Boston University



HEW 1Birth NotificationQ. 1.1 First, I want to ask a few questions regarding your job as a Health Extension Worker (HEW). Can you tell me how long you’ve been working as a HEW in this community?A. “I am among the first woman who was given the training. I have been serving since 2005gc. It’s been seven years.”Q. What do you do that specifically relates to maternal and newborn health?A. “We were mainly giving vaccinations before because we didn’t take the other trainings. And we gave antenatal care services. But nowadays, after we took the training, we’re protecting the mothers by advising them about HIV. Now we are trying to deliver babies free of HIV. We also give medical services for kids of less than five years old. We are also trying our best to give treatment for children less than 2 years old. We refer them only if their condition is beyond our capacity.”Q. How do you identify newly pregnant women?A. “From the reports of the Voluntary Community Health Workers (VCHWs). We identify other new pregnant women who are not recognized by the VCHWs when we are doing other door to door services. If I am the one who identifies the pregnant woman, I will take her name and address and I will give it to the VCHW and the VCHW will visit her and advise her after I notify her. Then the VCHW will bring the report back to me. In addition to that, I will also visit her. Most of the time, when we do door to door visits, we take important materials to them. We check blood pressure and record it on the form. I will attach my visit reports to the VCHW’s reports. Some pregnant women come to report to us about their pregnancy on their own. They come to us when their menstruation stops, and they want to know why. After they come to visit us at the health post, we will start giving them follow up visits. But if they want to know whether they are pregnant or not right away, we will do a urine test for pregnancy. We do this only if their stomach is not big. After we confirm that the woman is pregnant, we will tell her to come four times for follow up checkups before delivery.”Q. What about after delivery?A. “The VCHW will give her the important service immediately after delivery. Then she will notify us after that. But before delivery, on the eighth month of pregnancy, the VCHW will tell the pregnant woman to call her when her contractions start. So if the VCHW was notified when the woman’s contractions start, she will tell us as soon as possible. But if the VCHW finds out about the delivery after birth, she will send me the report as soon as she can. We will visit the woman after we receive the report. And we will tell this woman that we will be coming back three days after she gave birth. Then we will visit her on the third day after she gave birth. We will attach the VCHW’s report and our report together and put it at the health post. Then we will give her a vaccination on the 45th day after birth.”Q. 1.2 How do you hear about deliveries within the community?A. “VCHWs are the ones who notify us. Those mothers who live close to us will send someone to tell us. They will send someone to call us when the pregnant woman is in labor. Because ritually, we do not deliver babies at the health post, we will go to their home to deliver the baby. If we are not the one who delivers the baby, it is most probably the VCHW who did.”Q. How soon after deliveries do you hear?A. “I might hear immediately after the baby is born, maybe after five hours, or on the next day.”Q. Who notifies you?A. “The VCHWs.”Q. When was the most recent delivery you heard of? Who notified you?A. “I heard a week before. The VCHW was the one who notified me.”Q. 1.3 In the past three months, how many post natal care visits did you attend?A. “I visited about ten mothers. For those mothers whom I heard about immediately after the birth, I visited them in their home. For those mothers whom I didn’t hear about immediately, I visited them, but not right away.”Q. Who notified you about the most recent delivery?A. “The VCHW notified me immediately when the woman gave birth. She gave me the report on the second day after the woman gave birth. I went to visit this woman on the third day after she gave birth.”Q. Why didn’t you go on the day you were notified?A. “When the VCHW brought the report to the health post, she put the report under the door. My last visit was last week on July 11th.”Q. 1.4 In your experience, what are the main challenges in making early delivery or post natal care visits?A. “We mostly do not spend our time at the health post. We only open the health post twice a week, Wednesdays and Fridays. On the other days we open the health post from 8:00am until 10:00am and then we will leave. Because the people in the community know about our program, they come to the health post on Wednesdays and Fridays. Most people come to the health post to give us reports about recent deliveries, for TB, and for some other things. Otherwise, they won’t come to the health post. We have such problems because of this. Both of us should leave the health post to do door to door services. If one of us stays at the health post and one of us leaves, we will not fully cover all the services we need to give to the people in the village. If we have to give services separately, we have to serve separate kebeles individually. This is a problem for us because the other HEW who is working with me is new. So we have to go to give services together. That’s why we can’t be at the health post all the time.”Q. What can you do to solve this problem?A. “The new HEW is now getting to know the village. From now on, we might serve separately. One of us can stay at the health post, while one of us goes and serves the people in the kebele. But we didn’t start doing that yet. This is our plan for the future.” ................
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