Creative Solutions Address Skilled Births: Rethinking Skilled Delivery Approaches

Creative Solutions Address Skilled Births: Rethinking Skilled Delivery Approaches

All key indicators for SHTP II improve from FY10 to FY11: Diphtheria, Pertussis, Tetanus, third dose (DPT3); Intermittent Preventive Therapy, second dose (IPT2); first and fourth antenatal care visits (ANC1, ANC4); skilled birth attendant (SBA) deliveries; and family planning (FP) visits.


All project health indicators for the second phase of the USAID-funded Sudan Health Transformation Project (SHTP II), led by Management Sciences for Health (MSH) in partnership with the International Rescue Committee, have shown improved performance over the past two years.

On the ground, this means that more people are being immunized against diseases, communities are receiving education on HIV, and lives are being improved.

While other indicators improved by leaps and bounds, one indicator consistently lagged during the first year of the project: births attended by a skilled health professional.

Currently in South Sudan, more than 85 percent of women deliver alone or with an untrained attendant. Skilled attended deliveries are crucial; they provide the mother with a health worker who is trained to perform basic emergency interventions if complications arise, as well as recognize if further referral is needed.

Increasing the number of women delivering with a skilled attendant is a critical step towards lowering maternal mortality in South Sudan -- the country with the greatest maternal mortality burden in the world (2,054 deaths per 100,000 live births).

However, changing behaviors surrounding one of the most fundamental experiences of human beings is challenging. Cultural, logistical, and social barriers are daunting to overcome, and the country’s qualified health workers are sparsely dispersed.

Unique approaches increase skilled delivery

Several partners, recognizing the need of an infusion of innovative thinking, used the Leadership Development Program (LDP) to address this challenge. The Leadership Development Program encourages teams to work together to solve problems. The teams learn to see problems as challenges that can be solved by tackling the barriers step by step.

In Panyijar County, the LDP team (mobilized in March) set a target to increase skilled attended births from 5 to 15 a month over six months.

To achieve this target, they began working closely with local traditional birth attendants (TBAs) to do outreach and education in the communities. Traditional birth attendants are offered two bars of soap and two packets of salt for each week of conducting home visits to pregnant mothers. The attendants are encouraged to accompany women to health facilities where mothers can receive skilled care delivery. For each woman she accompanies, the traditional birth attendant is provided an extra bar of soap. In addition to this, USAID also supports a midwife in the county. Midwives provide education to both staff and community.

From the first quarter to the third quarter, skilled attended births in Panyijar County increased from 4 to 55 per quarter — an increase of 1300 percent in just six months!

Results from three counties utilizing the Leadership Development Program to address skilled births over six months. (South Sudan)


Similar efforts in Aweil South and Tonj South have seen increases in skilled attended births. Aweil South also offers incentives to traditional birth attendants and provides a vital mentoring system from midwives to Maternal and Child Health Workers (MCHWs) and traditional birth attendants. From the first to third quarter, skilled attended deliveries in Aweil South jumped from 3 to 79 per quarter.

In Tonj South USAID instituted a similar incentive program, as well as hiring two midwives. From the second to third quarter, births supported by SHTP II skilled attendants in Tonj South increased from 3 to 36.

Births supported by a skilled attendant increased in all three counties within a few months.

The Leadership Development Program is an important tool for brainstorming creative solutions to particularly difficult challenges. The improved rates of skilled attended births in South Sudan show that the Leadership Development Program can be applied to make public health goals a reality.

Erin Polich is a communications consultant with the SHTP II project and is working in South Sudan. Erin is a graduate of Boston University’s School of Public Health.