to address challenges with the provision or quality of health services. In this case, the community should identify what they will do as a community to facilitate their request from the government.

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• If participants have not included the key components of the programme, encourage them to incorporate them into their actions. Key components include:

- Emergency transport scheme

- Community Volunteers

- Community discussion groups

- Community emergency savings scheme

- Community blood donor group

- Women’s Support Groups

• Below is a suggested format for community action plans.

• Make sure that two copies of the action plan are written up: one to be kept by the community, and one to be kept by the coaching and mentoring support team.

Closing the Session

Close the session by congratulating the community on their action plan and thanking them for their participation in the community forum.

• Tell the community that the state and local government will support them to put their plans into action. A coaching and mentoring team will visit the community at regular intervals.

• Encourage participants to discuss the ideas raised during the Community Forum with people who could not attend the meeting.

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Module One:Maternal Health

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SESSION 1: OUR NEED & RIGHT TO GOOD MATERNAL HEALTH SERVICES

Time: 1 Hour 30 minutes

After the Community Forum and Dialogue, the community discussion sessions begin. Our Need and Right to Good Maternal Health Services is the !rst discussion group session.

Objectives

By the end of the session, participants will have:

• An understanding of the objectives of the Community Group Discussion sessions

• An understanding of pregnant women’s rights to good maternal health services

• An appreciation of the community obligation to reduce maternal death

Session 1 TopicsOur Need and Right to Good Maternal Health Care Services

Topic Method

1. Welcome to Our Community Group Discussion Presentation

2. Group Rules Discussion

3. Our Concerns About Maternal Health Care Discussion

4. Sad Memories – The Reasons Why Mothers Didn’t Get Emergency Maternal Care

Sharing Experience/Discussion

5. Our Need and Right to Good Maternal Health Services Presentation

Circular review: “Today I learned that….” Discussion

Closing: Encourage participants to discuss with friends and relatives and prepare for feedback. Tell them the next topic is maternal danger signs.

Presentation

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Topic 1: Welcome to Our Community Group Discussions

Introduction

• My name is ………. and I live in (name your community or section of the community).

• I am a Community Volunteer in our community.

• My role will be to facilitate our discussions.

• Introduce your co-facilitator.

Presentation

• Ways we can help reduce maternal deaths in our community. A maternal death is death occurring when a women is pregnant, delivering a baby, or in the !rst 40 days following childbirth.

• We will meet together for !ve sessions to !nd ways to ensure that women in our community are supported to have a safe pregnancy and also prepare for a safe delivery.

• Once we have !nished our maternal health group discussions, we will move to newborn health. After this, the community discussion sessions will focus on routine immunization.

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Topic 2: Group Rules

Discussion

To ensure that we all bene!t from our group discussions, we have to agree on some rules.

When our babies cry, what will we do?

Desired Response: Put them to the breast or leave the group until the baby is quiet.

When someone comes late, what should s/he do?

Desired Response: Do not disturb the group. Join the group quickly and quietly without greeting people.

When someone is talking, what will we do?

Summarise: Summarise the agreed ground rules.

Topic 3: Our Concerns about Maternal Health Care Services for Women in Our Community

• I will start with myself.

• My name is . . . . . . . . . . . . . . . One concern I have about women in this community receiving maternal health care services is . . . . . . . . . . . . . . . . .

• Just as I have done, we will all take turns to introduce ourselves and say one concern we have about women receiving maternal health care services during pregnancy, delivery and the !rst 40 days following delivery. The participant to my right will continue with the introductions and concern until every one of us, in turn, has introduced herself or himself.

Topic 4: Sad Memories: Reasons Women Never Got Emergency Maternal Care

Positioning: Pairs sit in a circle and count o". Count o" 1, 2; 1, 2; 1, 2, etc. Each person who called “1” turns to the person who called “2” on their right and asks her/him to form a pair by facing each other.

Pairs Discuss for 3 minutes

Remember our sisters, mothers, daughters, and friends who died or were harmed during pregnancy, childbirth or after childbirth. Tell your partner what happened.

Volunteers Share

Will some volunteers please share your sad memory with the group?

What is a Maternal Emergency

Amaternal emergency is when a woman who is

• Pregnant

• Delivering her baby or

• In the !rst 40 days after childbirth

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Question for Discussion

In our sad memories, what was it that prevented the women (who were pregnant, delivering a baby or were in the !rst 40 days following childbirth) from getting emergency care at the health centre or hospital on time?

Facilitator’s Note: Allow participants to discuss what they remember and think are the causes of the delays. The participants will probably mention most of the “reasons we didn’t rush” that are listed below. If the participants omit any of the reasons listed below, tell them that we will discuss a few other “reasons we didn’t rush” later in the session.

Possible Responses

• No one knew that the woman was in serious danger

• The family did not decide on time to take the woman to the health centre/hospital

• Transport was not available, was too costly or took too long to arrange

• Distance to the health centre or hospital was too far and the pregnant mother and her family did not start on time

• They feared that the mother might die before reaching the health centre.

• The family sought emergency care !rst from the TBA or traditional healer

• The mother and her family members didn’t believe the health centre could save her life and the baby’s life.

Summary

• Our sad memories have reminded us of what can happen if we delay in rushing our wives, daughters, sisters and other women in our community who have maternal complications during pregnancy, delivery and in the !rst 40 days following childbirth to the health centre.

• The life of a woman su"ering a maternal emergency, and the life of her unborn baby, can be saved by getting medical care at the health centre.

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Topic 5: Our Need and Right to Good Maternal Health Care Services

Presentation

• It is a moral responsibility on the part of the government and the community to ensure a woman that carries a pregnancy for nine months has access to good maternal health care so that she can deliver safely. The government recognises our need and your right to good maternal care. The government is improving services to ensure that women with or without complications/problems during pregnancy, delivery and in the !rst 40 days following delivery receive good health care in the following health facilities and hospitals (Name the nearest PHC, BEOC and CEOC facilities). These are some of the things the government has done and is still working on:

- Health sta": E"orts are being made to ensure that the right health sta" are in the right place at the right time.

- Special training: Health sta" have received special training on how to provide urgent care to women that come to the facility for delivery and to women with a maternal emergency so that their lives and the lives of their unborn babies can be saved.

- Equipment: The health facilities are being given equipment to help the health sta" do their work better.

- Supplies: Essential supplies to deal with emergency maternal cases are being provided.

- Ambulance service: Some of the bigger health facilities have an ambulance service. This moves women from a health centre to the hospital. Priority is given to emergency maternal care cases.

Health Centres and Hospitals Serving This AreaInstructions: Fill in the names of the health centres and hospitals in your catchment area

• Community members have also come together to volunteer their time, cars and to donate blood and money to support women to access maternal care. As a result of this sense of communal responsibility, this community has the following systems:

- Community Volunteers like myself have been nominated by the community and are voluntarily facilitating and raising awareness of community members to access maternal care services. The volunteers are not paid. You may personally know some of the lead volunteers [name them].

- Emergency Transport Scheme (ETS) to transport women in labour or with maternal complications to the hospital at minimal cost. The ETS drivers are members of National Union of Transport Workers and also members of your community. Neither the NURTW nor the government pays the ETS drivers. The drivers are volunteers requesting for the cost of fuelling their vehicle. [Name them]

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- Blood Donor Groups are groups of community volunteers who donate their blood to women with maternal complications in order to reduce the delays associated with getting access to blood in the hospital. The group members are not paid. [Name them]

- Community Saving Schemes have been established through donations from community members to reduce the delays associated with getting hold of money to pay for treatment. The schemes can give loans or grants depending on the economic position of the woman and her family. Community saving schemes are di"erent from individual savings by a pregnant woman or a couple. [Name the leaders of these schemes]

• All these commitments show that people in the community recognise the right of pregnant women to timely health care and the obligation of the community to support women.

Summarise

• We can make it easier to rush our wives, sisters and women in our communities, including the vulnerable and the excluded, to the health centre so they will no longer die from pregnancy complications by working together as a community to put our recommendations into action.

• We will be doing this in the course of the group discussion sessions.

Circular Review

Facilitator’s Note: Participants bring out the main points of the session themselves.

Closing

Topics to Share with Relatives and Friends

• Sad memories about the reasons our mothers did not get emergency maternal care• What the government is doing to improve maternal health services• The work of Community Volunteers• The existence of community systems in a form of emergency transport scheme, emergency

savings schemes and blood donor groups

Topics for Next Session

• Danger signs that mean we must rush the woman to the hospital

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SESSION 2: MATERNAL DANGER SIGNS

Time: 2 Hours

Objectives

By the end of the session participants will:

• Recognise that not knowing the maternal danger signs can delay decision-making when a maternal complication occurs

• Feel con!dent that they know the maternal danger signs

• Begin to feel responsible for ending delays by planning for maternal emergencies

Session 2 TopicsMaternal Danger Signs

Topic Method

Our discussions with spouses, relatives and friends: share what was discussed

Review

1. Recalling Signs of Danger Before a Maternal Death Sharing Experiences

2. Introduction to the Maternal Danger Signs Presentation

3. Learning the Danger Sign Poses Say & Do poses

4. Learning Ciwon Ladi, a Maternal Danger Signs Song Song

5. Responding to Mistaken Beliefs That Prevent Women With Danger Signs Being Rushed to the Hospital

Discussion

Circular review: Today I learned that….. Discussion

Closing: Encourage participants to discuss with relatives and friends and prepare for feedback. The next topic will focus on antenatal care, supporting women in the community who face di$culties in accessing care, and planning for a safe pregnancy and delivery.

Presentation

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Presentation

Welcome. In this session, we will:

• Learn the signs that will tell us that the life of a pregnant woman, a woman delivering a baby or a woman in the !rst 40 days after childbirth is in danger and she needs to be rushed to the hospital.

• Discuss our beliefs that prevent us from recognizing that the danger signs are really dangerous and require us to rush women to the hospital.

• Discuss and learn about the actions that pregnant women and their families and other members of the community can take to ensure that women who have problems and complications are rushed to the hospital on time and receive the care they need to save their lives and the lives of their unborn babies.

Review

First we will review the discussions that we had with husbands, wives, family members, friends and other people in the community following last week’s session.

• Tell participants: “I hope you all shared our discussions with your spouses, relatives and friends. Please share with us your discussions. What did you tell them?”

• Encourage 3-4 volunteers to share their discussions.

Facilitator’s Note: If participants omit to mention what government, volunteers and volunteer systems are doing, then ask them speci"cally:

• What is government doing to improve maternal health?

• What is the work of the Community Volunteers? Who are the lead volunteers?

• What systems have been set up in the community to help women access services? Who should you contact to volunteer or to obtain the services?

Summarise

Summarise the main points made by the discussion group participants and give feedback.

Topic 1: Recalling Signs of Danger Before a Maternal Death

Experiences

Let’s think of some experiences we have had

• Let’s think about our experiences with women who were in danger during pregnancy, delivery and the !rst 40 days after delivery.

• What did we see when these women su"ered a complication? What was it that told you that the life of a woman and that of her unborn child was in danger?

Possible Responses

• Mother began !tting

• Mother bled

• Mother was still in labour after a whole day and night; etc.

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Topic 2: Maternal Danger Signs

Presentation

• Together we have recalled from our various experiences some maternal danger signs. That is signs that tell us pregnant women, woman delivering a baby or women who are in the !rst 40 days following childbirth are in danger and need emergency care at the hospital.

• The doctors have identi!ed danger signs to watch out for during the maternal period from the beginning of pregnancy, during childbirth and after childbirth for the !rst 40 days.

• A woman who has any of these signs before, during or after childbirth must be rushed to the hospital. The doctors and midwives can save her life and her baby’s life.

There are eight danger signs. The signs are:

Facilitator’s Note: Use the Say and Do body signs while you talk about these signs.

1. Severe headache means she may start !tting. Don’t delay. Go to the hospital so the health workers can prevent the !tting.

2. Swollen feet, hands or face means she may start !tting. Don’t delay. Go to the hospital so the health workers can prevent the !tting.

3. Fitting (often preceded by headache and swollen feet, face & hands). Don’t delay. Rush to the hospital.

4. Severe bleeding. A mother who keeps bleeding after childbirth can die in a few hours. Bleeding during pregnancy also means something is wrong. Rush her to the hospital.

5. Fever/chills in the days after childbirth is caused by a serious infection that can cause death or sterility (a sterile man or woman cannot have children). Foul smelling discharge also indicates infection. Don’t delay. Rush her to the hospital. Do not go to the chemist/patent medicine vendor for help.

6. High fever during pregnancy can mean infection or malaria and are dangerous for both the baby and the mother.

7. Labour lasts more than 12 hours. Something is wrong. Don’t delay. Rush to the hospital. The birth canal may be too small; the baby’s umbilical cord, hand or feet could be coming !rst. It will be di$cult or impossible for the baby to come out. If the baby comes out, it will tear the mother’s birth canal hurting both the baby and the mother. Don’t delay. Rush to the hospital.

8. Hand, foot or cord comes !rst. Don’t delay. Rush to the hospital. The baby will not come out without medical assistance.

9. Placenta does not come out within 30 minutes of childbirth. Something is wrong. Don’t delay. Rush to the hospital.

Remember the Maternal Danger Signs

• Swollen feet, hands and/or face (!tting may start soon)

• Severe headache (!tting may start soon)• Fitting (often preceded by severe

headache and swollen feet, face & hands)• Severe bleeding • High fever after childbirth; or fever during

pregnancy• Labour lasting more than 12 hours• Hand, foot or cord comes !rst• Placenta still has not come out after 30

minutes

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Topic 3: Learning the Danger Sign Poses Using the Rapid Imitation Method

Facilitator’s Note: The facilitator needs to learn how to demonstrate the Danger Signs Poses. Facilitators can use the guidance in the box below.

Instructions: Use the rapid imitation method to learn and recall the maternal danger signs

The Rapid Imitation Method described below ensures that each participant learns how to demonstrate each maternal danger sign. Repeating the demonstration of each sign makes it easier for participants to easily remember and recall the danger signs.

Rapid Imitation Method

Facilitator demonstrates a sign.

Facilitator says she will lead and asks participants to imitate her two times.

Participants imitate facilitator 2 times.

Participant demonstrates:

Facilitator notes a participant who is doing a sign well and asks her/him to move one step into the circle and demonstrate the sign.

Facilitator asks participants to imitate the Participant Demonstrator 2 times.

Participant leads everyone 2 times.

Volunteers demonstrate each sign:

Facilitator asks for volunteers to demonstrate a sign.

Volunteer moves one step into the circle and demonstrates a sign.

Volunteer leads everyone 2 times.

Facilitator leads all the participants to demonstrate the key danger signs together.

Participants imitate her/him 2 times.

Practice each danger sign pose, one at a time. Continue using this rapid imitation method until all the dangers signs poses have been learned.

Facilitator’s Note: Facilitators need to ensure that all participants are following the process correctly. The 2x repetition is the minimum. Repeat as many times as necessary to ensure that at least all of participants are imitating very well.

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Descriptions of the Maternal Danger Signs Poses*

1. Severe headaches: Hold the side of your hand on your forehead pretending to have a terrible headache.

2. Swollen feet, hands and/or face: Touch the places that will be swollen one after the other. Touch the top of your foot; hold one of your wrists; put your hands on the sides of your face and pu" up your face.

3. Fitting: Hold your hands up in the air and let your head fall to one side while shaking your hands and whole body.

4. Severe Bleeding: Hold your hands #at, face down above your lap and push away from your body to remind us that the blood #ows away from the womb.

