Promoting Safe Motherhood Model for
Miskitu and Sumu-Mayangna
Indigenous People, RAAN, Nicaragua
Vision
A world in which the poorest and most
marginalised enjoy their right to health
Mission
• Work with the poorest and most marginalised
communities in Africa, Asia and Latin America,
often in difficult environments
• Enable these communities to achieve both
immediate and long-term improvements to
their health, as a fundamental human right
• Campaign for changes in policies and practices
to create and sustain good health among the
world’s poorest people.
WORKING IN NICARAGUA SINCE 1993
NORTH ATLANTIC AUTONOMOUS REGION
•
Historically excluded from the
socio-economical and political life
of the country
•
Different Political organization:
Autonomous Regions
•
28% of the national territory,
32,819 Km2
•
314,130 inhabitants: 42%
Mestizos, 40% Miskitus, 10%
Creoles y 8% Sumu-Mayagnas
•
70.9% living in extreme poverty:
HDI 0.466 (low)
•
Maternal Mortality Rate,
207.7/100,000 live births (2008),
18% of national Maternal Death.
69% low level education, 62% IP
•
Worst determinants of health in
the country
Who are we working with?
• Indigenous People and
Ethnic Communities
–
–
–
–
Miskitus
Sumu-Mayagnas
Mestizos
Creoles
• Woman, Men, Children,
Youth, especially those
living in the remotest
rural areas
Who are the people?
• Identity and sense of
belonging
• Different Cosmo vision
• Different language
• Different beliefs and
practices
• Own social and political
organization
• Different learning system
• Holistic understanding of
health
To be a Miskitu Woman
•Miskitu Women: Take care of the
household and children, work with
their husbands, work in the field, fish
in the sea and rivers, cut the wood,
participate in community activities
•Among the Miskitu there is no respect
for woman. Women have no rights and
are frequently ill-treated.
•Are raised to become housewives, so
instead of going to school they learn
how to work and how to serve
•Not valued as contributing towards
the construction of a multi ethnic,
multilingual and multicultural,
inclusive nation
HOW DO WE SUPPORT GOVERNMENT POLICIES?
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•
•
•
•
•
•
•
•
Participatory Methodology
Revitalization of culture
Long Term Commitment
Building and strengthening government
health services
Complementing the government work
through Health Education, Health
Promotion
Accompanying the agents of change by
Facilitating community organization and
development
Building capacities and alliances at all level
(networking)
Advocating (Political Incidence) with the
communities - bottom up approach
Sharing information and learning,
constantly redesigning and redefining
programme
Lessons Learned
in Nicaragua
Where are we working?
Puerto Cabezas
10 Miskitu Villages
Waspam
12 Miskitu Villages
1 Sumu-Mayangna
Village
DIRECT BENEFICIARIES
in Nicaragua
•
496 pregnant women every year
•
3,630 women of reproductive age (15-49 years) every year
•
446 newborns every year
•
54 Traditional Birth Attendants
•
23 Community Health Commissions (138 members)
•
56 Health workers from the MOH
RAC Health Commission
Health Secretariat
Socio- Anthropological Research:
•
Antenatal care, birth attention, after
birth and new born caring practices
among the Miskitu and SumuMayangna Woman
•
Evolution of TBA role
•
Role of MOH units (health post, health
centres, hospital)
Baseline of
disabilities after
birth attention
with TBA and
health staff
Municipal Health Commissions
Service Managers MOH
Service Providers MOH
Service Providers:
TBA
Tec. Facilitators:
Sociologist
Anthropologist
Gynaecologist
Woman, Men
CHC
Safe Motherhood
Model of Attention
culturally
appropriate for
Miskitu and SumuMayangnas IP
SRH Policies
“Here we have different
cultures, so we expect that
services to be provided
according to ones culture,
the one of each community.
We are people of many
cultures. Services need to be
adapted for the people, so it
would be good to dialogue
with the communities and
see how they want to be
attended, if with traditional
medicine or the other. Both
the traditional medicine and
the other, should work
together” (Miskitu Woman)
Why
Culturally
Appropiate?
Implementation of the Culturally Appropriate
Safe Motherhood Model within the RAAN
Intercultural Health Model of Attention
S
i
s
t
e
m
a
ti
z
a
ti
o
n
MOH Serv.
Providers:
•Rehabilitation +
equipping of units
•Antenatal + Birth
Attention Guidelines
•Training
• Supervision
capacity building
TBA
•Equipment
•Training
manual
•Training
•Follow up
with MOH
Health Service
Managers:
•Information
system + referral
system
•Communication
strategy and
campaign
CHC:
•Equipment x
role
•Training
manual
•Training
•Follow up with
MOH
Capacity
building MOH
+ Health
Secretariat to
manage +
replicate model
Improved Services at Health Units
Training Manuals
IMPACT ON DAILY PRACTICE
Evolution of TBA role
TBAs are important members of the
community, and were the first choice
for providing birth assistance, with a
high level of community trust.
TBAs are formally recognized members
of the culturally appropriate safe
motherhood model, alongside the
health services providers.
“In the past in the communities we feared
being assisted by the TBAs, but we also
Training TBAs to recognize danger
signs in pregnant women reduces the feared being attended at the hospital.
Now this fear does not exist anymore.”
first delay – in seeking skilled help –
which leads to maternal morbidity and Erbalina Masis
mortality.
Lessons Learned- Process
Design and implementation of appropriate model of attention:
• Organization of the community
• Research on cultural practices, Cosmo-vision
• Participatory design process (consultations/ validation): community (CHC),
authorities at all level, other organizations, service providers, woman and
men
• Consensus between beneficiaries, authorities, specialist: Role and
responsibilities, human resources and equipment needs, training needs,
working guidelines, information needs for monitoring and evaluation
• Approval for implementation
• Communication strategy and campaigns
• Rehabilitation facilities, equipping, training, supervision, monitoring (data
collection)
• Systematization of process (adjustments, sharing and replication) all along
Lessons Learned – People
Facilitators:
• Personal Identity, open, free of prejudices towards other
ethnic groups
• Language
• Understand and respect IP traditional practices
• Experience working with communities
• Staff with health profile or experience working health field
• Address health with a rights based approach
• Gain community trust, respect their life cycle (rest day,
farming)
Health Poverty
Action’s Mothers on
the Margins campaign,
launched in June,
highlights the right
to maternal health of
women from
indigenous
communities and
other cultural
minorities in the
developing world.
Mothers on the Margins
Objectives:
• Raising awareness of indigenous women’s maternal health
inequities.
• Highlighting innovative solutions in partnership with
communities themselves.
• Securing commitments from governments, international
community and developing country governments on
specific policy areas.
Mothers on the Margins
What we are asking for:
• Culturally appropriate, accessible maternal health services,
free from prejudice and discrimination.
• A voice for indigenous mothers to participate and make
decisions about their own health and wider development
outcomes.
• Progress against poverty and poor health to be tracked by
breaking down data into ethnic groups.
Mothers on the Margins
Why and why now now?
• International and UK focus on maternal health.
• MDG to reduce maternal mortality by three-quarters is
the most off track.
• Equity being highlighted as a major gap in the MDGs – they
lack a focus on the poorest and hardest to reach –
including indigenous women.
Achievements so far include:
• Issue raised in UN MDG Summit & is now a part of Global
Strategy on MCH.