Sustainably Improving Maternal Health

Sustainably Improving Maternal Health

Uganda
Organization type: 
nonprofit/ngo/citizen sector
Budget: 
$10,000 - $50,000
Project Summary
Elevator Pitch

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

Every year, more than 350,000 women die in childbirth while millions more are injured. Despite many attempts to improve these conditions, progress has been minimal. In Uganda, rural villagers attribute this lack of progress to development agents refusing to work with them in designing and implementing development projects. Safe Mothers, Safe Babies thus seeks to reduce maternal and neonatal mortality through a model of “participatory development” in which we work directly with local populations to define maternal and child health in their terms, identify the diverse contributing structural and cultural barriers to good maternal and child health, and leverage community engagement and ingenuity to develop innovative, community-sustainable solutions that we implement together.

About Project

Solution: What is the proposed solution? Please be specific!

Billions of dollars have been spent on development over the past several decades, so why does poverty and ill-health persist? As expressed by a personal friend from rural Uganda, “They don’t ask us. They think they know our problems from their books and internet and what-what, but they don’t! They don’t know us. So why would we listen to them?!” In other words, many development projects are created in a non-participatory process in which people living in poverty aren’t involved in creating and employing the policies and projects designed to benefit them. Resultant initiatives often rely on Western conceptions of what it means to be “developed” that alienate intended recipients and disregard cultural perceptions. While the need to engage recipients in development projects is widely accepted, very few organizations successfully implement theory in practice. The need for truly “participatory development” is why SAFE was founded. We are innovative because we effectively implement the belief that a true transformation in health and health-seeking behavior can only be achieved when initiatives really seek to work with their target populations, treating them as partners not just participants. That innovation can be seen in the number of our projects that are the only of their kind, for example, using solar power not just to light a health center, but also to change maternal behavior to deliver there (as opposed to their homes), or using a women’s bicycle race to gather more than 1,000 people to attend the very first, community-planned celebration of International Women’s Day.
Impact: How does it Work

Example: Walk us through a specific example(s) of how this solution makes a difference; include its primary activities.

We believe that the single greatest resource to improve maternal and neonatal mortality is the people whose lives it impacts. We thus work diligently in each community with which we partner to undertake the following process: (1) Identify local leaders and engage them as key partners, (2) Work with those leaders to engage the community at large, (3) Work with the community to define maternal and child health in their terms, and prioritize structural and cultural barriers to good health, (4) Design and implement low-cost, innovative, and community-sustainable solutions, and (5) Gradually transition project management to the community the project(s) serves. Because we seek to empower each individual community, this process has resulted in different projects based on each community’s needs, resources, and ingenuity. For example, one community wanted to address the lack of paved roads and distance to their health center; together, we developed a maternal referral system using motorcycle ambulances that were fuel efficient and able to handle rough terrain. In another community, the lack of electricity in their health center made women reluctant to deliver there at night, so we installed a solar system at the facility. In almost all areas, people prioritized the need for culturally appropriate education; so, we worked with men’s and women’s groups to develop reproductive health dramas and songs that the groups perform in their communities. Our primary activity is thus empowering rural villagers to take charge of their own health in innovative ways that the community can sustain.
About You
Organization:
Safe Mothers, Safe Babies
About You
First Name

Jacqueline

Last Name

Cutts

About Your Organization
Organization Name

Safe Mothers, Safe Babies

Organization Phone

(801) 428-7827

Organization Address

Box 2205 Provo, UT 84603-2205

Organization Country

, UT, Utah County

Country where this project is creating social impact

, IGA

How long has your organization been operating?

1‐5 years

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Innovation
What stage is your project in?

Operating for 1‐5 years

Tell us about the community that you engage? eg. economic conditions, political structures, norms and values, demographic trends, history, and experience with engagement efforts.