5. Fever/chills (with or without foul smelling discharge): Cross your arms on your shoulders and shiver; hold your hands #at, face down above your lap and push away from your body to show that there is #ow away from the womb; wave your right hand down from your lap area with a facial expression of a foul smell to show that the #ow from the womb has an o"ensive odour.

6. Prolonged labour (more than 12 hours): Put your two knees on the #oor, hold tightly to the right side of your waist, press your left hand on the #oor and wriggle in pain.

7. Hand, foot or cord comes out !rst: Push your right hand out in front of you; push your foot out in front. Pull your hand out from your belly button.

8. Placenta does not come out 30 minutes after childbirth: Be on your two knees, hold out your two hands in a receiving position above your lap and open out with an expression on your face showing anxiety.

*These poses were developed by Hausa women to help them remember the danger signs. Women and men from other cultures can create poses that are meaningful for them.

Facilitator’s Note: Previous experience of running this session has shown that some elders and mallams prefer to teach assistants to demonstrate the poses on their behalf. However, they all enjoy learning and doing the poses in workshop settings.

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Topic 4: Learning Ciwon Ladi, a Maternal Danger Signs Song

Presentation

Sing this song repeating each line twice while doing the Say & Do action.

WAKAR DA ALAMOMIN CIWON LADI NA CIKI DA NA DANGANE DA CIKICiwon Ladi

Kumburin Kafar Ladi % 2Intai Haka ta fara % 2

(Demonstrate Swollen Feet/Foot)

Ciwon Kan Ladi % 2Intai haka ta fara % 2

(Demonstrate Severe Headache)

Ciwon Jijjigar Ladi % 2Intai haka ta fara % 2

(Demonstrate Fitting)

Rashin Jinin Ladi % 2Intai Haka ta dashe % 2

(Demonstrate Anaemia--Lack of Blood)

Zubar Jinin Ladi % 2Intai haka ta fara % 2

(Demonstrate Severe Bleeding)

Doguwar Nakudar Ladi % 2Intai haka ta fara % 2

(Demonstrate Prolonged Labour)

Hannu Kafa Cibi % 2In sun !to akwai Matsala % 2

(Demonstrate Hands, Feet or Cord Come First)

Jinkirin Mabiyiyar Ladi % 2 Intai haka ta fara % 2

(Demonstrate Placenta Not Released )

Ciwon Zazzabin Ladi % 2Intai haka ta fara % 2

(Demonstrate Severe Fever)

Ciwon zazazabin bayan hauhuwai Ladi % 2Intai haka ta fara % 2

(Demonstrate Fever After Birth)

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Topic 5: Responding to Mistaken Beliefs that are Preventing People From Rushing a Woman with Danger Signs to the Health Facility

Discussion

Let’s consider each danger sign one by one and discuss:

What do people say about these signs? What do they believe?

• Now that we have learnt what the doctors say about these signs, how can we help to save lives?

• How can we respond to these mistaken beliefs?

Facilitator’s Note: The purpose of this discussion is to allow participants to bring forward their traditional beliefs and to consider modern reasons why they should rush women to the EOC facility despite these beliefs. The ‘Possible Responses’ described below were provided by Hausa women. When working with other cultures, it will be necessary to replace these possible responses with culturally relevant responses.

Fitting

What do people say about !tting?

What do we, community members with new knowledge on maternal health, say in response to beliefs about !tting?

Fitting is not contagious. Doctors and midwives work with "tting women every day but they do not start "tting.

What do people say about swollen hands and feet?

As community members with new knowledge on maternal health, what do we say in response to beliefs about swollen hands and feet?

Swollen feet are a reaction of the body to the pregnancy. It can be a sign that the pregnant woman will begin "tting if they do not get special medicine from the midwives and follow their advice. Rush her to the health facility.

What do people say about severe headache?

Possible Response: “Some people say it is caused by fever (malaria) and so it is nothing to worry about”.

As community members with new knowledge on maternal health, what do we say in response to beliefs about severe headache?

In pregnancy severe headache can be a sign that the mother may start "tting soon. If she has fever, malaria may be the cause of her headache. Malaria can kill the baby in the womb even if the mother gets over the fever. Rush her to the EOC facility. The health worker will be able to determine if her headache means she will start "tting or if her headache is from malaria. Don’t wait for "tting to start! Rush her to the EOC facility.

Too much bleeding

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What do people say about too much bleeding?

Possible Responses:

• “The heavy bleeding is good. She will give birth to a baby boy.”

• “The bad blood needs to get out of her body; otherwise she will have stomach pain.”

As community members with new knowledge on maternal health, what do we say in response to beliefs about too much bleeding?

A small amount of bleeding is normal during childbirth but no bleeding is normal during pregnancy. Too much bleeding can kill a person in a few hours. Rush her to the EOC facility. The doctors and midwives can stop the bleeding and, if necessary, replace the lost blood.

Fever/chills (and/or foul smelling discharge) in the days after childbirth

What do people say about fever/chills in the days after childbirth?

Possible Response: “Dahuwar kashi (literally boiling bones) is normal during and after childbirth. Do not worry about it. ”

As community members with new knowledge on maternal health, what do we say in response to beliefs about fever chills in the days following childbirth?

An infection in the birth canal and the womb causes this fever. It is very dangerous for the woman. The woman needs special medicine from a hospital to prevent the fever from causing sterility. A sterile man or woman can never have a baby again. Rush her to the hospital. Do not delay. The infection can spread to the narrow tube that carries the mother’s egg to meet the man’s sperm. If the infection blocks the tube, then the mother cannot become pregnant.

Labour lasts more than 12 hours

What do people say about long labour?

Possible Response: “When Allah says it is time, the baby will come.”

As community members with new knowledge on maternal health, what do we say in response to beliefs about prolonged labour?

That is true, but God also asks you to stand up to help yourself, so God will help you. Rush her to the hospital.

Umbilical cord, a hand or foot comes !rst before the baby’s head

What do people say about umbilical cord, hand or foot comes !rst before the baby head?

Possible Response: “It’s a bad omen. A jealous co-wife or other person has caused this su"ering. An evil spirit or a witch has harmed her.”

As community members with new knowledge on maternal health, what do we say in response to beliefs about umbilical cord, hand or feet coming !rst before the baby’s head?

Doctors and midwives have proved that they can save the life of the mother and baby. Rush her to the hospital.

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Placenta does not come out within 30 minutes

What do people say about a placenta that does not come out within the !rst 30 minutes of birth?

Possible Responses

• “Tie her wrapper tight; press on her stomach.”

• “Give her pepper to make her cough.”

As community members with new knowledge, what do we say in response to beliefs about a placenta that does not come out within 30 minutes of birth?

It is dangerous to leave the placenta or part of it inside the mother. The doctors and midwives can remove it safely without any danger to the mother. They can save the life of the mother. Rush her to the hospital.

Discussions

• We have come together to discuss these ideas, and learned more about how to help reduce deaths of mothers in our communities. With our new knowledge, what do we do if our wives, sisters and community members show any one of these signs during childbirth?

Desired Response

“We rush them to the hospital without delay.”

Who are the women in our communities that are likely to lack the necessary support to respond to the maternal emergencies we have discussed?

Possible Responses

• Women who have very poor husbands and no parents or kin to support them

• Women in polygamous marriages, particularly those not favoured by the husband, in-law and other relatives

• Women who live in the remote areas in the settlement

• Women whose husbands get drunk and beat them even during pregnancy

• Ask participants what can be done about the women who are unable to take action.

• Encourage participants to make a commitment to these women:

“We support every woman in the community, whether our relation or not, and will rush her to the hospital without delay.”

Circular Review

Today I learned that……

Closing

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Topics to Share With Relatives and Friends

• The eight maternal danger signs• How local beliefs about danger signs can delay us from taking a woman with a complication

to the health facility8. Placenta does not come out 30 minutes after childbirth: Be on your two knees, hold out your two hands in a receiving position above your lap and open out with an expression on your face showing anxiety.


• Importance of antenatal care• Steps to take to remain well during pregnancy• Supporting women who will !nd it most di$cult to remain well during pregnancy• Planning for a safe pregnancy and delivery

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SESSION 3: PLANNING FOR SAFE PREGNANCY AND DELIVERY

By the end of this session participants will:

Know that every pregnancy carries its own risk

• Be convinced that attendance at four ANC sessions is very important

• Understand that every woman should plan for safe pregnancy and delivery

• Know how to organise a Safe Pregnancy Plan

Session 3 TopicsPlanning for Safe Pregnancy and Delivery

Topic


Review

1. Go for ANC Because Every Pregnancy Can Have a Complication Say and Do

2. Importance of 4 ANC Visits Rapid Imitation

3. Helping Women Remain Well During Pregnancy Presentation

4. How We Can Help the Women With the Least Support Discussion/Commitment

5. Preparing a Safe Pregnancy Plan (SPP)

6. Knuckle and Groove Reminder Method to Recall the Safe Pregnancy Plan

Circular review: Today I learned that…..

Closing: Encourage participants to discuss with relatives and friends and to be prepared to feed back. The next topic will be the bene!ts of delivering with a Skilled Birth Attendant and how we can make it easier for women in our communities to deliver their babies with a Skilled Birth Attendant.

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Presentation

Welcome. In this session, we will:

• Learn the importance of going for antenatal care when a woman is pregnant

• Learn how to help women remain healthy during pregnancy

• Think about how to support the women who will !nd it most di$cult to remain well during pregnancy

• Learn about safe pregnancy plans

Review

• First we will review the discussions that we had with husbands, wives, family members, friends and other people in the community following last week’s session.

• “I hope you all shared our discussions with your spouses, relatives and friends. Please share with us your discussions. What did you tell them?”

• Encourage 3-4 volunteers to share information on the discussions they had with family, friends and others over the last week.

Ask the following, if participants do not mention these issues:

• Did you remember the maternal danger signs?

• Did you teach anyone the maternal danger signs?

• What did the people you spoke to say about the maternal danger signs?

Summarise

Summarise the main points made by the discussion group participants giving feedback.

Topic 1: Go For ANC Because Every Pregnancy Can Have a Complication

Presentation

• Every pregnancy can have a complication. Most pregnancy complications occur suddenly and unexpectedly.

• We must go for antenatal visits in order to obtain advice and care that helps prevent complications thereby saving the lives of the mother and the newborn in the womb.

• The ANC healthworker can detect many, but not all, complications before they happen and provide treatment to prevent or reduce the complication.

Discussion

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What does the health worker do during ANC that protects the life of the mother and the newborn in the womb?

Facilitator’s Note: Encourage discussion.

Say and Do: Use Say and Do to communicate the bene!ts of ANC.

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Summarise

• If the mother su"ers from anaemia, malaria, overwork and/or poor nutrition, the baby is likely to be a low birth-weight baby.

• Low birth-weight babies are more likely to die in the !rst days and weeks of life.

• ANC therefore protects the health of pregnant mothers and the life of newborns.

Topic 2: The Importance of Four ANC Visits

Presentation

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•

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Demonstration

Facilitator’s Note: Use your "ngers to count out the four visits. Repeat the schedule several times. Then ask for a couple of volunteers to repeat the schedule by counting out the visits on one hand.

1st After three missed periods (before 4 months)

2nd Health Worker will tell you when to return (5-6 months)

3rd Health Worker will tell you when to return (7-8 months)

4th During the last month of pregnancy: Health Worker will tell you

Small Group Discussion and Report

What can we do to make it easier for women in our communities to begin ANC on time and make all the visits as advised by the health worker?

Facilitator’s Note: Encourage discussion and then ask a representative of each small group to report back.

Commitment

Encourage participants to make a commitment to address the barriers and support a pregnant woman to go for the four ANC visits.

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Topic 3: Helping Women Remain Well During Pregnancy

Discussion

What are the problems that women in our communities face that could prevent them from staying well during pregnancy and put their health and the health of their unborn babies at risk?

Facilitator’s Note: Encourage discussion. Use the list below to add in new ideas if these are not mentioned by participants.

Possible Responses

• No food/not enough food during pregnancy

• Women doing too much heavy work

• Women who do not make their ANC visits

Presentation and Discussion

How Women Can Stay Healthy During Pregnancy

• Diet: pregnant women need to make some changes in their diet. Women need three types of food to ensure the baby grows well and the mother stays healthy: protective, growth and energy foods.

Facilitator’s Note: for each of the food types, describe them and ask the participants to list locally available foods.

Protective food: (any green, yellow or red local vegetable or fruit). This could be: bean or pumpkin leaves, sweet potato leaves, cassava leaves; or mangoes, pawpaw, carrots

Growth food: (foods that will help the woman and baby to grow).This could be: beans, groundnuts, milk, eggs, chicken, meat, !sh, cray!sh

Energy food: (the main meal of the day). Millet, sorghum, maize, rice, cassava

• Rest: pregnant women need to rest well, particularly during the later stages of pregnancy and should avoid lifting and carrying heavy items

• Free from physical harm: domestic violence is bad for every woman and even worse for pregnant women. Domestic violence can result in physical harm to the mother and the unborn child. A heavy fall or blows from wife beating can endanger the life of both mother and child.

• We have also discussed the need for pregnant women to begin ANC on time and complete their visits.

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Topic 4: Helping the Women With the Least Support

Discussion

Who are the women in our communities who will likely lack the care we have discussed?


Possible Responses

• Women who live in the remote areas in the settlement.

• Women whose husbands neglect them and fail to provide money for food or basic health needs (or beat them) even during pregnancy.

• Women whose husbands have left the settlement in search of work and fail to send money back home.

• Women whose natal family lives far away.

Small Group Discussion and Report

What can we do to help women who need the most help to remain well during pregnancy?

Instructions

Discussion group participants split into groups of 3-4 to discuss the questions below:

Who are the women in our settlements that need the most help to remain well during pregnancy?

As female community members, how can we help them?

- As male community members, how can we help them?

- What support do we need from the Community Volunteers?

- What support do we need from our community leadership?

• Each group will feed back to the group as a whole on their discussions.

Commitment

• Discussion group participants are encouraged to make a personal commitment to taking action to support the women who need the most help to remain well during pregnancy.

• We will share our suggestions with other community members.

• We will then agree as a community how to progress with our suggestions.

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Topic 5: Preparing a Safe Pregnancy Plan (SPP)


Remember our sisters, mothers, daughters, and friends who died or were harmed during pregnancy, childbirth or after childbirth. Turn to the person next to you and tell them what happened.

Volunteers Share

Will some volunteers please share your sad memory with the group?


In our sad memories, what was it that prevented the women (who were pregnant, delivering a baby or in were in the !rst 40 days following childbirth) from getting emergency care at the hospital on time?

Facilitator’s Note: Allow participants to discuss what they remember and think are the causes of the delays. The participants will probably mention most of the “reasons we didn’t rush” that are listed below. If the participants do not mention any of the reasons listed in the table, tell the participants we will discuss a few other “reasons we didn’t rush” later in this session.

Possible Responses

No one knew the danger signs

• Not enough money, no savings

- too costly care at the hospital (fees, drugs, equipment)

- took too long to collect the money

• Husbands hadn’t given permission to go to health facility/the husband was away.

• The woman did not call for help in time.

- No one stayed with the mother during childbirth to raise the alarm.

• Transport was not available, was too costly or took too long to arrange.

• The blood was too costly and there were no donors readily available.

