“The Green Militias” – encouraging mothers for skilled delivery

In Ethiopia, skilled delivery is still too low compared to pregnant mothers expected to deliver in health facility assisted by skilled birth attendant.  This phenomenon greatly affects the maternal and child health situation. 

In connection to this, World Vision Ethiopia (WVE) designed a new approach, the Health Green Militias approach, at Dembia District in North Gonder Zone of the Amhara Region in 2013. Health Green Militia is an innovative idea which is community empowerment model to care for others and develop positive health behaviour.

To this end, WVE organized training for 32 nominated ladies (Health Green Militias) from the District on the full package of health and nutrition of skill delivery, environmental sanitation and personal hygiene.  The training was given in collaboration with Gondar University and the Woreda Health Bureau.

The Health Green Militias includes active key influential mothers like: positively deviated mothers, respected traditional birth attendants and others who can be a model in their community or who are known to be innovators and early adopters.

The women, with their green uniforms, go house-to-house and attend social gatherings and events to identify pregnant women and teach them the importance of skilled delivery as well as other issues such as nutrition and hygiene.

Next, they send the mothers to health institutions for Ante Natal Care (ANC) and follow them until delivery at their health institutions, and then they will bring them back to their home and celebrate in the presence of the entire Green Militias.

Also, they have a role in creating Open Defecation Free environment.  In this regard, they mobilize the community to construct communal latrine by local material and follow the sustainability of the latrine.

These groups have their own leaders and cashier.  They hold regular weekly meetings whereby they exchange information with each other on how many pregnant mothers are there in their Kebeles and how many of them are following ANC, child health, nutrition, hygiene and sanitation status in their area.

Additionally, the groups are also recognized and authorized by local administrators (Kebele administrators) to punish their members when traditional birth attendants attended delivery at home. This punishment is both in monetary terms (500 birr/nearly $25) and three months imprisonment.

The Green Militias are already impacting skilled delivery at health centers. In the past, on average each quarter, only three mothers gave birth with a skilled attendant present in this area.  Between the start of the Green Militia Programme in November 2013 and July 2014, however, 351 mothers gave birth in health centers.  According to the District and Regional Health Bureaus, as a result of these women’s efforts a number of Kebeles declared as Home Delivery and Open Defecation Free Kebeles.