Iganga District, Uganda is home to approximately 700,000 people, more than 85% of which live in rural areas relying on subsistence agriculture. It is the second largest and fastest growing district in the country, spanning more than 4,000 square kilometers, in which there are only 2 paved roads and a myriad of dirt feeder roads that wash out during the rainy season. It is largely a patriarchal society, and is home to Christians, Muslims, and Animists. Polygamy is prevalent, which, combined with an average fertility rate of 6.9, leads to very large families. Local beliefs relevant to maternal and neonatal health include preferring delivery with a traditional birth attendant, the desire to use herbs during delivery, the thought that only sick women should attend prenatal care, and post-birth practices of immediately washing the newborn, feeding it honey, and putting creams on the umbilical cord. Iganga is served by one, and only, hospital--the Iganga District Hospital--that provides services to 1.2 million people, although it was built to serve only 200,000. Very few rural health centers have electricity, and quarterly shipments of medical supplies last only a few weeks.

More important, however, is the will of the people to improve their own circumstances. For the past 3.5 years, SAFE has been working with a network of more than 700 people from village government and grassroots development associations, women's groups, and men's groups to engage the population at large, who help us design, implement, and manage all projects.

Share the story of the founder and what inspired the founder to start this project

As I entered the Iganga District Hospital Maternity Ward on January 9th, 2009, 3 women experiencing complicated labor were scheduled for emergency C-sections. As a collegiate Emergency Medical Technician, I was leading my third medical volunteer trip to Uganda and was at the hospital to perform a capacity assessment. I hadn’t intended to be providing medical care, but one woman, only 19, had nobody to support her, so I put down my clipboard and did my best, reassuring her that the doctor would be there soon. But it was 4 hours later when he finally arrived, at which point all the nurses had left. I was thus asked to be in the O.R. to care for the babies after they were delivered.

Three times I watched blue and lifeless babies make their way into the world. I performed CPR on each infant, hoping and praying for signs of life. Never have I worked harder or wanted anything so badly. And some of the best noises I’ve ever heard were the first cries those 3 infants wailed.

This experience and others like it during that trip sent me on a quest to learn everything I could about why maternal and neonatal mortality remained high despite attempts to reduce it. I conducted focus group discussions in-country and dedicated my 100-page senior thesis to studying the phenomenon. I learned that many programs fail to adequately engage target populations in the development of projects designed to benefit them, leading to underutilization and unsustainability. Understanding these gaps led me to evolve my college-based initiative, the Vassar Uganda Project, into Safe Mothers, Safe Babies.

Social Impact
Please describe how your project has been successful and how that success is measured

SAFE currently operates in 14 parishes (1 parish=several villages), impacting 125,000 people. To gauge our success, we initiated assessments at the only health center serving our first intervention area (9 parishes), 6 months before and 16 months after the program start date, revealing more than 100% increases in the incidence of health center delivery, prenatal care attendance, and HIV/STD testing.

Because our emphasis is “participatory development,” we feel that the best proof of impact is not just measurable indicators, but also the level of initiative taken by communities to improve health in response to but outside of SAFE-initiated projects. Two examples include: (1) Kalalu Women’s Voice: “Empowered by the idea that we could affect our own health,” 32 women formed Kalalu Women’s Voice (KWV) to improve reproductive health. They organized the first county-wide celebration of International Women’s Day, wrote and performed songs about safe motherhood, and founded a community garden to improve their nutrition. (2) KAMEDE: After their wives formed KWV, Kalalu men formed KAMEDE to improve health and development. They organized “Sanitation Week” to construct latrines and improve sanitation practices, and organized a public debate to promote discussion of family planning.

Prior to our work in these areas, participants reported that reproductive health projects would sometimes result in domestic violence when women utilized a project without their husbands' approval. We thus feel that the level of participation is a true testament to the unique nature of our program.

How many people have been impacted by your project?

More than 10,000

How many people could be impacted by your project in the next three years?

More than 10,000

Winning entries present a strong plan for how they will achieve growth. Identify your six-month milestone for growing your impact

Scaling up to work with ten new parishes, with national and international media campaigns promoting the participatory development approach.

Task 1

Review all inquiries from the 14 parishes who have requested SAFE participatory projects, and choose 10; then, begin identifying local leaders to start the participatory process.

Task 2

Hire 3 new Ugandan staff members, and convene an in-country conference with staff and representatives from each partner community to gather feedback and promote sharing of best practices.

Task 3

Recruit 3 new media relations volunteers, with domestic and international media outreach experience. Then develop a comprehensive outreach plan that includes consistent use of social networking tools.

