Mauritanians Improve Obstetric Care through Trainings, Community Mobilization

Mauritanians had two goals for the safe motherhood program developed by Action for West Africa Region-Reproductive Health (AWARE-RH): master the knowledge and techniques to improve maternal and infant mortality, and be able to run the program independently. Less than two years after the first training sponsored by the USAID-funded projects AWARE-RH and ACCESS, they have taken ownership of the program, and they are running with it.

Preventable complications, such as eclampsia and torn placentas, caused a large number of deaths during childbirth in Mauritania, a major reason for its high maternal mortality rate of almost eight deaths per 1,000 births. In rural areas, where trained medical professionals attend only half of all births, women die in even larger numbers.

With government approval, AWARE-RH and ACCESS trained a core group of health care providers in improved procedures for antenatal and emergency obstetric care. The new system worked, the Ministry of Health adopted it, and the original trainees are now training health care providers nationwide. As community mobilization campaigns are attracting more women to access health care, mortality and morbidity are decreasing.

The AWARE Approach

In collaboration with the Ministry of Health, UNICEF, the ACCESS Project, and the regional nongovernmental organization Mwangaza Action, AWARE-RH first targeted the district of Kaedi in southern Mauritania, where maternal and infant mortality and morbidity are amongst the highest in the nation. A three-week course was held in November 2005, at which 13 midwives and two anesthesiologists were trained in expanded emergency obstetric care and antenatal care.

Monitoring and evaluation activities conducted afterward showed that all participants certified in the course had indeed improved their service provision after the training. Two midwives and one anesthesiologist, however, stood out for their strong clinical and leadership skills. These three were chosen to become trainers and attended a two-week training of trainers course in Burkina Faso in September 2006.

Training of Trainers

Within a year of the first training, the government revamped its entire obstetric care system to include elements introduced by AWARE-RH and practiced by the trainees. With this curriculum in hand, the three professionals, now trainers, instructed 20 government reproductive health care providers in a three-week course at the Aleg district hospital in May-June 2007.

Meanwhile, other trainees from AWARE-RH’s 2005 training have also become trainers, conducting sessions for midwives and doctors with support from the Ministry of Health, the United Nations Population Fund, and the World Health Organization.

Now, in several districts throughout the country, Mauritanians are training each other in the best practices for safe motherhood using the new national curriculum.

Community Mobilization

Even as Mauritania’s Ministry of Health is taking charge of clinical trainings, AWARE-RH’s safe motherhood program continues to encourage communities to take responsibility for pregnant women, ensuring their health and the health of their unborn children.

Community outreach in towns and villages has alerted everyone—women, their husbands, and village elders—to the signs of healthy and unhealthy pregnancies, the benefits of antenatal care, and the importance of having money and transportation arranged for pregnant women to deliver at a health center. Such planning is especially critical in Mauritania, where rural populations often live far from health centers.

AWARE-RH partners with Mwangaza Action, a regional organization based in Burkina Faso and specializing in dynamic community outreach and social mobilization programs, to conduct informational and motivational campaigns about safe motherhood in the district of Kaedi. Concurrently, the Ministry of Health is scaling up awareness activities about safe motherhood in rural districts where clinical trainings have taken place.

Such initiatives have led several villages in Kaedi to buy into a health savings system called Forfait Obstetrical, in which members save for the anticipated costs of obstetric care (including transportation). Such village associations are leading the way in expanding the role of communities in the health of mothers and their newborns.

Partners Add Value

As the safe motherhood program expands to new districts in Mauritania this year, Mauritania’s Ministry of Health and UNICEF will continue to provide materials and equipment for the health centers where trainings take place. USAID’s ACCESS program remains committed to providing technical experts to support trainings conducted by the growing number of Mauritanian trainers and to assess health care providers to confirm their skills are at the highest standards. Always in close collaboration with ministries of health, AWARE-RH implements parallel programs in Cameroon (with UNICEF), Niger (also with UNICEF), and Togo (with PLAN Togo). “We are excited to share this program throughout the region,” said Dr. Fatima Dia-bate, the technical advisor for AWARE-RH, “because we know it works.”

For more information about AWARE-RH’s safe motherhood programs, please contact Fatimata Diabate at fdiabate@aware-rh.org.

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