The Use of iDARE Methodology to Incorporate Community Cultural ANC Beliefs into ANC Services at Kabeywa Learning Site in Uganda
By Joyce Draru, Gender and Youth Specialist
iDARE work begins in the same fashion for every new site: with the formation of iDARE teams. The teams work with their USAID Social Behavior Change Activity (SBCA) / WI-HER Gender and Youth Specialist to identify root causes in health care gaps. related to gender, youth, and social inclusion (GYSI), design solutions to address the root causes, apply the co-designed solutions, record the results that they see from the solutions in their community, and then expand on solutions that have worked well, including sharing their experience.
This was the process for the Kabeywa Health Center III (HC III) learning site in the Kapchorwa District in Uganda. iDARE teams were formed with health care facility providers, community health workers and volunteers (CHW/V), and people identified as social change influencers in the community. SBCA Gender and Youth Specialist, Joyce Draru, facilitated this team. However, when the team started to address root causes impacting the uptake of early antenatal care (ANC) services in the first trimester, it was discovered they had missed a key influencer for the team.
The iDARE team took deliberate steps to identify root causes that explained the reasoning for why pregnant women in Kabeywa did not attend first ANC services in their first trimester, as is recommended. In the past, health workers and midwives at Kabeywa had put forth great effort to increase the percentage of pregnant women attending early ANC services; however, they were not able to make a permanent impact on facility coverage. The baseline data collected in March 2021 indicated that only 37% of pregnant women attending their first ANC services were in their first trimester.
The iDARE team initially identified one barrier to ANC care as inconsistent active screening by health care providers of all women of childbearing age for pregnancy in the outpatient department and antiretroviral therapy (ART) clinic. In April, the team applied their solution and screened all women of childbearing age for pregnancy and referred the suspected cases to the ANC department for further assessment by the midwife in the same visit. To the surprise of the iDARE team, in April the data showed only 14% of first ANC attending mothers were in their first trimester; the numbers had plummeted from the baseline assessment in March (37%).
To investigate further into these numbers and get an in-depth understanding of the women’s views on ANC services, a sample of pregnant women attending first ANC services at the facility were interviewed by influencers and the iDARE coach. During this process it was revealed that a traditional herbalist was providing ANC and midwife services no more than 300 meters from the health care facility. In fact, approximately 80% of the mothers in the community had sought out care from this woman. The Kabeywa health facility iDARE team were all astonished at these findings.
“I strongly believe that herbal medicine clears all the dirty substances in the uterus and thus make the uterus safer place for the baby to grow.” – Pregnant woman in the community
Interviews were adjusted to investigate the mothers’ perceptions of the professional health care workers compared to the services offered by the herbalist. The mothers and pregnant women identified that the herbal medicine cleaned the uterus. Furthermore, the participants lacked adequate information about the importance of attending first ANC services in the first trimester.
“I appreciate the work of the herbalist so much, because she gives us treatment for secondary infertility, sexual transmitted diseases, conducts deliveries and offers ANC services in the first trimester.” – Pregnant woman in the community
The iDARE team determined the best course of action moving forward was to include the herbalist on the team of influencers, and incorporate the traditional aspects of her practice into the model of care for the community. A call to her was successful; she came and acknowledged that pregnant women come to her, and she treats them with traditional herbal medicine. She even mentioned that she has specific clinic days for first ANC on Thursdays and Sundays. On other days she offers treatment for syphilis, infertility cases, and other needs related to reproductive health.
“This is my third pregnancy, I always come to facility for ANC services when the pregnancy is 6 months, because I fear to mix intake of herbal medicine with medicine given at the health center.” – Pregnant woman in the community
Moving forward, it was agreed that the herbalist would work closely with a midwife counterpoint to follow up with pregnant women, seen by the herbalist in May 2021, who would still be within their first trimester. Together, they talked to the expectant mothers about the benefits of attending first ANC services in the first trimester at the health care facility. The team also dispelled myths around care and escorted the pregnant women to the health facility for an ANC checkup.
The team has learned that working as a team fuels results that address GYSI issues impacting health outcomes and development. By moving to incorporate traditional medicine instead of combatting it, the iDARE team in Kabeywa was able to recover and improve on the percentage of women attending ANC in their first trimester to 42% in May. The team expects to continue their work, find creative solutions to complex problems, and accomplish 80% by the end of September of this year.
USAID Social and Behavior Change Activity is made possible by the support of the American people through the United States Agency for International Development (USAID) and is implemented by Johns Hopkins Center for Communication Programs (CCP) in partnership with The Medical Concierge Group (TMCG), The Busara Center for Behavioral Economics, Women Influencing Health, Education and the Rule of Law (WI-HER), and World Vision Inc.