How Art Can Revitalize Communities to Improve Access to Quality Sexual and Reproductive Health Services
Last spring, I met an art therapist. The same week, I had been offered a placement for a Global Health Corps fellowship, but I was conflicted. With a degree in International Studies and a passion for the arts, I wasn’t sure if the position would allow me to integrate the two fields. One day, I reached out to the art therapist, who is also an artist herself, for advice. Seated around a small table with piping hot cups of tea in our hands inside of the Frida Kahlo themed Calabash Teahouse in D.C., I asked her a question that would change the way I viewed compassion and care:
“How does art heal and empower communities?”
She answered, “Art alone cannot heal and empower communities. In the field that you want to go into, there is so much compassion fatigue due to poor self care. But being intentional in art making can change that...and that is what I hope you will translate into real life.”
Flash forward to a couple months later. I was seated at an end of project dissemination meeting in Lusaka, and I saw how intentional art making could be translated into reality, even at an organization focused on sexual and reproductive health.
A group of community members from Masaiti and Mpongwe Districts of the Copperbelt Province in Zambia, many of whom I had met before, were present in the meeting to share their stories, best practices, and recommendations. In the last presentation, they shared that when asked if they would participate in community construction and painting workshops for the development of One Stop Service sites in their communities, they were confused. Usually, when new health facilities were built and initiatives were launched, everything was pretty much facilitated solely by outside professionals and foreign experts. As a result, once program implementation was done, facilities were always shorthanded for maintenance, funds were not available to sustain the efforts of community volunteers, and communities faced challenges transferring skills learned from some projects to others.
To address these challenges, Planned Parenthood Association of Zambia (PPAZ), with help from the Japanese Organization for International Cooperation in Family Planning (JOICFP) and architect Mikiko Endo from Mother Architecture, developed a method of involving community members from the onset of program implementation. Through the Maternal, Newborn and Child Health One Stop Service Project 2015–2017, PPAZ worked towards the goal of expanding efforts to provide comprehensive sexual and reproductive care for women and raise awareness among youth on adolescent-friendly health services. Through the construction of One Stop Service sites — which include a maternity ward, maternity waiting house, youth center, residence for midwives, and a water tank — access to skilled health service providers, youth-friendly spaces, and health services were greatly expanded to those living in rural areas.
The first One Stop Service site was built in Mutaba in October 2016. Together with Safe Motherhood Action Groups (SMAGs), local steering committees, and health staff, construction plans were co-created and painting workshops were soon underway. SMAGs from the previously constructed One Stop Service site in Mukolwe taught the newly-trained SMAGs and peer educators (PEs) in Mutaba how to design tailored messages to paint on the walls of maternity waiting houses and youth centers. Encouraging and teaching other community members in the local language, SMAGs and PEs led all of the participatory painting activities within their own neighborhoods.
Community members came up with many ideas of which messages they wanted to paint, and when the One Stop Service sites finally opened to the public, the painted messages functioned very well. For example, the illiterate were able to interpret the paintings, families were able to better discern which foods were healthier to feed their newborn babies, and adolescents were able to use youth centers for various health sessions and recreational activities.
These messages helped SMAGs and PEs share knowledge and information about maternal, newborn, and child health regarding the importance of antenatal care, postnatal care, and facility delivery. Community volunteers took pride in the work and felt a strong sense of ownership and responsibility for these spaces, as they were critical in developing and promoting the use of the One Stop Service center.
Soon after, the construction of two more One Stop Service sites in Kalweo and Mikata commenced in 2016 and 2017, respectively. Without any assistance from the external partners, the communities were involved in constructing, painting, and promoting use of these spaces from start to end of the project. Over the course of three years, three One Stop Service Sites were established as hubs for quality information and services and helped improve the quality of sexual and reproductive health services in rural communities that may have otherwise been neglected. By decentralizing a lot of the health promotion activities from the District Health Offices to trained community members, the project strengthened the community network to continuum of care.