• The husband and family sought emergency maternal care !rst from the people who usually provide their health care (TBA, traditional healer, chemist, small health facility).

• The mother and her family members didn’t believe the hospital could save her life and the baby’s life. They feared that the mother would die at the hospital.


What do we need to know and do in order to be able to rush a woman with a maternal emergency to the hospital?

Desired Responses

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Facilitator’s Note: The table below presents the main “reasons we didn’t rush” and the actions we need to take to prepare for a maternal emergency. For each “reason we didn’t rush”, ask what we need to do in order to be able to rush a woman with a maternal emergency to the hospital/health facility. You may use your "ngers to help you recall the reasons we didn’t rush and the actions we need to take.

Reasons we failed to rush our pregnant mothers to the hospital when they had complications and what we can do about it

•

•

Other reasons include:

• The mother and her family members didn’t believe the hospital could save her life and the baby’s life.

• They feared that the mother would die at the hospital.

Presentation

We have identi!ed actions we could take in our families and in the community to help women deliver at the health centre and also to save mothers lives when there is an emergency.

The actions we have identi!ed will enable our pregnant mothers to receive timely care as well emergency maternal care from the health centres.

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These actions are a plan that families and community members need to make in order to ensure that pregnant women are prepared for delivery.

• The Safe Pregnancy Plan Actions are: 1. Know the danger signs: Pregnant mothers and their families should know the danger signs. 2. Save money: Pregnant mothers, husbands and their families should save money; communities

should be prepared to help families with money when there is a maternal emergency. 3. Contribute to community savings: Know about community savings for Emergency Maternal Care

and, if possible, contribute to the community savings. 4. Get standing permission: Husbands of pregnant women should give standing permission

for their wives to go to the EOC facility; male elders and religious leaders should encourage husbands of pregnant mothers to give standing permission.

5. Have a mother’s helper: Pregnant mothers should have a mother’s helper who can help identify

danger signs and raise the alarm; husbands and senior women in the home should ensure that pregnant mothers have a mother’s helper during their childbirth.

6. Have a transport plan: Husbands of pregnant mothers, the pregnant mothers themselves, the

mother’s helpers and other community members should know the NURTW ETS drivers or should know a driver or vehicle owner who will be available and willing to transport the mother in case of an emergency.

7. Arrange for blood: Families of pregnant mothers should arrange for blood; know family members

and volunteers who will be willing to donate blood in case of an emergency.

Next we will introduce you to a method that will help you remember the safe pregnancy plan.

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Topic 6: The Knuckle and Groove Say & Do Reminder Method for Recalling the Safe Pregnancy Plan

Demonstration

Preparing for a Safe Pregnancy

Facilitator’s Note: Use the knuckle and groove reminder method to help recall how to prepare for a possible maternal emergency so that we can rush a mother with a maternal emergency to the EOC facility without delay. Recall each action by touching the reminder knuckle or groove on the back of the left hand starting from the knuckle nearest the thumb.

Knuckle and Groove Say & Do Reminder Method for Recalling the Safe Pregnancy Plan

Knuckles and Grooves

Use your left hand. Start with knuckle nearest to the

thumb

Safe Pregnancy Plan Actions

1 Knuckle Know the Danger Signs

2 Groove Save Money

3 Knuckle Know About and Contribute to Community Savings

4 Groove Obtain Husband’s Standing Permission

5 Knuckle Identify a Mother’s Helper

6 Groove Arrange for Transport

7 Knuckle Arrange for Blood Donors

Demonstration

Use the knuckle and groove method to demonstrate the SPP actions.

• Repeat the Say & Do activity again a second time.

• Ask participants to Say & Do after you.

• Then look for a participant who is touching the reminder !ngers correctly and saying the correct reasons why mothers do not receive timely emergency care.

• Ask the participant to step forward into the circle.

• The demonstrator-participant leads and other participants join him/her. They do the !nger reminder method and say the seven key actions to plan for a maternal emergency.

Repeat this process for all SPP actions until participants are comfortable with the knuckle and groove reminder method.

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Summarise

• We have identi!ed actions we could take in our families and in the community to help save mothers lives when there is an emergency.

• The actions we have identi!ed will enable our pregnant mothers to receive timely emergency maternal care from the EOC facility.

• These actions are part of a safe pregnancy plan

Circular Review

Today I learned …

Closing


• Importance of going for antenatal care• The care that women need when pregnant• How we can support the women who are least able to take care of themselves• How we need to plan for a safe pregnancy• The seven safe pregnancy plan actions


• Bene!ts of delivering with a Skilled Birth Attendant • How we can make it easier for women in our communities to deliver their babies with a Skilled Birth Attendant

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SESSION 4: IMPORTANCE OF HOSPITAL DELIVERY

Time: 1 Hour 30 Minutes

Objectives

At the end of this session participants will:

• Know the bene!ts of skilled birth attendance and begin to feel responsible for ending the barriers preventing access to skilled birth care.

• Know that they can use their knowledge and social pressure to support pregnant women to have a hospital delivery.

Session 4 TopicsImportance of Hospital Delivery

Topic Method


Review

1. All Pregnant Women in Labour are at Risk Presentation/Discussion

2. Bene!ts of Delivering with a Skilled Birth Attendant (SBA) Discussion/Presentation

Circular review: Today I learned that….. Review

Closing: Encourage participants to discuss with relatives and friends and to be prepared to feed back. The next topic is community emergency systems.

Presentation

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Presentation

Today we will look at why hospital delivery is so important.

Review


- “I hope you all shared our discussions with your spouses, relatives and friends. Please share with us your discussions. What did you tell them?”


If the volunteers do not mention the following points, introduce them into the discussion.

• Why is it important to go for antenatal care?

• What special care do women need when pregnant?

• How can we support the women who are least able to take care of themselves?

• What are the seven safe pregnancy plan actions?

Facilitator’s Note: Use the ‘Say and Do’ knuckle and groove method to remind participants of the seven safe pregnancy plan actions.

Summarise


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Topic 1: Plan to Deliver in the Facility Because Every Delivery Can Have a Complication

Presentation

Experience has shown that a woman can have dozens of deliveries, but each delivery is di"erent.

• Some of the deliveries might be normal, while others may come with complications. Most complications occur suddenly and unexpectedly.

• We have traditional sayings that remind us that every pregnancy can have a complication. What are these sayings?

Possible Response

“A pregnant woman in labour has one foot in heaven and one foot on earth.”

Discussion

Are there other sayings that suggest that labour is unpredictable?

Presentation

In the last session we learnt that it is important for every pregnant woman to attend ANC four times beginning from the third month of her pregnancy.

• However, ANC is not enough, because every woman, even a woman who attends ANC, can suddenly have a maternal complication.

• To help save women’s lives, there are two things we must do:

1. plan for a delivery with a skilled birth attendant

2. plan for a maternal emergency (which we have already discussed)

Topic 2: Bene!ts of Delivering with a Skilled Birth Attendant

Facilitator’s Note: The facilitator will ask some questions and encourage participants to discuss these in turn. If participants do not make key points, the facilitator will introduce these points into the discussion.

Discussion

In our community, where do we like to deliver our babies?

Possible Responses

• Our homes

• Health centre/hospital

• It depends on whether the pregnant woman has complications or not

• It depends on whether the pregnant woman is in a good state of health or not

Why do many mothers deliver their babies at home instead of in the clinic or hospital?

Possible Responses

• The health centre is too far and transport is not available

• The cost of delivery in the hospital

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• Tradition/common practice/we have always given birth at home

• The services in the hospital are inadequate and poor

• Health workers are not always friendly; sometimes they are rude to women in labour

• No female health workers at the health facility

• We avoid exposing ourselves to people

• Not sure of the expected delivery date – “I was caught out by labour”

Why does a pregnant woman need to give birth with a skilled birth attendant?


Desired Responses

• A normal labour can suddenly change to a dangerous labour.

• Skilled birth attendants have skills and medicines that can identify and prevent many dangers before we can see them.

- They can prevent dangers or make them less dangerous, or rush mothers and/or newborns to the hospital without any delay if they need hospital care.

- They can give some treatment as soon as they see danger so that the mother/newborn is safer while being transported to the hospital.

• Skilled birth attendants can help us avoid ragged tears that take longer to heal and leave ugly scars.

What is government doing for pregnant women to have good service when they go to deliver in the hospital?

Possible Answers

• Health facilities are now organised to serve you better

- 24/7 health centres

- BEOC

- CEOC for emergencies

• Increased number of specially trained female health workers in health facilities

• Cost of delivery is very low compared to emergencies because of free MNCH drugs and the sustainable drug supply system (SDSS).

Summarise

The facilitator will summarise the session by presenting the information in the box below.

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Importance of Delivering with a Skilled Birth Attendant

• In all countries, including Nigeria, around 1-2 woman in every 10 pregnant women have serious complications.

• Most pregnancy complications occur suddenly and unexpectedly. Every pregnancy can have a complication even if:

- The mother has had easy deliveries before

- She has attended ANC

• The doctors advise that every woman should have her delivery attended by a Skilled Birth Attendant. This is the safest delivery for a mother and newborn.

- During delivery skilled birth attendants can identify dangers before we can identify them.

- They can treat the dangers before they become too serious.

- If necessary, they will rush the woman to a bigger hospital sooner than we can.

• Delivering with a Skilled Birth Attendant is much, much safer than delivering at home for both the mother and the newborn because:

- Of the uncertainty associated with labour.

- Skilled attendants use their medical knowledge, skill and equipment to test for danger signs so they see dangers before we can see them and before they become too dangerous.

- Skilled attendants can treat and prevent many dangers.

They know how to help the placenta come out

They can give a severely bleeding woman an injection to prevent further bleeding.

They can give a woman who is !tting medicine to stop this.

They know when a danger is beyond their skill and will rush the woman or the newborn to a bigger health facility without delay.

Circular Review Today I learned …

Closing

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• Every pregnancy carries a risk• Importance of facility delivery• Planning to deliver in a health facility is safer and saves lives

Topic for Next Session

• The support that is available at community level for pregnant or newly delivered women – community emergency systems

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SESSION 5: SUPPORTING COMMUNITY SYSTEMS TO INCREASE ACCESS

Time: 2 Hours

Objectives


• Know how to access the community emergency systems established to support women to have a safe delivery.

• Have made a commitment to actively support the community emergency systems.

• Have learnt about other types of support or services available, such as the work of Facility Health Committees or the availability of ‘door-step health services’.

Session 5 TopicsSupporting Community Systems for Increasing Access to MNHI Care

Topic Method


Review

Review Presentation

1. Emergency Transport Scheme Presentation/Discussion

2. Community Saving Scheme Presentation/Discussion

3. Blood Donor Groups Presentation/Discussion

4. Other Types of Support: Community Based Service Delivery and Facility Health Committees

Presentation/Discussion

5. Making Sure That Everybody in the Community Bene!ts From Community Emergency Systems

Presentation/Discussion

Circular review: Today I learned that…..

Commitment to action

Discussion

Closing: Encourage participants to discuss with relatives and friends

Presentation

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Presentation

Today we will look at:

The emergency systems that have been set up by the community to help pregnant women

• How to access these systems

• Other types of support available within the community (e.g. Facility Health Committees and health services that are delivered ‘to the door-step’).

Review


Positioning: Participants sit in a circle.

• I hope you all shared our discussions with your spouses, relatives and friends. Please share with us your discussions. What did you tell them?


Facilitator’s Note: If participants do not mention some key issues, ask the following questions.

Which pregnancies carry a risk?

• Why is facility delivery important?

Summarise


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Topic 1: Emergency Transport Scheme

Presentation

What is the Emergency Transport Scheme (ETS)?

It helps to reduce life-threatening delays by assisting communities to transport pregnant women, women in labour or after delivery to hospital in cases of maternal emergency or for normal delivery at a very low cost.

• ETS is a collaboration between the community, National Union of Road Transport Workers and government to help pregnant women.

• NURTW or its members receive no money or any incentive from government for the service. It is a voluntary work done expecting reward from Allah.

Who are our ETS drivers?

ETS drivers are generally members of NURTW who have volunteered their vehicles and time to transport pregnant women to the hospital.

• They can also be other community members who own cars and are willing to volunteer their vehicle and time.

Who Pays for ETS?

• As mentioned earlier, the government does not pay the ETS drivers and NURTW.

• The community or individuals who bene!t from ETS are only expected to cover the basic cost of fuel.

Discussion

How can we support ETS operating in our community?


Desired Responses

Pay for the fuel promptly without delays (save for this as part of the safe pregnancy plan).

• Show appreciation and gratitude to the drivers.

• Give or obtain standing permission from husband or his representative to transport women to hospital in the husband’s absence.

• Learn how to access the scheme by ‘for example’ knowing how to contact the ETS driver.

• Participate in a monthly community meeting where the issue of community funds is discussed.

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Topic 2: Community Saving Scheme for EMC

Presentation

What is the Community Savings Scheme for EMC?

• Community members collectively agree to make a regular contribution towards funding maternal emergencies, especially for families that may not a"ord the costs.

• This fund aims at reducing delays in rushing a woman to hospital.

• The fund is a demonstration of communal and collective responsibility and of the commitment to reduce the number of women dying because of maternal complications or because her husband or family cannot a"ord the cost of emergency. We have a saying, Yi ma Allah sai an daure. It is not easy, but it is sadakatul zariyya, an act that accumulates rewards beyond one’s life time.

• It is to be used for maternal care ONLY.

Who contributes to the funds?

All adult members of the community, both the men and the women, are expected to contribute to the funds for the bene!t of every woman, especially those that cannot a"ord the cost.

• This contribution is di"erent and separate from individual and family saving.

• Communities can consider contacting indigenes of the community residing in towns and cities to contribute to the funds.

Who manages the funds?

• Decisions about how to collect money, how to spend it and who is to bene!t from it are to be taken by the community.

• Community Volunteers will help the community work out how the Scheme is to work. This will take place under the leadership and guardianship of the community leaders.

• Where a Community Savings Scheme is operating, a community will take the following decisions:

- Who contributes to the funds?

- What will be the regularity of the contributions?

- Who will receive a loan from the funds for emergency maternal care?

- What is the sanction for those refusing to repay loans?

- Who will receive a grant from the funds (money they are not expected to repay) for emergency maternal care?

- What are the criteria and who applies them?

Discussion

How can we give our support to the Community Blood Donor Scheme?


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Desired Responses

• Make regular contributions

• Encourage your spouses, friends and relatives to contribute

• Support Community Volunteers in their e"orts to mobilising funds.

• Participate in a monthly community meeting where the issue of community funds is discussed

• Request information on how much has been raised and how much has been spent to ensure accountability.

Topic 3: Blood Donor Scheme

Presentation

What is blood donor scheme?

• It is a group of male volunteers that donate their blood to any woman in need of a blood transfusion.

• Every adult male can become a blood donor.

• The blood donors are not paid for what they do.

• Donors must be prepared to travel to a hospital at short notice to give blood.

• Blood donors help save lives.

Why do women loose blood?

Bleeding early in pregnancy is usually caused by miscarriage. Miscarriage is not caused by spirits. Miscarriage is caused by the following conditions:

• Malaria.

• Drugs: modern or traditional. Never take drugs during pregnancy unless prescribed by a doctor or midwife.

• Blow (trauma) to the womb: domestic violence such as being beaten, kicked or pushed by the husband or an accident like a fall from an Okada.

• Strenuous work: like farming or carrying heavy loads.

