1.6.3 Establishing partnerships with community gatekeepers
The primary targets of postnatal care are the mother, her newborn baby and the father. However, there are secondary targets — the community gatekeepers who can influence decision-making that affects the mother and baby’s health. You need to involve these people right from the outset when you introduce a postnatal care service in your community. Give particular attention to involving:
- Official village administrators
- Religious leaders, church or mosque groups
- Opinion leaders and village elders
- Women’s associations or women’s clubs
- Youth associations
- Neighbourhood social committees
- Farmers’ associations or agriculture associations
- Traditional birth attendants (TBAs), traditional healers
- Village drug vendors
- Any others you think are relevant to the specific circumstances.
Without the cooperation and collaboration of these individuals and groups it will be difficult to provide optimum postnatal care. In particular, it is essential to establish a good link and harmonise your efforts with the traditional birth attendants (TBAs). The following activities will help you to do this (Box 1.2):
Box 1.2 Establishing a partnership with traditional birth attendants
- Contact the TBAs in your community and discuss how you can support each other in providing postnatal care to women, newborns and families. Together you can create new knowledge which is more locally appropriate.
- Respect their knowledge, experience, opinions and influence. Ask them to explain the knowledge they share with the community.
- Share with them your information about postnatal care. Provide copies of health education materials that you wish to distribute to community members and discuss the content with them.
- Involve them in counseling sessions for families and other community members. Include them in meetings with community leaders and influential groups.
- Discuss the recommendation that all deliveries should be performed by a skilled birth attendant like you. When this is not possible, or not preferred by the woman and her family, discuss how the TBAs can provide more effective postnatal care, and when to make an emergency referral to you or to a higher health facility.
- Make sure TBAs are included in the referral system and provide them with feedback on women they have referred to you.
Why do you think it is important to involve TBAs and local healers as described above?
They are important partners, because they know the local culture, are respected by the community, and have a lot of experience in dealing with most of the social problems arising during the postnatal period.
Imagine you are a TBA with many years of experience. A Health Extension Practitioner begins to work in your village and asks for your help. What kinds of things would make you most likely to want to cooperate and support her practice?
Of course there is no single right answer to this question, just as there is no single TBA to whom all answers will fit equally. However, you probably included some of the following points:
- She treats you with respect and as an equal.
- She shows a real interest in the traditional childbirth practices in your village.
- You can see that she values your knowledge and experience.
- She gives you the opportunity to learn about new childbirth practices.
- She asks you to join her as a partner in a joint effort to improve postnatal care for the women and newborns in your village.
- She invites you to meetings with village leaders and other gatekeepers to mobilise community support for postnatal care services.
1.6.2 Why is community participation so important?