The Problem

Socio-cultural factors are significant barriers to women seeking maternal and newborn health (MNH) services. In the Somali community, for instance, the main reason for home deliveries is the medicalization of the birthing process that ignores social and traditional norms surrounding this family event. This community has traditional institutions – though weakened considerably by modem life – that remain vital for sustainable social and economic development. The reer (clan) and the heer (the Somali customary law) are some of the most dominant and important traditional institutions in the Somali community, which are used to effectively mobilise social change in many aspects of life. These traditional social systems have shown to enhance ownership and can generate healthy competition among local people to trigger local community actions. This potential has not been well leveraged by the health sector, despite its success in other sectors. Documentation of the evidence of its usefulness is also limited.

Afya kwa Ukoo: Culturally Appropriate and Sensitive Health Services

The Afya kwa Ukoo project – translated from Swahili to mean community health –seeks to innovatively blend socio-cultural norms and delivery of health services so as to boost service acceptance and uptake. It intends to use socio-cultural structures, institutions and decision-making to raise awareness and increase the uptake of maternal and newborn health services and behaviours. At two health facilities (Iftin Sub-County Hospital and Simaho Health Centre), the project will facilitate positive birthing experiences by providing culturally and socially sensitive delivery services through locally adapted approaches. It’s implemented in partnership with two local organisations: Sisters Maternity Home and Preventive Health Care and Epidemiology Consultancy, who bring contextual knowledge and a community network of social influencers who shape positive perceptions and drive local actions for improving maternal and newborn health.

Expected Results

• Enhanced engagement of clan institutions and customary processes to improve awareness and uptake of MNH services and practices
• Increased male participation and support in promoting maternal and newborn health
• Enhanced delivery of culturally-sensitive and responsive MNH services at 2 targeted health facilities
• Strengthened linkages between community and health facilities
• Improve quality of services that are culturally responsive
• The final outcome will be increased utilization of MNH services resulting in reduction in maternal and newborn deaths

Progress as of August 2018

• Community mapping exercise through which socio-cultural influencers were identified and engaged.
• Five community units revitalised, and community health volunteers provided refresher training on MNH.
• 20 health care workers trained and sensitised on culturally appropriate and sensitive services.
• Maternal and Perinatal Death Surveillance and Reporting (MPDSR) committees formed in the two health facilities.
• Community leaders’ forum on MNH commissioned with membership drawn from key cultural, religious and social influencers. The forum is expected to deliberate on MNH issues including MPDSR reports and agree on action plans and clan decrees.
• Identified and trained 40 male champions engaged in MNH promotional messaging using a positive deviance approach.
• Undertook minor infrastructural improvement in two target health facilities for delivery of culturally acceptable services.
• Sensitised 39 traditional birth attendances on safe motherhood and linked them with health facilities as birth companions and safe motherhood promoters.

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