• Baby not well-formed.

During the delivery period there are many reasons for excessive bleeding. Bleeding more blood than you can hold in your cupped hands is a danger sign.

• If a mother bleeds that much blood after delivery, rush her to a big hospital without delay.

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• If a mother with anaemia (weak blood) starts bleeding too much, she will die faster than a healthier mother.

• During ANC they give all women small pills to make their blood stronger and they will test their blood.

Discussion

Why are people unwilling to donate blood?

Facilitator’s Note: Encourage participants to think about the reasons why people are unwilling to donate blood. Possible responses are listed below. Introduce these ideas into the discussion if they are not mentioned by the participants.

Possible Responses

They may fear:

• The unknown

• That the health worker will take too much blood and the loss of blood will weaken them.

• Having their blood rejected (some men have had their blood rejected in front of the other men from their community).

• Being accused of wishing an emergency complication on the woman by preparing for the emergency in advance (“Someone is looking for a complication for this woman.”)

• Women do not know they can give blood.

Presentation

What happens when we agree to give blood?

Families are always asked to bring 3 or 4 people to donate blood. This is because there are four main groups of blood. The blood of mothers, fathers and children can be from di"erent groups.

• If you mix the blood from one group with the blood from another group, the receiver will get very sick or die.

• Before they give your blood to another person, they test your blood to be sure that your blood matches the receiver’s blood. The health workers now ask people to bring blood donors from home instead of buying blood. It is safer to have people from home donate blood. All donated blood will be tested for HIV/AIDS.2

• The health workers will only take blood from people who are strong enough to give blood without danger to their health.

• Women can also give blood and they do give blood in most countries.

Discussion

How can we give our support to Community Blood Donor Scheme?


2

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Desired Responses

Encourage your spouse, friends and relatives to become blood donors.

• Congratulate blood donors on their life-saving actions.

• Participate in a monthly community meeting where the community blood donor scheme is discussed.

• Share the facts that you know about blood donation with others who may know less.

Topic 4: Other Types of Support

Presentation

In addition to the emergency systems established by the community (blood donor scheme; emergency transport scheme; emergency savings schemes) there may be other types of support available at the community level.

• Some communities have a Facility Health Committee, which is working to improve the health of the community, while other communities are bene!ting from basic health services delivered ‘at the door- step’. This is Community Based Service Delivery.

• Not all communities have these committees or these services. However, if they prove to work well, it is hoped that government will introduce both schemes to more communities in future.

Discussion

Facilitator’s Note: the following section on Facility Health Committees is only relevant in those communities with a FHC. If a community does not have a FHC, skip to the next presentation on Community Based Service Delivery.

What do you know about the role and membership of the Facility Health Committee in this community?

How is the Facility Health Committee working to improve maternal and newborn health in this community?

Facilitator’s Note: Encourage discussion. Add in new ideas if these are not mentioned by participants.

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Introduction to Facility Health Committees

What is the Facility Health Committee?

This is a committee of people drawn from the community and the facility. The Committee’s job is to help improve service provision and utilisation. It is a committee that enables health service providers and users to talk to each other and support each other to ensure a good service and client satisfaction.

Who are the members of the FHC?

They are representatives of di"erent communities that utilise the health facility. The membership is chosen to ensure that all categories of community people, especially women who visit the health facility more, are represented on the Committee.

What is the role of the FHC?

• Support the health facility to deliver good quality services

• Help build a good relationship between the facility and local communities

• Help increase access to services, especially by the very poor

• Promote the active participation of women and young people in the committee

• Be champions for community level health activities

• Act as !rst point of contact for all service delivery and quality improvement activities that require community input

• Monitor facility performance

• Help manage and monitor any scheme introduced to improve the supply of drugs at the facility.

• Advocate for increased government !nancial and other support to the facility

Discussion

How can we give our support to the Facility Health Committee?


Desired Responses

Encourage your spouse, friends and relatives to stand for election to the FHC.

• Learn who are the members of the FHC.

• Keep in contact with committee members in order to !nd out what the FHC is doing and ask how you can support it.

• Attend meetings called by the FHC to learn about its role and achievements.

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• Seek out members of the FHC and share your thoughts and concerns about the state of health services or about the health of the community. Ask them to represent your views at committee meetings.

• Work with others in the community to !nd ways to recognise the hard work of FHC members.

Presentation

Introduction to Community Based Service Delivery

Discussion

Facilitator’s Note: all discussion groups can discuss the following questions on CBSD, whether or not they have the service in their community.

What are the bene!ts of Community Based Service Delivery?


Possible Responses

• We don’t have to walk far to the health facility if the JCHEW can see us at home.

• We don’t have to stop our other work (e.g. cooking) to spend a long time at the health facility.

• Services at the door-step are cheaper for us. We don’t pay for transport.

• We know the JCHEW well and have built up a good rapport with them.

• Because our husbands know the JCHEW, they encourage us to use their services.

• We learn from the JCHEW about some of the challenges facing health services in our area. This helps us understand the constraints better.

• We can plan with the JCHEW how and to whom to complain about drug shortages, about equipment shortages, or about other issues that are a"ecting the JCHEW’s work.

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What can we do to support Community Based Service Delivery in this community?

(Facilitator’s Note: this question is for communities with CBSD)

Possible Responses

• Get to know the JCHEW.

• O"er to help and support the JCHEW (e.g. by o"ering them a lift into the nearby town if someone from the community is going there).

• Encourage other people in the community to use door-step health services.

• Complain to the health facility or to local government if the JCHEW is not given adequate support or supplies (drugs, equipment, etc.).

• Ensure that the JCHEW’s accommodation is kept at an acceptable standard. Help with maintenance.

• Don’t expect the JCHEW to talk about other people’s health problems. They have a duty to maintain con!dentiality.

• Let the LGA know about the bene!ts that CBSD has brought to your community. Make the LGA o$cials realise that they must continue to fund the scheme.

What can we do to campaign for CBSD to come to this community? (for communities that don’t yet have CBSD)

Possible Responses

• Visit a nearby community with CBSD to !nd out about the service.

• Talk with the FHC about how CBSD can be brought to this community.

• Arrange a meeting with the LGA Health Department and let them know that we are interested in having CBSD in our community.

• Talk to our local elected representatives about how to get CBSD in this community.

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Topic 5: Commitment to Action. Ensuring Community Systems are Available to Everyone

Presentation

• We have discussed the systems that have been set up by the community to assist pregnant women, women in labour, or newly delivered women.

• We have also discussed other initiatives that aim to improve the health of the community (Facility Health Committees and Community Based Service Delivery).

• However, there are some women in the community who will not bene!t from these systems or services. We will now discuss these women.

Discussion

Who are the women in our communities likely to lack access to the community systems or services?

Possible Responses

• Women who do not have information on the systems or services.

• Women who have poor husbands and no parents or kin to contribute anything to the ETS or the community savings schemes and who do not want to advertise their condition.

• Women in polygamous marriages, particularly those not favoured by their husband, in-law and other relatives.

• Young unmarried adolescents.

• Women who live in the remote areas in the settlement.

What can we do to ensure that our community systems bene!t everyone?

Encourage discussion. Use the list below to add in new ideas if these are not mentioned by participants.

Possible Responses

• Encourage our Community Volunteers to travel to the most distant parts of the community.

• Tell our Community Volunteers about women who seem to be vulnerable and therefore unlikely to bene!t from the community systems.

• Make contact with women who we feel may be vulnerable, share our knowledge with them and o"er our support.

• Make sure that we talk about how to make access to the community systems more equal at monthly community meetings.

• Make sure that community savings schemes give grants to families that cannot a"ord to pay for emergency maternal health care.

• Make sure that the community pays ETS drivers in cases where families cannot a"ord to do so.

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Facilitators Note: Encourage discussion. Use the list below to add in new ideas if these are not mentioned by participants. Summarise by listing all the things that community members feel they can do to ensure that everyone in the community bene!ts from the community systems.

Commitment

Participants are encouraged to commit themselves to support the less privileged and least supported members of the community.

Participants are also encouraged to commit themselves to give their time, support and contributions to the community systems so that they function well and can be sustained.

If participants are interested in volunteering as a Community Volunteer, a blood donor, an ETS driver, or are committed to raising funds for the maternal health, the facilitator should agree a time and place to meet with these individuals to discuss the details.

Circular Review

Today I learned …

Closing


• Our community emergency systems – how they will help us• How to ensure that everyone in the community bene!ts from these systems• How Facility Health Committees can help improve community health • The bene!ts of Community Based Service Delivery

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Module 2Newborn Health

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SESSION 1: IMMEDIATE NEWBORN CARE

Time: 1 Hour 30 minutes

Objectives

By the end of the session participants will have:

Learned the objectives of the newborn care community discussion group

• Begun to feel comfortable discussing issues relating to newborn care

• Felt the need to improve home based care of the newborn

Session 1 TopicsImmediate Newborn Care

Topic Method

Welcome to the Newborn Care Part of Our Community Group Discussions

Presentation

Our Sad Experiences With Newborns Presentation/Experience sharing

Babies Need Extra Warmth and Protection From Infection Mime/Experience Sharing

Immediate Care of the Newborn Presentation/Experience sharing

Say & Do


Closing: Encourage participants to discuss with friends and relatives and prepare to feed back. The next topics are: immediate and exclusive breastfeeding and newborn danger signs.

Presentation

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Topic 1: Welcome to Our Community Group Discussions - Caring for Our Newborns

Introduction

• My name is ………. and I live in (mention the name of your community or section of the community).

• I am a Community Volunteer in our community.

• My role will be to facilitate our discussions.

• My co-facilitator is ............................

Presentation

We are meeting together for three sessions to discuss:

Ways we can help reduce the deaths that occur from the time the baby is born to the end of the !rst month of life.

• Ways to ensure that families in our community are supported to care for their newborns using the new knowledge we will be receiving in our discussion groups.

Topic 2: Our Sad Experiences with Newborns

Pairs Discuss

Many of us have had sad experiences with newborns.

What were your experiences with newborns who were having health problems any time in their !rst month of life?

• What happened that told you the newborn had problems and his/her life was in danger?

• What did you/family members do?

• What happened to the newborn?

Volunteers Share

Will some volunteers please share your stories with the group?

Summarise

We have shared our experiences with our newborns that were not doing well.

• Name some of the actions taken to care for newborns with problems.

• Some of our traditional practices are good, and help to promote the health of the newborn. For example, wrapping the newborn in a clean cloth is good because the newborn should be kept warm.

• But some of what we do is not good because it can harm the baby.

• Now we are going to learn the safest ways to care for our newborns.

What is a Newborn?

For the !rst month of their lives, babies are called newborns. This is a critical period for babies. Many deaths occur in this period. Proper newborn care can make a di"erence.

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Topic 3: Babies Need Extra Warmth and Protection

Presentation

• The newborn’s body is small and not yet able to adjust to the temperature on its own. Newborns need to be kept warmer than adults. Newborns that get too cold can die. Even a small amount of washing and rinsing can cool the newborn’s body and put it in danger. Therefore doctors tell us to wait 24 hours before washing the newborn with soap and water. We should wipe the newborn’s body with a clean cloth, cover the baby loosely and give the baby to the mother so her body will keep the baby warm.

Presentation

• A newborn is born with some of its mother’s protection against some infections and diseases. The !rst yellow milk and all breastmilk give the baby some more protection. Vaccinations give the baby protection against many terrible diseases. Every time we come into contact with germs and disease, our body makes some more protection. That is why children and adults don’t get sick from some germs that make babies sick.

• Let’s look at why it is important to protect babies from germs.

Demonstration

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How is hot pepper like the germs that cause diseases?

Facilitator demonstrates how hot pepper, if it gets on our hands or into our eyes or on our skin, can burn us.

Ask a volunteer to help you do an experiment. Tell the volunteer to:

- Break the pepper in your hands.

- Rub your eyes with your hands.

Response: The volunteer refuses to do it.

• Ask in an irritated tone pretending not to understand the fear: Why are you refusing?

Response: The pepper will sting my eyes.

• Ask the other participants in your irritated tone: But do you see anything on the volunteer’s hands? What is so di$cult about it? OK, we will help the volunteer. They can wash their hands before rubbing their eyes. Give the volunteer water in a basin and say:

- Wash your hands with water and dry them.

- Now rub your eyes.

Response: The volunteer will still refuse.

• Ask again, pretending to still be irritated that you cannot see anything so what is the problem. Why is he refusing?

Response: you can’t see the burning part of the pepper but it is still on the volunteer’s hands.

Facilitator’s Note: At the end of the demonstration, be sure to give the volunteer soap and encourage them to wash their hands very well and dry them.

Then tell participants the following

• If I give you a piece of pepper and ask you to open and rub your hands in it, will you rub your hands on your eyes? NO!!

• If you rinse your hands in water, will you rub your hands in your eyes? NO!!

• Why not?

• Your hands still have the thing in pepper that burns. This burning thing in pepper that hurts us is invisible.

Summarise

• Germs are like the invisible thing in pepper that burns. We can’t see the germs with our naked eyes but they still hurt us.

• Doctors use a special instrument called a microscope to see the invisible germs. Using the microscope, doctors can see the germs that cause each of the diseases.

• Germs are living things that multiple fast. Each disease has its own germs. Di"erent medicines kill di"erent germs.

• The pepper demonstration reminds us that invisible germs cause diseases so we must protect our newborns and children and ourselves from the invisible germs.

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Experience Sharing

What do we do to protect the newborn from germs every day?

Facilitator’s Note: Encourage discussion. Note the responses that are omitted and ensure that they are included in the discussion. Additional notes on clean delivery can be found in Annex 1.

Desired Responses

Wash hands with soap and water before touching the newborn.

• Wash hands with soap and water after cleaning stool and urine.

• Bathe.

• Keep the cord clean and dry. Use a new razor to cut the cord. An old razor will be covered with invisible germs.

• Breastfeed. Don’t give water or other liquids. They can have invisible germs in them or on the bowl or spoon used to feed the baby.

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Topic 4. Doctor’s Advice for Immediate Care of the Newborn

Presentation

Facilitator’s Note: Make the presentation based on the Say and Do activity below and then teach the participants the Say and Do activity.

Say and Do Immediate Care of the Newborn

Say Do

Use a new razor to cut the cord. Tie the cord in two places: (the width of 2 !ngers from the belly and the width of 4 !ngers from the belly). Cut the cord on the side nearest the mother. Don’t put anything on the cord.

Ayi amfani da sabuwar reza idanza’a yanke cibi. A daure zaren cibi gaba biyu ta wajen jariri sai a yanke a gaba ta uku da. Ka da a sawa cibi komi don kariya daga kwayoyin cuta.

Hold a new razor up for all to see.

Pretend to tie the cord two times and then cut with the new razor blade.

Put the baby on the breast within thirty minutes (the time between magrib and insha’i prayer).

A ba jariri nonon uwa da zaran an haihu.

Pretend to hold the baby with your left hand and hold the breast for the baby to suck with your right hand.

Wipe the baby’s body with a clean cloth.

Check the baby’s body for any abnormalities for possible treatment.

A goge jariri da kyalle mai tsafta.

A duba jiki ko da matsala don maganinta.

Place your hands under your eyes and draw them down your entire body.

Put a cap on the baby, cover the baby with a cloth, carry the baby or back the baby.

A sa hula, a lullube, a rungume ko a goya.

Touch your head with your hands as if you are putting on a cap.