Identify your 12-month impact milestone

Show clear proof of impact and communicate that impact nationally and internationally towards further financial investment and organizational growth.

Task 1

Obtain IRB-approval for a study evaluating project impact, under the guidance of academic advisers from UC Berkeley, Brigham Young University, and Makerere University (Uganda).

Task 2

Seek publication of articles in national and international journals and in newspapers, blogs, and magazines, utilizing connections with present and past interns, donors, and partner organizations.

Task 3

Grow current internship and practicum student program (international volunteers) from 20 volunteers per year to 40 volunteers per year; then, retain those volunteers in long-term advocacy roles.

How will your project evolve over the next three years?

Our goal is to expand Safe Mothers, Safe Babies to three new districts over the next three years, towards eventual international expansion to other countries. To accomplish this goal, we need to phase our current projects over to community control, expand our human resources by recruiting and retaining more volunteers, and increase our funding by diversifying our funding sources. We plan to meet these tasks by expanding our volunteer internship and practicum program, continually pursuing grants and corporate sponsorship, maintaining constant communication with our donor database (to increase repeat donors), updating our website, finishing the filing process to obtain our 501c3 status, and following the path plans we have with each community to ensure transition of project management.

Sustainability
What barriers might hinder the success of your project and how do you plan to overcome them?

The single greatest challenge I feel we will need to overcome is not spreading ourselves too thin. Because our approach has worked so well, we are receiving more and more requests for our projects from other communities; having limited resources means that we have to be selective about where we work and the projects we fund. To overcome this challenge, SAFE has instituted a careful screening process to identify which communities are truly eager to engage in the participatory process with us, towards achieving community well-being. Additionally, we are seeking to grow our volunteer program and financial resources, which would allow us to scale up over the next 1-5 years.

A second barrier we will encounter is international staff management challenges. Thus far, we have 1 full-time and 10 per-diem employees in Uganda. We feel that it is absolutely essential for the participatory approach to work to employ local people. However, due to communication barriers and cultural differences, we have had difficulties at times with keeping our personnel focused on individual tasks, staying on budget, and not funding unauthorized projects. To overcome this challenge, we are implementing an incentive program that will provide small monthly bonuses when a list of objectives are met (not making unauthorized expenditures, staying on-budget, submitting reports on certain days, etc.).

Tell us about your partnerships

We feel honored to have the following partners: (1) Rotary International Districts 7210 and 9200: Funded $35,000 grant providing 2 eRanger motorcycle ambulances, 4 shallow wells, 1,700 mosquito nets, and 250 “mama kits” (supplies for vaginal delivery). (2) WE CARE Solar: Working together on “Light the Night”, project to install WE CARE Solar Suitcases in 6 rural health centers and the Jinja National Referral Hospital Maternity Ward and Operating Theater. (3) Humless Inc.: Provided corporate sponsorship for installation of lithium solar units in 2 rural health centers and the Iganga District Hospital Maternity Ward and Operating Theater. (4) The Uganda Village Project: Work together on all safe water projects. (5) Iganga District Health Office and Hospital: Work together on any projects involving multiple communities or the Iganga District Hospital. (6) Buyanga Sub County Leaders: Work together on all activities carried out in Buyanga Sub County. (7) Uganda Development and Health Associates: Acts as an adviser to SAFE on all clinical projects. (8) Bugya Bukye HIV/AIDS Integrated Development Association: Partner on all projects in Buyanga Sub County. (9) Kalalu Women's Voice: Partner in reproductive health educational outreach using drama and song, and in the training of other women’s groups. (10) KAMEDE Men's Group: Partner in any male-targeted maternal and child health outreach.

We also recruit volunteers, practicum students, and project advisers from Jefferson Medical College, the University of Texas, Columbia University, and Brigham Young University.

