Maternal and Child Health: Chamas for Change
Worldwide, pregnancy is often times the most difficult phase in the life of a woman. This is especially so in Kenya where women often face pregnancy early in life with poor supports. The high mortality rate in some areas increases the uncertainty of survival for both mother and child. It can also be a very lonely phase for women who come from communities with weakened community support structures. AMPATH, through the Maternal, Newborn and Child Health core has initiated a program to bridge this gap known as Chamas for Change.
The program derives its design from a longstanding culture in East Africa where women come together and pool resources in groups known in Swahili as Chamas. Using this existing cultural script, we have developed Chamas for Change, a peer-support model that links pregnant and breastfeeding mothers to their most important resource -each other. To form the groups, mothers are approached for voluntary enlisting either at the clinic or in their homes.
Facilitated by government Community Health Volunteers (CHVs), each group comprises 25 mothers who come from the same community unit. The groups integrate health, social and financial literacy education with GISE; a form of table banking that enables women to save and obtain loans. When bundled together, we call this GISHE - Group Integrated Savings for Health and Empowerment. Together, the women pledge to uphold common health related goals of the Chama which are; to attend 4 prenatal visits, deliver in a facility, breastfeed exclusively, obtain long term family planning and ensure their children are fully immunized.
Upon completion of the first two years that focus on pregnancy, breastfeeding and early nutrition, the mothers graduate and join Malezi Mema. This parenting program introduces mothers to a core set of parental skills aimed at strengthening mother-child bond through play, song and storytelling. The mothers are also provided with effective behavior modeling skills.
Its impact; homes provide children with the positive environment needed for their growth and development. The mothers in this category still continue with GISHE.
Since our launch in October 2012 in Bunyala, one of the rural areas with significantly high maternal and child mortality in Western Kenya, more than 800 mother-child pairs from 18 community units have participated in the program from year to year. So far, we have achieved tremendous success. Compared to women not participating in Chamas, Chama women are 5 times more likely to deliver in a facility and receive a 48 hour visit from a CHV. Among women participating in 2013-2014, 98% delivered in a facility, 91% breastfed exclusively to 6 months and 70% had received long-term family planning.
Through AbbVie Foundation support, we are now scaling-up this program to two new counties where AMPATH is active in implementing population health strategies. We are most excited this year to see the start of our first fathers' program: Chamacha BabaToto, to promote greater male involvement in pregnancy and parenting. These are the first steps towards scaling up this integrated solution as a population-wide strategy to rapidly and sustainably achieve high coverage of facility delivery, long-term family planning, exclusive breastfeeding and school readiness.
We hope that through Chamas,we shall improve maternal and child health indicators. Maternal confidence, wellbeing, and parental skills will be enhanced. Homes belonging to Chama women shall provide a nurturing, safe and supportive environment for our children. They will in turn develop and meet their milestones faster. We also aim at empowering women with skills to prioritize savings and subsequently invest in their children's education, health expenditures and income-generating activities. By pledging to achieve all these together, mothers become shareholders in each other's futures.
By Elvirah Riungu and Evelyn Kaluhi, Chama Implementation Leads, AMPATH Maternal Newborn and Child Health