Alice Sinyinza, one of the PPAZ project officers, presented on findings from the qualitative research conducted at project endline. When asked whether they felt empowered through the painting workshops, community members responded by saying:
“I became aware that painting is useful to educate people who cannot read.”
“I gained confidence to overcome difficulties.”
“I realized that we can achieve the goal when we work hard together.”
“The project has involved the participation of the community, making sure that we are aware that the project belongs to us.”
“The picture of a happy, pregnant woman will keep us going.”
Also in the qualitative study led by PPAZ, when asked how the maternity waiting houses and youth centers were different from the other facilities made by external contractors, community members shared that they felt:
- A sense of ownership
- The need to guard and protect the One Stop Service sites
- The full responsibility to sustain the activities within these spaces
- A commitment to protect the wellbeing of future generations
- Pregnancy is no longer solely a “women’s business”
To sustain the health educational activities involving SMAGs and youth PEs, the local steering committees — comprised of health service providers, community leaders, traditional leaders, teachers, SMAGs, and PEs — formulated a community action plan. One of these plans included income generating activities such as goat rearing and vegetable cultivation to secure the costs of maintaining the One Stop Service centers. To this day, community members are the first to clean and take care of these properties and they even orient pregnant women on how to use the facilities so that they can have safe deliveries.
On November 7, 2017, a dissemination meeting was organized to discuss key findings, best practices, and recommendations from the project to hand over to the Zambian government. It was found that the ratio of women giving birth in health facilities in the project sites has increased from 48 percent at project baseline to 94 percent at project endline. In addition, since project inception, the proportion of pregnant women returning for four antenatal care visits has since doubled and postnatal care access has increased from about 60 to 91 percent. There was also a noticeable increase in the usage of sexual and reproductive health services, such as family planning and HIV testing and counselling; this could be attributed to women’s increased knowledge of and high levels of satisfaction with the services they were receiving. The community mobilization efforts of SMAGs and PEs in Masaiti and Mpongwe Districts helped 900,000 residents obtain knowledge and information about maternal, newborn, and child health, as well as adolescent sexual and reproductive health.
Since the project was so successful, PPAZ is working with JOICFP again on a new project called the Promotion of Women’s Health throughout the Life Cycle at One Stop Service Site in Zambia. This project will further expand access to quality health services and scale up community-based health promotion activities in select communities within Masaiti and Lufuwanyama Districts.
Overall, following the district hospital, the One Stop Service site has become a model center for health promotion in the community. The project shows how community mobilization and outreach through participatory means like art, can enable increased reach in terms of service provision through the creation of synergy. The One Stop Service model has shown that increasing availability and accessibility of integrated reproductive health services into community-led, maternal, newborn, and child health initiatives, help reduce the spread of HIV/AIDS and sexually transmitted infections, teenage pregnancy, sexual debut, child marriages, and maternal mortality. Even after the project completion, the One Stop Service model is sustained by the District Health Offices to oversee health promotion activities on an ongoing basis, regularly monitoring and supervising SMAGs, peer educators, and local steering committees in each of the sites.
Activities such as painting have empowered communities in Masaiti and Mpongwe Districts to take ownership of facilities and programs to which they had previously not contributed. Through the project, community health volunteers, such as SMAGs and PEs, became artists in their own way, creating spaces to teach and learn from, and honing in new capacities to build a movement towards greater access to sexual and reproductive health information and services. This transition from increased knowledge to increased self-efficacy of communities to promote use of family planning services is an important link in public health that ought to be sustained.
Nancy Chong is a 2017–2018 Global Health Corps fellow at Planned Parenthood Association of Zambia (PPAZ). All GHC fellows, partners, and supporters are united in a common belief: health is a human right. If you want to get involved, check out these great opportunities to join the health equity movement and consider joining us as a fellow or partner when applications open later this year! Connect with us on Twitter / Instagram / Facebook