Pretend your left hand is holding the baby and pretend to bring a cloth over the baby with your right hand.

Hold your two hands in front and then in back.

Immunize the baby before the naming ceremony.

A yi allurar rigaka" ka"n kwana 7.

Pretend you are holding a baby in one arm and jab the baby’s arm.

Summarise

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Understanding why some new practices are healthier than our usual practices

Facilitator’s Note: The purpose of this discussion is to help participants re!ect on their reasons for being reluctant to adopt new, healthy behaviours and learn the reasons for the doctors’ recommendations for the new behaviours. Since many reasons for reluctance and opposition to adopting healthier behaviours are culture speci"c, facilitators will need to adapt this topic to the culture where they are working.

Doctors recommend these new practices to protect babies from getting too cold and to protect them from the invisible germs.

We need to give our newborns every possible protection. We know that during the !rst week people will come and congratulate us and want to hold our newborn. Yet we don’t know what invisible germs these people are bringing with them, germs that may not bother them but that may be very dangerous to our newborn.

Discussion

Why do doctors tell us to use a new razor to cut the newborn’s cord?

Desired Response

• The cord is connected to the baby’s blood inside its body. Invisible germs on a used razor, even if it looks clean, can infect the baby.

Why do doctors tell us not to put anything on the cord and to be patient without trying to dry the cord with some heat source?

Desired Response

• The cord is connected to the baby’s blood inside its body. The things we do to make the cord fall o" can also make it easier for invisible germs to infect the cord. After 5-10 days the cord will fall o" itself.

• We need to stop the following practices (only mention the harmful practices that the participants mentioned):

- Using a hot cloth compress.

- Burning the stump.

- Applying powder, ointment, toothpaste or any other thing to the stump.

• Watch for signs of cord infection: delay in falling o", swelling, redness, pus, foul smell at the belly button. Go to the health facility for treatment if you identify any of these signs.

• Tell participants that if the placenta does not come out and there is an emergency, use a clean cloth to tie the cord to the mother’s thigh so that the cord will not withdraw inside the mother. Then follow the directions for cutting the cord.

Circular Review

Today I learned that…..

Closing

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• Importance of keeping the newborn warm• How to protect the newborn from germs• How and when to bathe the newborn• How to cut the cord


• Immediate and exclusive breastfeeding• Newborn danger signs

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SESSION 2: CARING FOR NEWBORN IN FIRST 30 DAYS AFTER DELIVERY


Objectives

At the end of this session participants will:

• Learn the bene!ts of immediate and exclusive breastfeeding

• Recognise the delays that prevent a timely response to newborn danger signs.

• Feel con!dent that they know the newborn danger signs.

• Begin to feel responsible for ending delays by planning to support families to adopt positive newborn care practices.

• How we can support families in our community to take their newborns to the health centre for the care that they need.

Session 2 TopicsCaring for the Newborn in the First 30 Days After Delivery

Topic Method

Our discussions with spouses, relatives, friends Experience sharing/Say and Do

1. Putting the Newborn to the Breast Within 30 Minutes of Delivery Experience sharing/Presentation

Say and Do

2. Protect the Baby From Germs by Giving the Baby Only Breastmilk for Six Months

Presentation

Say and Do

3. Making Immediate and Exclusive Breastfeeding Easier for Women and New Caregiving Roles for Grandmothers

Discussion/Presentation/Say and Do

4. Supporting Vulnerable Women to Take Care of Their Newborns Presentation/Discussion

5. Learning the Newborn Danger Signs Say and Do


Closing: encourage participants to discuss with friends and relatives and to prepare to feedback. The next topic is postnatal care.

Presentation

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Introduction and Review

Welcome. In this session, we will learn more about:

Breastfeeding the newborn

• Caring for the newborn

• Including vulnerable women/families in our activities to improve care of newborns

• Newborn Danger Signs

Review

Please share with us your discussions based on the last session. What did you discuss with family members, friends etc?

Facilitator’s Note: In each session encourage 3-4 volunteers to share their discussions. Make sure that the same people don’t feed back every week.

If participants do not mention the key issues, ask the following questions:

What did we learn about

- keeping the newborn warm?

- looking after the cord?

- protecting the newborn from germs?

Summarise

Summarise the main points.

Topic 1: Putting the Newborn to the Breast Within 30 Minutes of Delivery

Sharing Experience

We are going to talk about the best way to feed the newborn. Doctors tell us to put the newborn to the mother’s breast immediately after delivery, within 30 minutes, before cleaning the mother. Most of us are not doing this. Why aren’t we doing it?


Possible Responses

The mother does not have enough milk.

• The newborn cannot suck immediately after delivery.

• The mother needs to be attended to !rst.

• The !rst milk is dirty.

• We don’t know that doctors advise immediate breastfeeding.

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Are there any women in the community who gave breastmilk to the newborn immediately after delivery – in other words, within 30 minutes? Please let them share their experience with us.

What were the reasons?

• Who in#uenced the woman to give breastmilk immediately?

• What was the reaction of friends and family members?

Summarise

We have thought about why we don’t breastfeed immediately. Now we are going to learn why the doctors want us to put our babies to the breast within 30 minutes of birth. But !rst, we need to praise the women who are already giving breastmilk immediately to their baby.

Presentation

Doctors and nurses advise us to put the baby on the mother’s breast to feed even before cleaning the mother. Let’s learn the bene!ts of immediate breastfeeding.

Bene!ts of Immediate Breastfeeding

Say Do

Makes the womb contract to push the placenta come out faster

Yana taimakawa uwa ta !to Biya

Hold your hands over your lower abdomen (the womb area) and pretend to push out the placenta by sweeping your hands down and out.

Gives baby all the yellow milk (colostrum). The milk is yellow because it has medicine in it to protect the baby against sickness.

Nonon farko yana da kala mai rowan dorowa,yan dauke da magani wanda ke bawa jarirai kariya daga cuttutuka

Make your hands into !sts, hold them up and shake them to show strength

Keeps baby warm and helps with mother and baby bonding so the mother will take the best possible care of her baby.

Yana samar da dumi da shakuwa a tsakanin su.

Pretend to hold the baby to the breast. Then wrap arms around yourself.

Swing your arms around yourself signifying protection.

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Topic 2. Protect the Baby by Giving Only Breastmilk for Six Months

Share Experiences

Have you ever seen a baby with diarrhea that lasts and lasts for days? What happens to the baby’s health?

Response

• Babies keep getting sick and some die.

Presentation

Doctors and nurses tell us to give our babies only breastmilk for the !rst six months because the baby’s body has not yet built up enough protection. Other liquids or foods can have invisible germs in them that harm the babies like the invisible thing in hot pepper that burns.

Say and Do Protecting the Baby From Germs by Giving Only Breast Milk

Say Do

For the !rst six months of life, give the babies breastmilk only.

Don’t give babies any other liquid. Don’t give them water, goats milk, herbal drinks, etc.

A wata shidan farko a bada nonon uwa zalla kar a bada ruwa ko nonon akuya da sauran su.

Hold your hand on the breast. Pretend your right hand is holding a baby and pretend to hold the baby’s head near your left breast so the baby can suck.

Wave your hand back and forth to indicate, No.

Giving the baby anything except the mothers milk can give the child germs.

Shayar da jariri wani abu sabanin nono yana iya sa masa cuta

The germs can make the baby have disease like diarrhea and prevent the baby from growing and they can easily die.

Kwayoyin cuta zasu iya hadasa gudawa da hana girma,suna iya rasa rayuwarsu.

Hold your hand under the breast.

Put your hand on your bottom and sweep it away to show diarrhea

Breastmilk has plenty of water in it. Even hot and thirsty babies get enough water from breastmilk.

Nonon uwa yana da wadattacen ruwa da zai gamsar da jariri.

Wipe your brow to show ‘hot’ and open and close your mouth and touch your neck to show ‘thirsty

Breastmilk is made for our babies. It has all the nutrients the baby needs to grow strong and healthy for six months.

Nonon uwa yana kunshe da dukan sunadarai da zai sa yaro ya zauna da koshin la"ya.

Hold the breast.

Fold hands for all the nutrients

Make your hands into !sts, hold them up and shake them to show strength.

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Topic 3: Making Immediate and Exclusive Breastfeeding Easier for Our Women

Instructions

Encourage participants to form groups of three persons.

Small Group Re#ection

Each group will consider actions community members can take to make it easier for women to breastfeed their newborns immediately after delivery and to keep breastfeeding exclusively for at least six months.

Each group should prepare to report their responses to the following questions:

• What should fathers do to make it easier?

• What should pregnant women do?

• What should older women do?3

• What should the community do?

Reporting

Groups report their responses.

Summarise the key points and tell participants that they should meet with other members of the community to discuss these issues.

Presentation

Use the following say and do activity to emphasise the roles of grandmothers in caring for babies even though they need to give up their baby feeding roles to protect the baby from becoming sickly with diarrhea.

Say and Do Caregiving Roles for Grandmothers and Other Carers

Say Do

Help mothers take care of the baby (carrying and backing the baby; helping the baby sleep; washing the baby; and, playing with the baby) and bring the baby to the mother whenever the baby is hungry or thirsty.

Taimakawa iyaye mata kula da jariri (ta hanya goyo,a sasu suyi barci,ayi musu wanka, a shiryasu, da kuma wasa da jariri) da kai jariri idan yana jin yunwa ko kishi.

Bring your hands in front as if carrying the baby and then swing your hand as if moving the baby to the backing position; fold your hands together near the side of your face and pretend to rest on your hands. Bring your hands up and pass them over your shoulders and chest as if washing the body; clap hands and snap your !ngers 2 X as if playing with the baby.

3

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Facilitator’s Note: See Annex 3 for information on how to deal with breastfeeding problems.

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Topic 4: Supporting Vulnerable Women to Improve Care of Newborns

Presentation

We have a belief and saying that God created this hand at di"erent lengths. In this state a small number of families have a large number of all the newborn and child deaths. Also a small number of women in some compounds are experiencing many newborn and child deaths even though the other women’s children are staying healthy. We as a community need to be aware of this. We can help the families where this happens.

Small Group Discussion

Organise participants into groups of three people.

What are some of the reasons that some women/families are vulnerable and may face very great challenges caring for their newborns?

Facilitator’s Note: Encourage discussion. If participants do not mention the possible responses below, add them into the discussion.

Possible Responses

• Women who lack the support of a husband.

• Women who lack support from their natal family.

• The poorest women/families in the community.

• Women with many young children, who lack support of other family members.

• Women who live on the edges of the community and face terrain barriers (rivers to cross, etc)

• Women who are depressed or stressed because their husband is violent.

• Women who are members of an ethnic or religious minority.

Encourage participants to discuss the following:

• How can we help some of these women ensure their newborns stay healthy?

Possible responses:

• Make home visits to share our new knowledge.

• O"er to care for other children while the mother takes herself and the child to the clinic for ANC, postpartum care and/or for RI.

• O"er friendship to these women.

• Provide these women with other types of practical support.

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Additional Discussion Questions (for TOT and Lead Volunteers Training)

Facilitator’s Note: To avoid stigmatisation, do not use the following questions for the Volunteer Training in the community. Instead, use this discussion with the LGA Demand Creation Team and the Lead Volunteers to improve their understanding and commitment to vulnerable women and families.

What can the community do to identify women and families that have a high number of newborn deaths?

• How can the community do this without embarrassing these women and families?

• What practical things can the community do to help ensure that these newborns have the best chance of survival?

• What speci!c actions can the community take to ensure that vulnerable women and families are supported?

Reporting

Ask one member of each small group to report back their ideas.

Commitment

Let us commit to taking the following actions so that we can help vulnerable women/families in our community to care for their newborns. These actions are: (summarise)…….

Topic 5: Say & Do the Newborn Danger Signs

Possible Responses

• Not breathing

• Refusing to feed

• Fever - hot

Presentation

The doctors have told us danger signs to watch out for in our newborns from the period of delivery up to 30 days.

• A baby who has any of these signs before 30 days must be rushed to the clinic. The doctors and midwives can save the baby’s life. Don’t delay.

• We are going to learn six danger signs. The signs are:

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Newborn danger signs

Say Do

1. Sunken soft spot

Fadawar Madiga

Lower down your head allowing your chin to rest on your upper chest.

Touch the soft part of your head with both hands using the four !ngers in both hands to press downwards.

Say “Sunken soft spot”.

Remove your !ngers from your soft spot but still keeping your head down.

Repeat steps 2 and 3 twice more (sunken soft spot X 2).

2. Fever

Zazzabi

Use your right palm to touch the right side of your head.

Quickly repeat the !rst step above, but this time using the back of your right hand instead of your palm.

Say “Newborn has fever”. Say this 3 times.

3. Di$cult breathing; fast and noisy breathing

Numfashi da kyar

Lift up your chest cavity and breathe in and out fast. Then wait a little while and repeat the same process X 3.

Say “Breathing is di$cult” X 3.

4. Sti" neck and !tting

Sankarewa da zabura

Stretch your neck and your body. Also stretch both hands down on both sides of your body.

Say “ Say newborn’s neck is sti", body is sti"” X 3.

Hold your hands on your sides bent up to chest level and jerk your entire body at the same time.

Say “Newborn is !tting” X 3.

5. Diarrhoea for more than three days or bloody diarrhoea

Gudawa da ya wuce kwana uku ko atini

Use your right hand making fast sweeping movements away from the right side of your bottom.

Say “Newborn has had diarrhoea for more than 3 days or has blood or mucus in the diarrhoea”. Repeat this x 3.

Facilitator’s Note: See Annex 2 for a longer list of eight newborn danger signs and say and do activities. Some communities have demonstrated a capacity to learn all these signs well. The shorter list has been included because it is more important for parents to be able to remember the list well than to be vaguely familiar with many danger signs.

Circular Review:

Today I learned that…..

Closing

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• Importance of immediate and exclusive breastfeeding• What families and communities can do to support immediate/exclusive breastfeeding• How we can support vulnerable women/families to look after their newborns• Newborn danger signs


• Importance of postnatal care

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SESSION 3: POSTNATAL CARE FOR MOTHER AND NEWBORN

Objectives


Recognise the barriers of access to postnatal care

• Feel con!dent that postnatal care is important for both the mother and baby

• Begin to feel responsible for ending barriers by planning to support families to use postnatal services.

Session 3 TopicsPostnatal Care for Mother and Newborn

Topic Method

Our discussions with spouses, relatives, friends Experience sharing

1. Care for the Mother and the Newborn Small group discussion

2. Helping Families Overcome the Barriers to Attending PNC Group discussion


Closing: Encourage participants to discuss with friends and relatives and prepare to feed back.

Presentation

90


Introduction and Review

Welcome. In this session, we will learn about postnatal care for the mother and the newborn.

First, however, we will review the discussions that we had with spouses, relatives and friends on the topics from last week.

I hope you all shared our discussions with your spouses, relatives and friends. Please share with us your discussions. What did you tell them?

Facilitator’s Note: In each session encourage 3-4 volunteers to share the discussions that they had with other people. Make sure that the same people don’t feed back every week.

If participants do not mention the key issues, ask the following review questions:

Why is immediate breastfeeding important?

• Why is exclusive breastfeeding important?

• What can families and communities do to support immediate/exclusive breastfeeding?

• How can we support women who face challenges to look after their newborns?

• What are the newborn danger signs?

Use Say and Do to remind participants of the newborn danger signs.

Summarise


Topic 1: Care of the Mother and the Newborn

How is the new mother cared for from the period immediately after birth for the !rst month of life?

