Venture Strategies is expanding our efforts in Nigeria. In 2009, we began implementation of a community-based project in Kaduna state in conjunction with the Bixby Center at UC Berkeley and Ahmadu Bello University in Zaria. The project engages traditional midwives and birth attendants to administer misoprostol for prevention of postpartum hemorrhage (PPH) and will provide empirical evidence to inform policy makers on community availability of misoprostol for home births. To date, sensitization of the participating communities was accomplished, trainings of providers in the facilities were completed, and traditional birth attendants (TBAs) have received specialized training on Home-based Life Saving Skills and misoprostol for PPH. It is encouraging that the program has received support from religious and community leaders and the local emir himself attended the beginning of the traditional birth attendants’ training.

In March, Venture Strategies and Bixby Center staff conducted a monitoring trip to the five project areas in Kaduna State where community-based delivery of misoprostol is underway under the direction of our local partner organization Ahmadu Bello University Teaching Hospital. Our staff witnessed true collaboration and a positive community response.  Overall, about 1500 community members have participated in 18 dialogues, exceeding project targets.  Importantly the male involvement piece has been integral in this largely Muslim area. The husbands are receiving messages about misoprostol for the prevention of postpartum hemorrhage and leave their name, address and wife’s due date; then midwives follow up and visit the pregnant mothers in their homes to distribute tablets.

Indeed, a clear strength of the project is the strong community involvement. Village chiefs are hosting regular monthly meetings in their homes for TBAs, patent medicine vendors (rural drug sellers), and community resource persons to further reinforce messages around misoprostol use for the prevention of postpartum hemorrhage.  During extensive community dialogues local project staff worked with women to create awareness of too much blood loss after delivery. A local rubber cup used for drinking water, popularly called a moda, was found to hold exactly 500 ml of water. This provided a clear visual representation for the community to understand when a woman had lost too much blood after delivery and was facing a life-threatening emergency.  Because the dialogues took place during the fasting period, funds allocated for lunch were used to sew hijabs, the garb that Muslim women wear over their clothing, head ties for Christian women and butas for the Muslim men. Each of these items had an inscription in Hausa that read “Take three tablets of misoprostol immediately after birth to prevent PPH.”