Advocating for better health in Liberia

Her voice sounds just like a jazz vocalist’s should: low, melodic, and unhurried. She is Miatta Fahnbulleh and she is one of Liberia’s best-known entertainers. She is also the goodwill ambassador for Liberia’s Ministry of Health and Social Welfare, a post to which she was appointed last year.

“My entertainment background has helped. But I also have an NGO that serves girls and women and a weekly radio show that deals with those same issues. I think that also influenced my selection as goodwill ambassador. They thought, ‘yes, Miatta can go out there and talk to the people, she’s pretty convincing. And I think I am,” says Miatta.

A large part of Miatta’s role as goodwill ambassador is to travel throughout the country talking to communities about health issues affecting women and children. The JSI-implemented Rebuilding Basic Health Services (RBHS) project recently engaged Miatta in its effort to increase the number of women giving birth in health facilities instead of at home.

RBHS is funded by USAID to support Liberia’s Ministry of Health and Social Welfare in rebuilding the country’s health system, which includes increasing people’s use of available health services.

Miatta attended an advocacy meeting with a rural community in northern Liberia with RBHS. “For me, the meeting was fantastic. The way the advocacy meetings are set up, we get there and present the dangers of not giving birth in a health facility in simple English. We present the challenges and how we, from the Ministry of Health and our NGO partners, are trying to handle those challenges. And then we have a discussion with the community and chiefs, etc. about ways they can help us. Because they know. And they’ve really gotten into. They’ve even made some recommendations that I was a little anxious about, you know, some very draconian measures they want to take,” laughs Miatta.

When asked to explain, Miatta says, “For example, we’re trying to get women to have their babies in health facilities. That way we’re certain we cut down the number of deaths due to delivering babies in their homes just assisted by a traditional midwife. Because in the event of an emergency, whatever happens, the midwives don’t have the capacity to deal with it.
So in the community we visited, if you have a woman in labor and you are a traditional midwife, you are to escort her to a health facility, where we know that there is a 60-70% chance that the woman will be okay. And usually that traditional midwife can participate and help care for that woman while she’s there.

“But woe unto you if you allow her to have the baby at home! If you are a trained traditional midwife, your license will be revoked, yes! Your license will be revoked! This is the community deciding that.

“And in the event where there is a death of the mother of the child, the community will report it to the court for prosecution. I was saying, ‘oh no!’ But, yes, the community decided that. And also the husbands will be fined if they do not allow their wives to give birth at a health facility. So then you realize, oh my goodness, they are taking it seriously, because we present the dangers in such a way that they have to.”

Advocacy with recognizable and inspiring leaders like Miatta Fahnbulleh is a key component of RBHS’s efforts to increase the percentage of women who give birth in health facilities. Since 2009, when the project started, this number has increased from 29% to more than 60%.

When asked what she thinks is most effective about her advocacy efforts, Miatta says, “I just come from a very realistic and human place. I allow the bureaucrats to come up with the statistics for maternal mortality. But then I just say, ‘Hey, if your wife or daughter goes off to have a baby and doesn’t come back, we know the repercussions. It’s like taking a snake and cutting off its head – that’s what a mother is.’

“I give it back to them in that basic language. And this mother already has three children, so what happens to her children? Who looks after them? Who nurtures them? Who cares for them? And we know in our society, once that happens, the children are always divided, separated from their homes. And we’re going to have children, years down the road, you know, who are dysfunctional, traumatized. Yes, I put it to them like that, because that is how I see maternal mortality. You know, we can call up the numbers forever and call up the statistics. But at the end of the day, they are human lives that are affected. Forever, forever.”