• What are the family practices?

• What are the common practices in the community?

• Apart from the cord care and the breastfeeding practices for the newborn discussed in session 1, what other care does the newborn receive?

• Who are the family members and community members that play key role in these practices?

• What role do they play?

Volunteers Share

Will some volunteers please share your experiences with the group?

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Presentation

In addition to this important care in the family and in the community, new mothers and their babies also need support from the health centre.

• The health worker can identify and begin treating danger signs for both the baby and the mother before they become serious.

• We are now going to look at why postnatal care at the health centre is important.

Facilitator’s Note: use the information on postnatal care in the boxes below to complete this presentation on postnatal care for newborns and mothers. Then teach the participants to recall the importance of postnatal care using Say and Do.

Say and Do the Bene!ts of Postnatal Care For Newborns

The health worker uses her newborn knowledge and skills to: Malaman Asibiti suna amfani da kwarewansu wajen:

Say Do

Care for newborns with danger signs

Kulawa da jarirai masu alamomin hadari

Teach mothers the newborn danger signs

Koyarda iyayensu alamomin hadari

Demonstrate one or two of the signs.

Care for newborns who need additional care, for example small babies, those whose mothers have diabetes or are HIV positive, etc.

Kulawa da jarirai wanda iyayensu ke da matsala na masala ta masammam. Misali; Cutar HIV, ciwon sikari.

Use your hands to show a small baby.

Give the !rst and second vaccinations on time

Bada alular rigaka" ta farko da ta biyu

Softly jab the upper left arm and the outer thigh to indicate the two vaccinations.

Promote birth registration

Inganta yin regista

Show that you are holding a pen and writing.

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Say and Do the Bene!ts of Postnatal Care for the Mother

Malaman Asibiti suna amfani da kwarewansu wajen:

Say Do

Give advice and support for birth spacing

Bada shawara akan tazarar iyali

Hold your hands slightly apart with the thumbs at the top. Move both hands to the right, then again, to show spacing.

Care for mothers with delivery-related injuries

Kulawa da mata wanda suka samu matsala lokacin haihuwa

Support mothers having problems with breastfeeding

Taimakawa mata wanda suke samun matsalar shayarwa

Hold your left breast and make your face look worried.

Care for mothers who need additional care

Kulawa da iyaye wanda suke bukatar Karin kulawa

Presentation

Three postnatal care visits at the health facility are recommended for the mother and the newborn to ensure their health4:

• 6 hours after delivery

• Day after the naming ceremony

• 40 days after delivery

Topic 2: Helping Families Overcome the Barriers to PNC Attendance

Small Group Re#ection

Ask participants to sit in groups of three or four.

What are the reasons why women do not attend postnatal care at the health centre? How can these barriers be addressed?

• Each group will consider reasons related to one of the following: family, community or health centre.

• Give each group !ve to ten minutes to discuss.

• Each group should be prepared to report the outcome of their deliberation.

4

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Possible Responses

• Encourage our women to attend postnatal care, now that we know it is important.

• Ask relatives, friends or others to look after our children when we trek to the health centre.

• Encourage women to deliver at the health facility – this means that they will be able to get postnatal care after 6 hours.

• Arrange for the ETS to transport women to postnatal care after six days and six weeks.

• Organise child care for women who need someone to look after their children when they attend postnatal care.

Reporting

Groups report on their deliberations.

Presentation

• We will share our suggestions with other community members.

• We will then agree as a community how we can support women go for PNC

Circular Review


Closing

Encourage participants to discuss with relatives and friends


• Why postnatal care is important for the mother and the baby• Importance of three postnatal care visits: 6 hours; immediately after naming ceremony; at 40 days • The barriers that prevent our women from going for PNC • What can be done about these barriers

Topic for the Next Set of Community Discussions

• Routine immunization, including polio

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Module Three:Routine Immunization

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SESSION 1: INTRODUCTION TO ROUTINE IMMUNIZATION


Objectives

By the end of this session participants will know:

The bene!ts of routine immunization

• The Vaccination Hand, to help them remember their child’s vaccination schedule

• The Vaccination Slogan, to remind parents to start and !nish without delay

• Where and when to get a child immunized

Session 1 TopicsIntroduction to Routine Immunization

Topic Method

Our discussions with spouses, relatives, friends Experience Sharing

1. What is Routine Immunization? Discussion

2. Harmful Consequences of not Immunising Your Child Discussion/Say and Do

3. Learn the Vaccine Bene!ts Song Song

4. Say and Do the Vaccination Hand Say and Do

5. Don’t Delay and Vaccination Slogan Discussion/Say and Do Chant

6. Learn the Vaccine Visits Song Song

7. Know When and Where to Take Our Babies for Immunization Discussion/Presentation


Closing: Encourage participants to discuss with friends and relatives and to prepare to feed back. The next topic is about how vaccinations work and managing vaccine reactions.

Presentation

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TEACH THE VACCINATION HAND SCHEDULE

Facilitator’s Note: Use the 2 or more times method to give each person a chance to learn and remember the Vaccination Hand.

Introduction: Now we will learn the Vaccination Hand to remember exactly when to take each child to the health facility for his/her routine immunizations. Each !nger will remind us of one of the vaccination visits.

Step 1: Demonstrate the Vaccination Hand and the entire message/song. Hold your hand up high so everyone can see the inside of your hand.Touch the !nger that corresponds to the schedule for the vaccination visit starting with your pinky and moving to your thumbDiscuss and clarify that each !nger corresponds to a vaccination visit.Repeat your demonstration at least 2 times.

Step 2: Demonstrate the Vaccination Hand without the words so participants focus on the handSpread your !ngers of your right hand out as wide as possible.Hold the middle three !ngers together with your other hand. Keep these 3 !ngers together. Now spread out your thumb and pinky as far as possible and move your left hand away from your middle !ngers.

Step 3: Help the participants form the Vaccination HandCirculate among the participants and help those who have di#culty forming the Vaccination Hand. Congratulate the participants with good Vaccination Hands.

Step 4: Demonstrate and ask participants to copy you, !nger by !ngerHold up the !rst !nger (pinky) and say the accompanying wordsAsk the entire group to repeat at least 2 timesAsk one or two volunteers to repeatRepeat this process for each for each !ngerAsk the entire group to repeat at least 2 times

Step 5: Demonstrate the entire hand (moving from your pinky to your thumb) with accompanying words and ask participants to copy youDemonstrate again the entire Vaccination Hand with the accompanying wordsAsk the entire group to repeat at least 2 timesAsk one or two volunteers to repeatAsk a group of people sitting near each other to repeatEveryone repeat together

Step 6: Discuss the bene!ts of the Vaccination Hand with the participantsDo they think they can remember the Vaccination Hand?How the Vaccination Hand can help them?Who should know the Vaccination Hand?Who should teach other people the Vaccination Hand?Do they think they can teach anyone at home?

Step 7: Discuss the bene!ts of the 6 Step & 2 times method of teaching the Vaccination Hand Most people will remember because they: Learned one thing at a timeRepeated the modelled action 2 times or more timesUsed multiple ways of learning many times: hearing, seeing and doing

Step 8: Final review of the Vaccination Hand Check comprehension of volunteers !rst and then of the group.Repeat the Vaccination Hand with everyone together 2 times.

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Presentation: Introduce the Routine Immunization Discussion Sessions

In this set of community discussions you will learn all about routine Immunization

• We will discuss

- the bene!ts of vaccination the consequences of not vaccinating your child

- the Vaccination Hand, a useful method for remembering the vaccination schedule

- the Vaccination slogan to remind us to ensure each baby is vaccinated as soon as possible where and when to get a child immunised

Topic 1: What is Routine Immunization

Share Experience

Have your children been given vaccination drops or vaccination injections? Where did they get their vaccinations? How many times?

Encourage parents and caregivers of children under two to share their experience !rst and then ask others if they want to add anything.

Facilitator’s Note: Many people will only know about polio drops.

Presentation

Routine immunization is injectable immunizations and polio drops given by health workers one day a week at the health facility or one day a month at an outreach site. Some routine immunizations are also given at IPD !xed posts. Routine immunizations protect against measles, whooping cough, polio and other killer childhood diseases that spread very fast in communities.

Vaccine Preventable Childhood Killer Diseases

Parents have many, many things to learn about protecting the health of their children. They do not need to know all the diseases that immunizations prevent. However, the list below can be used if parents ask about the killer childhood diseases.

Tuberculosis (BCG) Tarin Fuka

Diphtheria (D in DPT) Busagoggo/Makarau

Whooping Cough (P in DPT) Tarin Shika/Tarin Lala

Tetanus (T in DPT) Sarke Hakora

Polio (OPV) Shan Inna

Hepatitis B (HBV) Ciwon Hanta

Measles (MV) Bakon Dauro/Kyanda/Nakwangwale

Yellow Fever (YF) Shawara/Ba-Yamma

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Summarise

• Polio drops are essential. The drops protect children from polio. Polio can make our children lame or can even kill them.

• But polio drops are not enough to give our children the complete bodyguard (garkuwa).

• Our babies need all their injectable, routine immunizations.

Topic 2: Harmful Consequences of Not Immunizing Your Child

Presentation

Tell participants that we will discuss the harmful consequences of not immunising our children

Discussion

Why is immunization important for our children?

Facilitator’s Note: Encourage participants to discuss.

The Say & Do tool is now used to help participants remember key parts of the message. The body (rather than counselling cards) is used as the tool for teaching and remembering. The facilitator positions parts of the body to represent a key element of the message, while calling out the message.

What are the possible harmful consequences for our children if we fail to take them on time for all their routine immunizations?

We need to protect our babies and children with immunization to prevent them from measles, whooping cough (pretend to cough), polio (hold your lower arm as though crippled) and other terrible childhood diseases. These diseases can make them su"er permanently. They can make them:

Blind Place your hands over your eyes

Deaf Plug your !ngers into your ears

Crippled Pretend to walk with a sti" leg.

Intellectually disabled Touch side of head.

Sickly Let eyes close and nod forward.

Babies also die from these diseases

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Discussion

• How will you feel if your child gets permanently harmed because you failed to take him/her for his immunization visits?

• How will you feel when your child is old enough to ask why he/she is di"erent from all the other children?

• How will it make us feel to know that we have been able to protect our children from these harms?


Summarise

Summarise the good feelings mentioned by participants.

Topic 3: Learning Amfanin Allurorin Rigaka!, a Vaccination Bene!ts Song

Facilitator’s Note: This topic is optional.

Kira garemu iyaye mu kai jarirai rigaka"Rigaka" na bada kariya ga mugayen cututtuka.$Masu hallaka yara cututtukan su barmu cikin bakin ciki.Banda kisa suna nakasarwa yaran duk su tagayyara,$Su kurmance ko su makance$ko gurguncewa gaba dayaKo kuma su yi ta rashin la"ya, yaran su kasance cikin wahala.Mu kai jarirai asibiti domin ayi musu rigaka"Rigaka"n gangami, a tabbatar anayi wa yara dan karin kariya. Kira garemu iyaye mu kai jarirai rigaka"

A call to all of us parents&to take our children for immunization.Immunization protects against terrible diseases,Those that destroy children’s life and leave us in agony.&Apart from killing they also lead to disability&and the children su"er a lot.&They become deaf or they become blind or completely crippledOr they will continue being sick and the children remain in continuous su"ering&Campaign immunizations, make sure they are given to the children for extra protection.&A call to all of us parents&to take our children for immunization.&&&&&&&&&

5 Composed by Dr. Isa S. Abubakar.

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Topic 4: Say and Do the Vaccination Hand

Presentation

• Now we will introduce the Vaccination Hand.

• This provides a simple way to remember the vaccination schedule – when we must take our baby for routine immunizations. The baby is born with some protection from its mother. The vaccination schedule ensures that the baby gets protection as soon as his/her mother’s protection !nishes. If you delay bringing your baby, your baby will be at risk of the terrible childhood diseases.

Facilitator’s Note: Use Say & Do to teach the Vaccination Hand so that each participant knows it and can teach it at home.

Summarise

To protect our babies properly, we need to take them on time and complete all the vaccination visits according to the Vaccination Hand schedule.

Topic 5: Don’t Delay and the Vaccination Slogan (Say & Do Chant)

Presentation

Tell participants that we will now discuss the importance of not delaying going for vaccinations.

Discussion

Tell us how old your baby was for his or her !rst vaccination visit. Who took the baby to the health facility?

Why don’t we bring our babies for their !rst visits as soon as they are born or at least before their naming ceremony?

Say & Do

Use Say & Do to teach the Vaccination Visit Slogan.

• This will help everyone remember how important it is too bring babies for their visits as quickly as possible.

Vaccination Visit Slogan

Ziyara hudu

A cikin wata hudu.

Ziyarar kyanda,

A wata tara.

Four visits

Within four months.

Measles visit

At nine months.

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Say & Do to Chant the Vaccination Visit Slogan and Hand Movements

Facilitator’s Note: Use the 2 times method. Repeat the 2 times method until all participants can remember the slogan

Demonstrating the slogan

• The leader says the slogan two times.

• The leader explains that the slogan reminds us to take our babies for four visits by the time they are four months old. Then come back when our babies are 9 months old for the measles vaccination.

• The leader repeats the slogan 2 times.

Practicing the slogan

• The leader asks everyone: Please say, “Ziyara hudu a cikin wata hudu.” 2 times along with me.• The leader asks everyone: Please say, “Ziyarar kyanda, a wata tara.” 2 times along with her/him.• The leader asks everyone: Please say the entire slogan 2 times along with me.• The leader asks for volunteers to recite the entire slogan. • Ask everyone to repeat the slogan 2 times along with me.

Facilitator’s Note: watch the participants while they are learning and pick participants who have successfully learned the slogan. If you pick someone who is having trouble, thank them for their good e"ort and ask for another volunteer. If participants are still having trouble remembering the slogan, start over again.

Summarise

To completely protect our babies, we need to take them for vaccinations on time and complete all the vaccination visits.

• The slogan reminds us to take our babies for four visits by the time they are four months old. Then come back when our babies are nine months old for the measles vaccination.

• Don’t delay. If you delay, your baby will not be protected.

• Go to the health facility RI Day as soon as you remember. The health worker can help you catch up.

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Topic 6: Learning Lokutan zuwa allurorin rigaka!, a Vaccination Visits Song6

Facilitator’s Note: This topic is optional.

Lokutan zuwa allurorin rigaka!

Kira garemu iyaye mu kai jarirai rigaka"Da zarar an haihu ka"n suna, akai jarirai rigaka",Sai kuma in anyi arba’in, akoma don yin rigaka",Bayan arbain da wata guda, akoma don yin rigaka",Bayan an kara wata guda, akoma yin rigaka",A tabbatar ziyara hudu, a yi su cikin wata hudu.A tabbatar ziyarar kyanda, a yi ta a daidai wata tara.Rigaka"n gangami a tabbatar anayi wa yara dan karin kariya.Kira garemu iyaye mu kai jarirai rigaka".

A call to all of us parents&to take our children for immunization.Immediately at birth before the naming ceremony, take your babies for immunization.Then at the 40th day, go back again for immunization.One month after 40 days, go back for another immunization.After another one month, go back again for another immunization.Make sure 4 visits do them within 4 months.Make sure the measles visit, you do it exactly at the 9th month.Campaign immunizations, make sure they are given to the children for extra protection.A call to all of us parents&to take our children for immunization.

