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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