ANGELS OF CHANGE: A Positive Deviant/Hearth Approach to Maternal Health

ANGELS OF CHANGE: A Positive Deviant/Hearth Approach to Maternal Health

Tanzania
Organization type: 
nonprofit/ngo/citizen sector
Budget: 
$1,000 - $10,000
Project Summary
Elevator Pitch

Concise Summary: Help us pitch this solution! Provide an explanation within 3-4 short sentences.

INTRODUCTION
In this world, every minute one woman dies of pregnancy or birth related complications. WHO defines maternal death as: death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of pregnancy from cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes. Perinatal death means death of a fetus from 28 weeks of gestation to seven complete days of life including stillbirths. The perinatal mortality; is a sensitive indicator of health status of women, the health of the newborn and quality of health care provided during perinatal period especially delivery and immediate postnatal period. According to TDHS 2004/5,there is high antenatal care coverage- 94% at least one visit; 62% makes four or more visits yet the maternal mortality ratio is still high- 578/100,000 live births and under 5 mortality rate = 112/1000 live births.
Tanzania is amongst countries with very high number of maternal deaths in the world, the high maternal and newborn mortality constitute a silent emergency in Africa, (WHO, 2004) .Two decades after safe motherhood initiative (SMI); the maternal and perinatal mortality levels have sadly continued to rise instead of declining. Health indicators are not improving which may be attributed by poor quality of health services provided (reproductive and child health survey, 1999; TDHS, 2004/5).Poverty, social exclusion, low levels of education and women violence/abuse are amongst the contributing factors.
ANGELS OF CHANGE
Angels of Change is an entry point to prevent maternal deaths using the Positive Deviant/Hearth Approach. Angels of Change is an Idea of intensive behavior change Intervention targeting Mothers of Childbearing age and Pregnant mothers who at risk of maternal complications. It is derived from the fact that despite of all of the above factors contributing to the high Maternal mortality in Tanzania, one thing is evident, that there are a number of women who has never experienced Pre, intra and post delivery complications within our communities under the same resources, these mothers has been able to explore the environment and make use of the available resources while others are not able to do that, these are the one I call the Positive Deviants or The Angels of Change. Through identifying these Positive Deviant Mothers and Using the Community Based Hearth Session Approach, women of Childbearing age and Pregnant women can be brought together to share the Positive Deviant behaviors practiced by Positive Deviant Mothers. Different issues involving locally-discovered positive deviant practices as well as promote other practices essential to healthy living. Hearth sessions incorporate a number of approaches for behavior change including identification of Angels of change in a community, peer to peer support, Mother Dialogues, counseling, negotiation, Adult learning principles, skills building, motivation through visible practices and Women mobilization. Family planning, prevention of unwanted and high risk pregnancies, ensure skilled care during childbirth; ensure access to quality emergency care when a complication arises are among the topics during Hearth sessions.
It involves learning what these Role Models (Angels of Change) has been doing to promote their socially and communally acceptable behaviors and practices promoting good maternal health, HIV/AIDS Prevention and Health care utilization and promoting these practices to be adopted by other mothers. The Hearth part of Angels of Change idea using a PD approach is an intensive behavior change Intervention targeting mothers at risk of maternal Complications.
Sites of implementation including selection of places where majority of Youths are found/lives/work in relatively close proximity, where there are a significant number of risk behaviors.
Angels of Change will be identified though Initial dialogue with respective mother’s groups in a particular community/Institution through peer voting systems especially during antenatal visits. The respective group, guided by Community health workers will anonymously select an Angels of Change with positive deviant behaviors and practices communally acceptable which promotes good maternal health using a special tool. Our Health Volunteer(s) together with the selected Angels of Change will facilitate a mothers Conversation process to discover behaviors and Practices depicted by a selected Role Model and the Group will set up Action Plan. The selected Role Model will trained on facilitation skills and be responsible to conduct Hearth Sessions with Material support provided. She will also be Our contact person in a Particular group observing how peers are adopting her/his practice and behaviors and recommending the way forward. The project will facilitate group meeting at least twice a month and Group learning visits to other successful group with the same socio-economical circumstances. Each group will have a chairperson, Secretary, one Angel of Change and one guardian, teachers/ a community member identified by the group will serve as Guardians. Our Health volunteers will be conducting regular supportive visits to respective group(s) and Provide Monthly report.
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About Project

Problem: What problem is this project trying to address?

Tanzania is amongst countries with very high number of maternal deaths in the world, the high maternal and newborn mortality constitute a silent emergency in Africa, (WHO, 2004) .Two decades after safe motherhood initiative (SMI); the maternal and perinatal mortality levels have sadly continued to rise instead of declining. Health indicators are not improving which may be attributed by poor quality of health services provided (reproductive and child health survey, 1999; TDHS, 2004/5).Poverty, social exclusion, low levels of education and women violence/abuse are amongst the contributing factors. Despite of all of the above factors contributing to the high Maternal mortality ratio in Tanzania, one thing is evedent, that there are a number of women who has never experienced Pre, intra and post delivery complications within our communities under the same resources. Through identifying these Positive Deviant Mothers and Using the Community Based Hearth Session Approach, women of Childbearing age and Pregnant women can be brought together to share the Positive Deviant behaviors practiced by Positive Deviant Mothers.
About You
Organization:
World Vision Tanzania-Lake Zone
Section 1: About You
First Name

Kahabi

Last Name

Isangula

Website
Organization

World Vision Tanzania-Lake Zone

Country
Are you an individual between the ages of 18 and 35 who would like to apply for a nine month Young Champions Program mentored by an Ashoka Fellow?

