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Health Visits at Home Educate Jordanian Women
FrontLines - June 2009
AMMAN, Jordan—“The first
time I am a little nervous, but
the second visit they are actually
waiting for me!” says
Rasha Mashaella.
She is one of the 140
female community health educators
who go door to door in
towns and villages throughout
Jordan. They conduct home
health visits with women who
are among the most difficult to
reach and have the greatest
health needs. |
Dr. Rita Leavell, left, and a community health
educator prepare for a home visit in Jordan.
|
The health educators discuss
the benefits of modern
family planning methods, the
importance of early detection
of breast and cervical cancer,
and the best methods for selfbreast
examinations. They also
provide referrals for family
planning and care before and
after childbirth.
The home visits, aimed at
women ages 15 to 60, are the
foundation of USAID’s Private
Sector Project for Women’s
Health in Jordan, active in the
country since 2005.
The project’s director, Dr.
Rita Leavell, is a physician
with an MBA in marketing and
over 20 years of field experience.
“Interpersonal communication
is one of the keys to
positive behavior change,” she
said, “and we have found that
talking to another woman privately
helps in making that
final decision to take action.”
Since its inception, the program
has reached over
900,000 out of 1.1 million
women in the target age group.
Nearly 92,000 married women
of reproductive age have
accepted modern contraceptive
methods for the first time.
Although Jordan’s health
statistics show relatively good
numbers in some family health
categories, certain challenges
persist among Jordanian
women.
Total fertility in the country,
for example, has dropped dramatically
since 1983, from 6.6
births per woman to 3.6 in 2007.
Since 2002, however, contraceptive
use—particularly modern
methods—has stalled.
According to the
2007 Jordan
Population and
Family Health
Survey, 57 percent
of married
women practice
family planning,
but only 42 percent
use a modern
method—the IUD
is the most popular,
followed by
oral contraceptives
or “the pill.”
About 12 percent
of married
women of reproductive age have
been unable to access family
planning, with highest unmet
need among poor women with
little or no education. Unmet
need for family planning also
varies by governorate, ranging
from 9 percent in Zarqa, a city
about 12 miles northeast of
Amman, to 21 percent in the
southern Jordan city of Ma’an.
In addition, breast cancer is the
leading cancer and second cause
of death among women in Jordan.
This is primarily because of late
detection, leading to a high mortality
rate. If found earlier through
regular self-exam or clinical
exams, the mortality rate could
drop as much as 35 percent.
This is where women’s home
health visits come in. During the
first visit, the health worker
develops a registration card that
details the woman’s maternal
health and family planning information.
The health worker will
then educate the client on women’s
health issues, family planning
methods, and how to conduct
self-breast exams. If the
client has no health problems and
is completely satisfied with her
ongoing family planning method,
she will receive one additional
visit from the health worker.
Women who have health
problems, are pregnant, are
trying out a new family planning
method, or who have some difficulties
with their family planning
method of choice will
receive four to eight return
visits from the health worker.
The health worker will conduct
additional health assessments
and provide necessary health
education, support, and referrals
during these visits as necessary.
Home visits are conducted
every four to six weeks.
Referrals are made to all
types of clinics in the country—
both public and private.
Dr. Leavell says that “to be
effective, it is important that
outreach is tailored to the woman’s
needs and does not promote
only one health issue or
service point.” The data from
an extensive reporting system
document the success of the
approach, with over 50 percent
of women acting on referrals.
The project works through
NGOs, Circassian Charity
Association, and General Union
of Voluntary Societies to recruit
and train women to become
community health workers.
Those hired typically have a
secondary education or high
school diploma and live in the
communities where they work.
“The NGOs have been
great partners and are very
enthusiastic about outreach as
it improves health and also
employs women,” says Dr.
Leavell. “We are now upgrading
the data system to Webbased
servers and introducing
handheld computers for data
collection.”
The outreach and referrals
are part of a comprehensive
private sector program including
mass media messages and
continuing education for private
physicians.
★
FrontLines is published
by the Bureau for Legislative and Public Affairs
U.S. Agency for International Development
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Material should be submitted
by mail to Editor, FrontLines, USAID,
RRB, Suite 6.10, Washington, DC 20523-6100;
by FAX to 202-216-3035; or by e-mail to frontlines@usaid.gov
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