6 Composed by Dr. Isa S. Abubakar.

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Topic 7: Know When and Where to Take Our Babies For Immunization

Presentation: We will now discuss when and where to take our babies for mmunization.

Discussion

Where do we take our infants for RI?

Summarise

The facilitator tells participants the places, days and times that routine is available.

Place/s, Days and Times RI is available for us

Facilitator’s Note: Each Discussion Group leader must obtain and share this information during each session.

Place . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Days. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Hours. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Circular Review


Closing

• Vaccinations prevent measles, whooping cough, polio and other childhood diseases• The Vaccination Bene!ts Song• The Vaccination Hand• The Vaccination slogan to remind us not to delay• The Vaccination Visits Song• Places, dates and times to get vaccinations

• How vaccinations protect our babies• How to manage vaccine reactions

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SESSION 2: HOW VACCINATIONS PROTECT YOUR BABY


Objectives


Understand more about how vaccinations work to protect us

• Know how to manage vaccine reactions

Session 2 TopicsHow Vaccinations Protect Your Baby

Topic Method


1. Hot Pepper and Invisible Germs Recall of Earlier Topic

2. Vaccinations Make Body Guards Mime/Discussion

3. Manage Vaccine Reactions Discussion/Presentation


Closing: encourage participants to discuss with friends and relatives and prepare to feed back. The next topics are the Road to Health Card (Vaccination Card) and how the community can encourage immunization uptake.

Presentation

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Presentation/Introduction

In this session we will look at how vaccinations protect our babies.

Review

First, however, we will review the discussions that we had with spouses, relatives and friends on the topics from last week.

Positioning: Participants sit in a circle.

• I hope you all shared our discussions with your spouses, relatives and friends. Please share with us your discussions. What did you tell them? What did they do?

Facilitator’s Note: In each session encourage 3-4 volunteers to share the discussions that they had with other people. Make sure that the same people don’t feed back every week.

If participants do not mention key issues, ask the following questions:

What are the bene!ts of vaccination?

• How do we do the Vaccination Hand?

• How do we say the Vaccination Slogan?

• What are the places, dates and times that we can get vaccinations?

• Would anyone like to sing the Vaccination Bene!ts song or Vaccination Visits song?

Now we will discuss our immunization successes.

Parents of babies, did you take your baby to the health facility for immunization?

• Tell us about who you encouraged to take their baby for immunization. What did you say/do? Did they take the baby to the health facility?

• By a show of hands, let’s see how many of us encouraged one parent, two parents or more than two parents to immunize their baby at the next immunization session?

Summarise


Practice the Vaccination Hand and the Vaccination Visit Slogan.

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Topic 1: Hot Pepper and Invisible Germs

Facilitator’s Note: If your participants have not participated in the Hot Pepper and Invisible Germs exercise (from the newborn care module), do the demonstration with them now.

Discussion

• Let’s remind ourselves about the way hot pepper is like the invisible germs? What is invisible in the hot pepper.

Desired Response

• The thing that causes the hot burning feeling.

• What do the doctors see in the microscope that is invisible to our own eyes?

Desired Response

• The germs that cause di"erent diseases.

Summary

Doctors can see the germs that cause di"erent diseases in the microscope. They have made vaccinations to kill many di"erent diseases including measles whooping cough, polio and other terrible childhood diseases.

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Topic 2: Vaccinations Make Bodyguards

Introduction

We are going to use mime to show how immunization helps our bodies !ght the germs. I will tell a story and volunteers will act out the story without talking.

Summarise

• Germs are invisible. We cannot see them but they can hurt us like the thing in pepper that burns.

• Doctors use microscopes to identify the germs and make vaccinations to make bodyguards to kill the germs.

• The vaccinations help our bodies make bodyguards to protect our bodies by !ghting the invisible germs.

• To protect our babies properly, we need to take them on time and complete all the vaccination visits according to the Vaccination Hand schedule.

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Mime: Vaccines Build Lifelong Bodyguards

Facilitator’s Note: Volunteers play the roles of the people identi"ed below with CAPITAL LETTERS. Keep the story and action simple. The purpose is to teach the participants that vaccines produce bodyguards that protect their children. Make sure your “stage” is large enough space so the participants can see clearly.

Facilitator: We need some volunteers to come forward and follow my directions.

1. Two volunteers come forward to act as CHILDREN and two more volunteers come forward and act as their MOTHERS/FATHERS.

The REFUSING/UNVACCINATED CHILD stands with his MOTHER on my right. His MOTHER will refuse to allow her child to be vaccinated.

The ACCEPTING/VACCINATED CHILD stands on my left. His MOTHER/FATHER will be happy to have her child vaccinated.

2. One volunteer come forward to act as a VACCINATOR.

3. Three volunteers come forward to act as the BODYGUARDS. They stand in line behind the VACCINATOR, ready to surround and protect the CHILD as soon as s/he is vaccinated.

4. Two volunteers stay in the audience and will act as CHILDREN WITH MEASLES.

Facilitator tells the story and the volunteers act out the story.

1. The VACCINATOR tries to vaccinate the REFUSING/UNVACCINATED CHILD. His/her MOTHER refuses.

2. The VACCINATOR vaccinates the ACCEPTING/VACCINATED CHILD. Watch what happens to the CHILD.

The VACCINATED CHILD tells his body to make BODYGUARDS against the germs. The three BODYGUARDS come and stand around the CHILD. They hold hands to guard and protect the VACCINATED CHILD.

3. Now watch what happens when a CHILD WITH MEASLES lives in the same neighbourhood. The CHILD WITH MEASLES is coughing and sneezing. Measles germs are everywhere but we can’t see them.

4. Watch the UNVACCINATED CHILD get infected. The invisible germs are making her/him sick with measles. Now the UNVACCINATED CHILD is coughing and sneezing. Now the UNVACCINATED CHILD is shivering with fever.

5. Now look at the VACCINATED CHILD. The BODYGUARDS !ght the invisible measles germs. The vaccination protected the VACCINATED CHILD.

Discussion What happened to the child who was not vaccinated?What happened to the child who was vaccinated?What did the vaccination do to protect the child?

SummariseVaccinations make the body make bodyguards. Whenever the bodyguards see germs that make their disease, the bodyguards destroy the germs. Vaccinations protect for life.Some vaccinations require multiple doses to provide the protection.Some vaccinations require multiple boosters to provide enough protection.

REPEAT the entire mime, debrie!ng and summary with other volunteers to make sure that everyone has understood the mime and the way vaccinations protect our children.

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Topic 3: Managing Vaccine Reactions

Overcoming Fears of Vaccine Reactions

Presentation

We are going to talk about overcoming fears of vaccine reactions.

• The !rst topic is managing normal vaccine reactions.

Facilitator’s Note: Encourage female Community Volunteers and members of female CBOs to organize additional female discussion groups on this session in particular to reach women with children under 1 year of age.

Experience Sharing

Have any of your children experienced any kind of reaction after receiving immunization?

• What kind of reaction did he or she experience?


Presentation

Most vaccine reactions are not serious.

Tell participants the following:

Don’t worry. Most vaccine reactions are not serious.

• Some children have reactions after immunization and some children have no reactions. Our bodies are di"erent.

• Normal reactions include:

- Mild fever

- Pain, swelling and tenderness at the injection site.

- Last for 2 – 3 days.

• Serious reactions:

- Last more than 3 days

- High fever

- Abscess (pus at injection site)

If your chid has a serious reaction, take the child to the health facility.

We are now going to look at how to manage normal reactions.

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Demonstration & Practice: MANAGING FEVER

Introduction: Ways to reduce a baby’s fever

Wipe the baby’s body with lukewarm water (slightly cool, like well water)

You can also give the baby paracetamol syrup according to directions

One good, lukewarm water wipe is equivalent to one dose of paracetamol

Demonstration: Wiping the baby’s body with lukewarm water.

Requirements

Clean small cloth or towel

Lukewarm water in a clean small bowl (preferably well water)

A stu"ed nylon bag or a mineral bottle wrapped with cloth.

Steps

Hold the baby on your lap exposed.

Dip the small cloth into the lukewarm water and squeeze out some water.

Wipe the baby’s body from head to toe. Continue wiping the baby till the temperature goes down.

If it is hot, leave the baby’s body uncovered.

If it is cold, cover the baby lightly. Do not make the baby hotter.

You can also give baby paracetamol syrup according to the directions.

Participant practice

Repeat the demonstration.

Then ask a volunteer to demonstrate.

Facilitator corrects mistakes observed.

All participants practice. Facilitators go round to correct mistakes.

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Demonstration & Practice: MANAGING TENDERNESS/SWELLING

Ways to reduce a child’s pain, tenderness & swelling near the injection site

Apply a cold compress to relieve the swelling and the pain.

Give paracetamol to relieve the pain.

Apply a very cold compress (only to the painful site)

Requirements

A clean small cloth or towel

Small bowl of very cold water, preferably drinking water from clay pot (ruwan randa) or cold water from a refrigerator.

Steps

Hold the baby on your lap.

Dip a clean cloth in a bowl of very cold water, squeeze it a little.

Gently place the cold cloth on the swollen area and keep it on for a few minutes.

Do not press or rub the swelling.

Remove. Wet the cloth again with cold water and repeat 3 times.

Do this to the child 2-3 times in a day.

Give baby paracetamol syrup according to the directions.

Repeat demonstration.

Then ask a volunteer to demonstrate.

Facilitator corrects mistakes.

All participants practice. Facilitators go round to correct mistakes.

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Demonstration & Practice: HOW TO CARE FOR A CHILD WITH BCG SORE

BCG is a special sore. It will heal in 2 weeks.

To care for the sore:

• Wipe the sore each day.

• Keep sore dry

Don’t do the following (Wave your pointer !nger and shake your head each time you say “Don’t”:

• Don’t put any ointment. (Pretend to put ointment on the sore)

• Don’t squeeze it. (Pretend to squeeze it.)

• Do not rub it. (Pretend to rub it.)

• Don’t allow #ies to touch it. (Pretend to swat #ies.).

Repeat demonstration.

• Then ask a volunteer to demonstrate.

• Facilitator corrects mistakes.

• All participants practice. Facilitators go round to correct mistakes.

Summarise

Most vaccine reactions end by themselves.

• Mothers can manage them at home.

• If they last more than 3 days or get worse, take your child to the health facility.

• If the fever is high, take your child to the health facility.

• Which is better for your baby, to have a mild vaccine reaction or to get measles, whooping cough, polio or another serious disease?

Circular Review


Closing

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• How vaccinations protect our babies by making bodyguards• How to manage vaccine reactions


• The Road to Health Card (Vaccination Card)• What the community can do to encourage uptake of immunization

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SESSION 3: SHARING RESPONSIBILITY FOR ROUTINE IMMUNIZATION


Objectives


Understand why vaccination cards are so important

• Have committed to making easier for people in the community to take their child for vaccination

• Have an action plan detailing how all babies in the locality are to be reached

Session 3 TopicsSharing Responsibility for Routine Immunization

Topic Method

Our discussions with spouses, relatives, friends, the vaccination slogan and hand

Experience sharing

1. Bene!ts of the Road to Health Card (Vaccination Card) Presentation/Discussion

2. What Can Parents and Community Members Do? Group Discussions

3. Sharing Our Responsibility and Planning Our Actions Presentation/Action Planning


Closing: encourage participants to discuss with friends and relatives and prepare to feed back. The next topics are the ways children spread polio; the reason polio spreads suddenly and rapidly; and ways communities can commit to taking action in support of vaccination.

Presentation

115


Review

Tell us about your discussions with others.

Who did you discuss with?

• What did you tell them?

• Who spoke to your wife/husband? What did s/he say? What did s/he do?

Let’s discuss our immunization successes



• By a show of hands, let’s see how many of us encouraged one parent, two parents, more than two parents to immunize their baby at the last immunization session?

Practice


Topic 1: Bene!ts of the Road to Health Card (Vaccination Card)

Presentation

• Introduce the Topic.

• We are going to talk about the bene!ts of the Vaccination Card.

Experience Sharing

• Let us discuss your experiences.• Who has a vaccination card for his/her child?

• How do vaccination cards protect our children?

• How do the cards help the health worker provide faster and better service?• Where can we keep our vaccination cards so we can easily !nd them to take with us each time we go to

the health facility?

Summarise

• The child’s vaccination card: - Helps the health worker quickly register your child, know the vaccines s/he has already been given

and provide her/him with the vaccines s/he needs.

- May be required for school registration.

- Helps researchers know how many children still need to be immunized so they can plan better to avoid stockouts and care for the children in your community

• Ask for a vaccination card for each baby.• Keep the cards in a safe and easily available place.

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Topic 2: What Can Parents and Community Members Do?

Presentation

• Introduce the Topic

• Tell participants that we are now going to look at what parents and community members can do to promote routine immunization in this community.

Group Discussions

Encourage participants to form small groups.

Group Work: What Can We Do As Parents to Make it Easier to Go to the Health Facility for Routine Immunization?

Facilitator’s Note: Ask participants to divide into three groups: parents, spouses and community members. They should discuss the question for "ve minutes. They should choose a member of their small group to report back to everyone.

Parents: Mother for female groups; Father for male groups

Spouses: Husbands and wives

Community Members: Other community members and leaders

Questions

Parents: What do we need to do to be sure our children go for RI?

Spouses: What help do we want from our spouses?

Community members: How can community members and leaders make it easier for parents to immunize their children?

Reports and Consensus

Each group reports back in turn.

As mothers/fathers we have agreed that we can…………………

We have also agreed that we want the following help from our spouses……..

As community members we have agreed that we can ………..

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Topic 3: Sharing Responsibility and Planning Our Personal Actions

Facilitator’s Note: This session needs a literate scribe and an exercise book.

Presentation

• Introduce the topic: We are going to look at how people in the community can support the health facility sta" to carry out immunization.

• Community members can support the O$cer in Charge of the health facility by:

- Mobilising parents to bring their children.

- Tracing children who have dropped out or are delayed.

- Helping out during immunization sessions.

• We are going to make an action plan.

• We will be listing the names of people in this group who will be willing to encourage parents to bring their baby for vaccination.

• We will also list the name of the Community Volunteer who works in the area in which the baby lives.

Facilitator’s Note: A notetaker lists the names of people who want to volunteer their time. This will be done in an exercise book.

Community Action Plan

“Parent Encouragers” “Baby Tracers”

Volunteers’ Names Name of Community Volunteer

Name of baby/Unguwa

1.

2.

3.

4.

5.

6.

7.

8.

9.

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Summarise

• Summarise the content of the action plan.

• Thank participants for volunteering.

Circular Review


Closing


• Why the Road to Health Card /Vaccination Card is important• What the community can do to encourage support for immunization rates• Who has volunteered to be a “parent encourager”


• How children spread polio• How polio spreads rapidly• How communities can commit to taking action in support of vaccination

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SESSION 4: HOW CHILDREN SPREAD POLIO


Objectives


Know about how polio spreads and how quickly it spreads

• Feel responsible for preventing infection by taking children for polio vaccination

• Understand how the community can work together to prevent the spread of polio

Session 4 TopicsHow Children Spread Polio

Topic Method


1. Polio - Introduction Presentation

2. How Do Polio Germs Spread? Mime/Discussion

3. People Spread Polio Rapidly Presentation

4. Community Commitments to Take Action Against Polio Presentation/Commitment


Closing: encourage participants to discuss with friends and relatives

Presentation

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Review

Tell us about your discussions with others.

