By Jessie Forsyth with Geromina Gouleau, Project Intern
In February, our project carried out a week-long training initiative focusing on the provision of gender-sensitive, humanized care, for 20 health workers and managers from the 7 new health facilities built by the project and their respective districts in Inhambane province. The training, held partly in a classroom in Maxixe and partly in the partner community of Inhapupo, Homoine, was organized by Argentina Munguambe, the project’s Training Coordinator, in collaboration with DPSI.
The term “humanization” is used in Mozambique to signify the process of transforming health worker attitudes and behaviours to result in more respectful, compassionate and responsive care. It represents a major priority in national health policy that is consistent with our project’s main objective of strengthening sexual, reproductive, maternal and newborn health through gender sensitive, humanized care and strong, supportive communities. Gender empowerment, humanization, and community engagement are all closely linked to the improvement of maternal health. Living in rural and isolated communities, women reached through this project have reported having limited decision-making power regarding their own lives.
Humanizing care practices helps open up discussion and deepen understanding of the social issues women face. When health workers become more aware of the challenges women deal with, they become more compassionate and respectful.
During the week-long session, various subjects were discussed including the improvement of prenatal care, the relationship between gender inequalities and maternal and neonatal mortality, and the humanized management of health centres according to government recommendations.
Community engagement and experiential learning
An important part of the session involved participants travelling to a nearby community, Inhapupo, for a day of mutual learning with members of the community health and youth committees. The group did an exercise using a fictionalized but realistic story of a young girl who was forced into an early marriage. The activity included an active listening exercise as part of the person-centered approach, followed by a role play of active listening in a professional context. During the role play, facilitators asked participants to act out a situation in a health centre where a client sought out a doctor or a nurse. Participants played the various roles of the health care provider, the client, and the people present at the health centre. When the client, a pregnant woman, arrived, she was stopped by a cleaner who told her to go home, saying that she still had time before seeing the doctor.
This example shows that a client can meet many people who interfere in her care before seeing the health care worker, emphasizing that barriers to care include not only the considerable logistical challenges (lack of transport, funds, roads, people to help care for children at home, etc.), but also the poor care and lack of listening or respect experienced at the health facility. During the last day of training, the group spent some time reflecting together and taking stock of the training. One participant talked about how “the experience in the community opened [her] eyes to many things [she] had been doing, without meaning to, that would discourage people from coming to the health centre.” The time spent learning together with community members had allowed that participant to see herself through community members’ eyes and reassess practices and behaviours from that perspective, thus opening up the possibility for transformation.
The importance of coordination and collaboration
Through the final debriefing, the importance emerged of strong coordination and respectful collaboration between the various health actors in order to ensure humanized care for clients. Indeed, considering how communities and health services are organized in the province of Inhambane, it seems essential that everyone who plays an important role can share a common discourse. The project work carried out with communities has an extremely positive impact since it brings together health professionals, community leaders, community members and community-based care providers including traditional healers and traditional birth attendants. They can then discuss the theme or problem together in order to find the most appropriate solutions but also learn from one other, enacting one of the project’s core principles of mutual learning. Improving overall coordination and respectful collaboration for humanized care, alongside meaningful experiential learning and sharing, will therefore strengthen maternal health.