No

Section 2: About Your Organization
Organization Name

World Vision Tanzania-Lake Zone

Organization Phone

+255282762256

Organization Address

P.o.Box 78,Shinyanga,Tanzania

Organization Country

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Your idea
Country your work focuses on
Website URL
Innovation
What makes your idea unique?

The Positive Deviance (PD) process identifies acceptable, effective and sustainable practices that are already used by at-risk mothers and that do not conflict with local culture. Through learning what their peers with equally limited resources and risk situations are doing to promote maternal Health, Mothers are then empowered through Hearth Sessions to adopt better practices and behaviors even in areas with very limited access to health information and services. It is, in essence, it is a “mop-up” program to eliminate the pool of maternal Complications among women of Childbearing age and Pregnant women , not only through Health Promotion but also by permanent behavior changes which are acceptable by the community and can be carried on to next generation of women.
PD Approach1 has been in Practice for nutrition rehabilitation programs in Vietnam and Rwanda resulting to marked reductions in child malnutrition and improvements in child health within a short period of Time .ITS USE FOR MATERNAL HEALTH PROGRAMMES HAS NEVER BEEN DOCUMENTED ANYWHERE,Making it unique. The angels of Change Project will be linked to other health interventions for all women within the target communities if any.
Its is a Programme which is self centered and Communally driven buiding the Capacity of women especially in resource limited areas to be responsible for their health by taking appropriate actions at the right time through guidance of their Positive Deviant Peers leading to improved maternal Health.

Do you have a patent for this idea?

Impact
What impact have you had?

PD Approach has been in Practice for nutrition rehabilitation programs in VManonga ADP of World Vision Tanzania resulting to marked reductions in child malnutrition and improvements in child health within a short period of Time .Its our hope that if used in Maternal issues the Result will be overwhelming.

Actions

FUNDRISING: My organisation is working to look for fundings for this Project
INTERGRATION;We also expect to intergrate the Project in our Current Health Projects
TRAINING: We expect to train more people on Positive Deviance/Hearth Approach to create a Pool of Competent workers

Results

We expect that mother's Capacity on Maternal health issues will be improved by strengtherning Positive behaviors leading to appropriate actions during Pregnancy,Delivery and Post deliverly leading to overall reduction of Maternal deaths

What will it take for your project to be successful over the next three years? Please address each year separately, if possible.

Training of co worker to create a Pool of Competent workers who will actively implement and Monitor the Angels of Chance Project.We also expect to intergrate it in our current Health Programmes.

What would prevent your project from being a success?

Lack of Enough Funding at Inital Stages and lack of commited team playing co workers

How many people will your project serve annually?

Fewer than 100

What is the average monthly household income in your target community, in US Dollars?

Less than $50

Does your project seek to have an impact on public policy?

Yes

Sustainability
What stage is your project in?

Idea phase

Is your initiative connected to an established organization?

If yes, provide organization name.
How long has this organization been operating?

More than 5 years

Does your organization have a Board of Directors or an Advisory Board?

Yes

Does your organization have a non-monetary partnerships with NGOs?

Yes

Does your organization have a non-monetary partnerships with businesses?

Yes

Does your organization have a non-monetary partnerships with government?

Yes

Please tell us more about how these partnerships are critical to the success of your innovation.

Through expertise exchange and referral support

What are the three most important actions needed to grow your initiative or organization?

FUNDS
TEAM WORK
INDIVIDUAL COMMITMENT

The Story
What was the defining moment that you led to this innovation?

Mariam(Not her Actual Name) an old lady with Seven children with the Last Born,Nameless dying in early days of her life.Mariam suffered a severe hemmorrhage afterwards,the cause being retained placenta which was very very difficulty to remove.She was brought to the hospital,exahusted and tired,paper white appearance and it was a weekend and a Doctor on Duty was not available in the ward.Luckly enough i was there visiting my wife who has just delivered a baby girl Eileen.After observing that the Doctor on duty was not there then i thought i've to do something to save Mariam's life.I told the nurse,'i'm a Doctor and i think i can help'.At first she didn't agree with me ,she needed to see my ID Card.Unfortunately i didn't have one.I was just Completed internship in Dar Es Salaam and moved to Shinyanga to wait for posting.Unwelcomed by the nurses i just grabed the sterlile gloves and gown from the Nurses hands and rushed to the Bed where Mariam was gasping,after a series of emergency Procedures Mariam became stable,back to life again.....at that point the nurses realized that i was really a medical Doctor.Nearby Mariam there was a Woman Called Fatuma(Not her real name),she knew Mariam of course and they were neighbours to our suprise.She was just delivered a Seventh baby without any Maternal Complications.After talking to her for some time i discovered that she was poor even more than Mariam,then i kept asking myself 'Why people having the same resources,others make good use of them while others are not???.I asked the same question to Fatuma ....to my suprise the practises she explained are those what i currently call Positive Deviant Behaviors.After some time i attended a Positive Deviant/Hearth Training and started offering technical support to one of our Programme area which was implementing the Nutrition Project among Underfives using the PD/Hearth approaches...very successifully.Then i thought the very same idea can pbe used in Maternal health issues ...of course as ANGELS OF CHANGE PROJECT.

Tell us about the social innovator behind this idea.

Majority of Programmes aiming at Good Materal Health are always Generalised and institutioanl approaches.However programmes aiming at Buiding Capacities of women to become the Angels of changes for their lives by observing and learning from peers who have the very same resources but having Positive deviant Practices are very few if Any.Angels of Change Projects is a Socially,acceptible and centered Projects which uses socially driven practices which are Positive to build capacity of expectant mothers in Materal Health issues.

How did you first hear about Changemakers?

Web Search (e.g., Google or Yahoo)

If through another, please provide the name of the organization or company