Who did you discuss with?

• What did you tell them?

• Who spoke to your wife/husband? What did s/he say? What did s/he do?

Let’s discuss our immunization successes



• By a show of hands, let’s see how many of us encouraged one parent, two parents, more than two parents to immunize their baby at the last immunization session?

Practice


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Topic 1: Introduction to Polio

Presentation

Polio spreads very fast.

• But we don’t see many crippled children. &

• Most children infected with polio don’t look very sick and don’t get paralysed.

• Stool spreads the polio virus - When children are infected with polio, they have the virus in their body.&

- Whenever they stool, they pass the virus in their stool for up to two months.&

Facilitator’s Note: Use Say & Do by putting your hand near your bottom when saying, “passes the polio germs in their stool”.

• Every child who is infected with the polio whether or not they are crippled will continue to stool the virus for up to two months.

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Topic 2: How Do Polio Germs Spread?

Presentation

Introduce the topic.

• We are going to look at how polio germs spread.

Mime: The Stool and the Standing Water

Introduction

How can polio germs from the stool of one child a"ect another child?

Facilitator’s Note: Use Say & Do: Put your hand near your bottom when you say “stool”. When you ask “how can polio germs get into the mouth of another child?” move your hand to near the mouth of one of the participants.

Ask for members of the discussion group to volunteer for the mime. Say that they should act out what the narrator is saying.

Narrator:

Here is a SMALL CHILD infected with polio germs. You see him leave the house and stool outside near the family’s water source. Polio germs are in the stool.

ALTERNATIVELY: Here is a SMALL CHILD infected with polio germs. He has just stooled outside near the family’s water source. (Point to a rock or crumpled piece of paper.) See his stool. Polio germs are in the stool.

And then the rain comes or someone washes away the stool. (Make the sound of rain or washing away the stool.) The rain carries the stool and the polio germs into the stream.

Now here comes the MOTHER to draw drinking water. She carries the water to the house and gives a drink to the small child who is thirsty.

Discussion

• What will happen to the child/children?

• What is the route the polio germs take from one person to another? What is the route from stool to mouth?

• How can we cut/break this route to protect our children?

• Can we always be sure everyone will break this route from stool to mouth? NO!

Repeat the entire mime and debrie!ng with di"erent participants.

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Mime: The Flies, Stool and tuwo shinkafa (or your favourite food)

Narrator:

Here is a two year old CHILD. See the CHILD stool in the compound.

ALTERNATIVELY: Here is a two year old CHILD. He has just stooled in the compound. (Point to a rock or a crumpled piece of paper.) See the stool.

See the FLY (a participant acts like a FLY) that comes and sits on the stool. Now watch the FLY. The FLY #ies over to the tuwo shinkafa that the child’s MOTHER has just !nishing preparing. The MOTHER scoops out the tuwo and puts it in bowls for the children.

The FLY sits on the tuwo. What is on its legs? The invisible polio germs from the stool.

But the tuwo looks delicious and TWO CHILDREN enjoy it.

Discussion

What will happen to the child/children if the two year-old child is stooling polio germs?

What is the route the polio germs take from one person to another? What is the route from stool to mouth?

How can we cut/break this route to protect our children?

Can we always be sure everyone will break this route from stool to mouth? NO!

Repeat the entire mime and debrie!ng with di"erent participants.

Discussion

If we can’t be sure everyone will break the routes from stool to mouth, what is the best and fastest way to protect each baby and child against polio?

Summarise

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The best and fastest way to protect each baby/child against polio

1. The fastest way: Follow the Vaccination Visit Slogan: Take your babies to the health facility (or regular vaccination outreach site)

Vaccination Visit Slogan

Ziyara hudu

A cikin wata hudu.

Ziyarar kyanda, A wata tara.

Four visits

Within four months.

Measles visit

At nine months.

2. The best way: Also give every under-5 child the booster polio drops during every campaign to make sure they are well-protected.

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Topic 3: People Spread Polio Rapidly

Presentation

Facilitator makes a presentation on the following.

Presentation: People Spread Polio Rapidly Without Realising They Are Spreading the Disease

1. Polio spreads very fast but we don’t see many crippled children because the polio virus a"ects children di"erently. Some children will:

Facilitator’s Note: Use Say&Do to illustrate the di%erent reactions children have when polio germs get onto their body.

Say Dodie from polioget crippled in both legs Hold both legs beneath the kneesget crippled in one arm or leg Hold one arm limp and then hold one leg limpnever get crippled Wag your !nger back and forth vehementlyget fever Cross your hands over your chestnever get sick at all Wag your !nger back and forth vehemently

2. People spread polio from one person to another very easily without being realising that they are spreading the disease.

• Most children infected with the polio virus do not get very sick.

• If one child is crippled by polio in your area, 200 other children are likely to be infected with the virus.

Facilitator’s Note: Use Say&Do. Spread your hands to encompass everybody.

• So the virus can spread fast from one child who doesn’t look sick to another.3. Stool spreads the polio virus.

• When children are infected with the polio even the children who are not crippled, they have the virus in their body.

• Whenever they stool, they pass the virus in their stool.

Facilitator’s Note: Use Say&Do by putting your hand near your bottom when saying, “passes the polio germs in his or her stool”.

• Every child who is infected with the polio whether or not he or she is crippled will continue to stool the virus for up to two months.

4. Polio drops are very safe and make permanent bodyguards. • The drops cannot give a baby or child polio.

• Polio drops do not cause any vaccine reactions and cannot harm a child.

• Some children get full bodyguard protection faster than others.

• After making the bodyguards, the drops are excreted from the body in the stool.

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Topic 4: Desired Community Commitments to Action Against Polio

Presentation

• Introduce the topic.

• You are going to make a presentation on how communities can commit to taking action against polio.

• The minimum commitments required by the community are as follows:

1. Standing permission for children to be vaccinated during polio rounds and for RI visits 1. All husbands or, in the absence of the husband, senior men in the home tell wives that they have

standing permission.

2. All wives:

- give their children for polio drops

- take their children for RI

- request standing permission if necessary

3. The mai-unguwa announces standing permission for all wives including those whose husbands have travelled. He requires that all children are given for polio drops.

2. Children wait at home (or designated site) for Vaccination Team 1. People should help parents arrange for someone to stay with the child if it is absolutely necessary

that they leave the home.

2. Parents can take the child to the !xed post before leaving the area; or

3. Parents can take the child to the Vaccination Team wherever they are vaccinating before leaving the area.

3. Report to mai-unguwa (or other) if Vaccination Team does not come before 1o’clock prayer (or sooner based on past practice in the community).

4. Take all newborns and under-1s to the health facility and to campaign !xed posts for their routine immunizations including polio drops according to the Vaccination Hand schedule.

Commitment

Encourage participants to commit to taking these actions in order to stop the spread of polio.

Circular Review


Closing


• Di"erent ways in which the polio virus can spread• The speed at which the virus can spread if we don’t take care• Things that families and communities can do to help prevent the spread of polio

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ANNEX 1: CLEAN DELIVERY !LEFEN HAIHUWA"

A. Cleanliness during and after delivery protects the mother and child1. What is the hadith about cleanliness?

Response: Tsafta cikon addini. (Cleanliness completes religion; is half of religion. or Cleanliness is next to Godliness.)

According to the WHO, about 1/3 of newborn deaths are caused by infection. Where hygiene is poor, newborns may become infect ed with germs which can cause serious infections in the skin, umbilical cord, lungs, gastrointestinal tract, brain, or blood.

• Wash your hands often. • Hand-washing with soap and clean water is the easiest and most e"ective way to prevent passing

germs.• Don’t let sick people near the newborn. • Breastfeed exclusively.• Wash everything that touches the newborn: hands, clothes, etc.

2. Let’s think about why cleanliness is important for safe delivery? Why is it very easy for germs to infect the mother during and after delivery?

Desired responses:

• Her vagina is very open and sore so the germs can easily get into her.

• Her pieces of cloth that collect the afterbirth blood (sanitary cloths) touch the entry to her body. • These sanitary cloths must be washed with soap or ashes, rinsed very well and dried so that no germs from the cloths can enter her vagina.

• She must change her sanitary cloths often because germs grow fast in the bloody cloth.

3. Why is it very easy for germs to infect the newborn?

Desired responses:

The newborn’s body is not yet strong. Adults and older children are stronger than babies because they already have fought many germs. Babies can be harmed by germs that are too weak to harm adults and older children.

B. “Tanadi Goma mahimmai na haihuwa,” the 10 essentials for delivery

Facilitator’s Note: The facilitator needs to learn how to sing the song.

Instructions for teaching a song

Teach the song in segments, preferably over several sessions. Ensure all participants master each segment before proceeding to the next segment; do not assume everyone has mastered a segment because you hear beautiful singing voices that have mastered it. Listen for everyone’s voices. Use the two times imitation technique for each segment. Demonstrate a line and then ask everyone to:

1) Repeat after me.

2) Repeat after me again.

Demonstrate the next line....... etc.

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LEFEN HAIHUWA ESSENTIALS FOR DELIVERY

Chorus (2 times) Da oooh Da da dadi,Da oooh Da oooh Da da dadi

In tanadi Lefan Haihuwa taKa!n Haihuwata ta zo ta

Chorus (2 times)

Child oooh a thing of joy

Child oooh Child oooh a thing of joy

I would get the essentials for my deliveryBefore my delivery

Da oooh Da Da dadi

Da oooh Da oooh Da da dadi

In tanadi Ledan Shim!dawaTare da Ledan sawa hannuDomin karbar Haihuwata



I would get my polythene sheet for bed spreadWith the polythene bag for the handsFor my delivery

Da oooh Da Da dadi


In tanadi Reza Sabuwa Tare da Zaren daure cibi



I would get a new razor bladeAnd thread for tying the cord

Da oooh Da Da dadi


In Tanadi Sabulun wanke danaGa tafassashen ruwa a robaTare da Tawil’in goge dana



I would get soap to bath my babyThere’s also boiled water in a plastic containerWith a towel for wiping my baby

Da oooh Da Da dadi


In samu Tufa!n Nakuda taDomin Tsaftace Haihuwa ta

Child oooh a thing of joyChild oooh Child oooh a thing of joy

I would get a dress for labour To keep my delivery clean

Da oooh Da Da dadi


In Tanadi tufa! na da danaMasu Tsafta domin sawaNa Hada Lefen HaihuwataNa Hada Lefen Haihuwata

Child oooh a thing of joyChild oooh Child oooh a thing of joy

I would get cloths for myself and my babyClean clothes to wearI have all my essentials for deliveryI have all my essentials for delivery

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D: Preparing for a Clean Delivery (Discussion) Let’s recall the things we need to prepare for delivery that are mentioned in the song “Lefen Haihuwa”.

What items are mentioned in the song and what are they used for?

2. What can happen to the mother and newborn if the delivery is not clean?

Desired Responses:

- The germs give the mother a serious infection that causes her to have fever and smelly private parts.

- The germs give the mother’s breast/s a serious infection (becomes red , swollen and painful)

3. Presentation: Infection can be very harmful to the mother and/or newborn.

- If not treated by a health worker, the germs that get into her vagina will travel up into her womb and can prevent her from getting pregnant again.

- Cleanliness helps prevent infections that cause fever that can kill or harm the newborn and the mother.

- When a fever gets too high, it spoils the brain and can even cause death. Newborn’s fevers can get too high very quickly.

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ANNEX 2: NEWBORN DANGER SIGNS !LONG LIST"

EIGHT NEWBORN DANGER SIGNSNS

HEAD SIGNS #4 SIGNS$Touch your head with both hands and say “there are 4 signs to watch out for in the head”

1.Sunken soft spot Fadawar Madiga

1. Lower down your head allowing your chin to rest on your upper chest.

2. Touch the soft of your head with both hands using the four !ngers in both hands to press downwards

3. Say “Sunken soft spot”.

4. Remove your !ngers from your soft spot but still keeping your head down

5. Repeat steps 2 and 3 twice more (sunken soft spot X 2)

2. Sunken eyes, no tears when crying

1. Lift up your head.

2. Touch both eyes with the !rst two !ngers following the thumb on both hands - the left !ngers resting on the left eyes and the right !ngers resting on the right eyes

3. Say “Sunken eyes no tears when crying” three times

3. Refusing to feed

1. Hold both your hands under your left breast and turn your face to the right side.

2. Say “Newborn is not feeding”. Say this 3 times

4. Fever Zazzabi

1. Use your right palm to touch the right side of your head

2. Quickly repeat the !rst step above, but this time using the back of your right hand instead of your palm

3. Say “Newborn has fever” Say this 3 times

WHOLE BODY SIGNS #2 SIGNS$Use both hands to touch your body making sweeping movements from your throat to just above

your hips and say “there are three signs to watch out for in the body”

5. Di%cult breathing; fast and noisy breathing Numfashi da kyar

1. Lift up your chest cavity and breathe in and out fast. Then wait a little while and repeat the same process 3 times

2. Say “Breathing is di$cult” X 3

6. Sti" neck and !tting Sankarewa da zabura

1. Stretch your neck and your body. Also stretch both hands down on both sides of your body

2. Say “ Say newborn’s neck is sti", body is sti"” X 3

3. Hold your hands up in the air and let your head fall to one side while shaking your hands and whole body at the same time

4. Say “Newborn is !tting” X 3

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BOTTOM SIGNS #2 SIGNS$Use both hands to touch your bottom making a downward sweeping movement saying “there are

two signs to watch out for in the bottom”

7. Not passing urine

1. Hold both hands in-between your legs tightly squeezing your legs together

2. Say “Newborn is not passing urine” X 3 times

8. Diarrhoea for more than three days or bloody diarrhoea

Gudawa da ya wuce kwana uku ko atini

1. Use your right hand making fast sweeping movements away from the right side of your bottom

2. Say “Newborn has had diarrhoea for more than 3 days or there is blood or mucus in the stool”. Repeat this x 3

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ANNEX 3: HELPING MOTHERS PREVENT AND TREAT BREASTFEEDING PROBLEMS

• Good positioning of the baby and good attachment to the mother’s breast help prevent sore or cracked or bleeding nipples. Ensure that the baby’s:

- body is close to the mother’s body

- chin touches the breast

- mouth is wide open

- lower lip is turned outward

- mouth covers less of the areola on top than below

• If a mother’s breast is too full, it becomes hard, swollen and painful. This makes it di%cult for the baby to breastfeed. Help the mother reduce this excess milk.

- Put hot, wet clean cloths on the breasts for 5-10 minutes or take a warm shower before each breastfeed.

- Hand-express a small amount of milk before putting the baby to the breast. (This softens the area around the nipple and helps milk #ow, making it easier for the baby to attach.)

- Breastfeed at least every 2-3 hours or if the baby is not able to suck,

- Express milk every 2-3 hours. (Engorged breasts that are not emptied can become infected.)

- Empty the !rst breast before giving the other breast to the baby.

- If the breasts still feel full after a breastfeed, encourage the baby to feed longer or express breast milk for a few minutes (until the breasts feel softer).

- Put a cold cloth on both breasts for 5-10 minutes after breastfeeding.

- Watch for signs of infection: pain, redness, heat, a lump in one breast, fever and chills

• Take the mother to the health facility for treatment and advice if she has signs of infection: pain, redness, heat, a lump in one breast, fever and chills, a painful breast and fever.

- She should express the milk from the painful breast to avoid more problems.

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