Explain your selections

SAFE has received support from the following sources: (1) Volunteer Program Fees: We feel strongly that it is important to educate the next generation in participatory development, so we accept up to 40 college, graduate, and professional students per year into our International Internship Program. Each volunteer raises $1,000 that supports their stay in-country as well as SAFE's projects. (2) Donor Outreach: We maintain a database of all donors that have donated to SAFE, or its predecessor the Vassar Uganda Project, and reach out to them for repeat financial contributions. (3) Foundations: We implemented a $35,000 grant from Rotary International, and are now starting to receive contributions from other private foundations. (4) Businesses: We have been fortunate to secure two corporate sponsorships, and are currently seeking more. (5) NGOs: We work with several other NGOs whose connections have brought funding to SAFE. In particular, we work with the Uganda Village Project on all safe water projects; we pay for construction materials, they pay for staff and travel expenses incurred to implement the projects. We are also working with WE CARE Solar on the installation of solar units paired with participatory outreach in rural health centers and hospitals, with financial support from WE CARE Solar contacts. (6) Regional Government/Communities: Each area in which SAFE works agrees to assume financial management of their projects over time. (7) Customers: We conduct several projects in an NGO-funded clinic that charges for services; the proceeds support some of those projects.

How do you plan to strengthen your project in the next three years?

Over the next three years, our goal is grow SAFE into a recognized leader in the improvement of maternal and child health through a participatory approach. We want to accomplish that not only by expanding in Uganda and communicating our success abroad, but also influencing other organizations by sharing best practices, particularly those that encourage a participatory, people-centered approach.

To strengthen SAFE in this capacity, we are recruiting young professionals from both the U.S. and Uganda who are passionate about improving the health of women and children and more particularly, about SAFE's participatory approach to accomplishing that goal. These individuals will help our organization grow by devising new ways to acquire funding, make projects even more low-cost and sustainable, and diminishing the work that is placed on any one team member, thus allowing each of us to be more effective in doing that at which we are good and enjoy. They will also help us to communicate our work to others through their participation in courses, writing of theses, dissertations, and published works, and giving public speeches at benefit events and pertinent conferences.

As these activities happen, our capacity will also grow, allowing us to fund more projects, in more places, and with more partners.

Challenges
Which barriers to health and well-being does your innovation address?
Please select up to three in order of relevancy to your project.

PRIMARY

Health behavior change

SECONDARY

Lack of physical access to care/lack of facilities

TERTIARY

Limited access to preventative tools or resources

Please describe how your innovation specifically tackles the barriers listed above.

SAFE's participatory approach is specifically designed to identify and respond to the specific behavioral and structural barriers to good maternal and child health affecting each community. To change health behavior, we work with civil society to conduct culturally-appropriate reproductive health education, usually through drama, songs, and public debates. To improve the lack of access to care, we have worked with communities to develop motorcycle ambulance systems, created networks of community health workers, and held biannual health fairs to bring services to those living too far from a health center. To improve access to preventative resources, we have undertaken projects like shallow well construction, mosquito net distribution, and immunization outreaches.

How are you growing the impact of your organization or initiative?
Please select up to three potential pathways in order of relevancy to you.

PRIMARY

SECONDARY

Enhanced existing impact through addition of complementary services

TERTIARY

Influenced other organizations and institutions through the spread of best practices

Please describe which of your growth activities are current or planned for the immediate future.

We are currently in the process of implementing the participatory approach in 7 new parishes in Iganga District, and in 2 new parishes in neighboring Namutumba and Jinja Districs. Additionally, we have expanded our impact through phasing out certain projects to community control, allowing us to take on new, complementary projects in the same areas. Finally, we pursue partnerships with like-minded organizations, individuals, and institutions, with which we discuss our approach of people-centered, participatory development. One primary way that we accomplish this is through a course on participatory development that we teach to all organization volunteers. We plan to expand our impact by accepting more interns, and by creating a documentary on the approach in 2012.

Do you collaborate with any of the following: (Check all that apply)

Government, Technology providers, NGOs/Nonprofits, For profit companies, Academia/universities.

If yes, how have these collaborations helped your innovation to succeed?

The more we collaborate with others, the greater our impact! In particular, working with: (1) Local government has helped us to engage more people in the participatory process. (2) Technology providers, specifically solar businesses and organizations, have helped us strengthen medical infrastructure with high-quality products. (3) Other nonprofits have allowed our projects to reflect best practices. For example, the Uganda Village Project is an expert in constructing shallow wells. Working with them means that we don't need to reinvent the wheel. (4) For profit companies have taught us about best practices pertinent to a few select projects, in particular maternal referral and solar electricity. (5) Universities supply us with most of our volunteers and advisers. We love to collaborate!