Bajenu Gox (a Wolof term for godmother) are respected local women, chosen to act as intermediaries between the community and the health system. Through home visits and community information sessions, more than 10,000 of these trained godmothers now support women during and after their pregnancy, and advise mothers on the care of infants and children.
On May 12, 2017, Senegalese President Macky Sall called to strengthen the country’s Bajenu Gox program to promote maternal and child health. This call was a renewal of the program launched in 2009 by his predecessor, Abdoulaye Wade, to tackle the country’s high maternal and child illness and death rates.
Working throughout the country, Bajenu Gox bring health information to isolated women. “We talk to them about going to the health centre and not giving birth at home, not missing the pre-natal check-ups, vaccinating their children, and using family planning to space births,” says Maimouma Seck, president of the Bajenu Gox association in the town of Kaolack.
Senegal’s government credits the Bajenu Gox for helping to reduce maternal and child deaths. With their help, maternal deaths fell from 410 to 315 per 100,000 between 2008 and 2015, while infant deaths fell from 59 to 50 per 1,000 during the same time period.
But, as Dr Boubacar Camara of Cheikh Anta Diop University and lead researcher of a project to strengthen the Bajenu Gox program explains, a number of weaknesses undermine the program’s success and its sustainability. Perhaps most important is the lack of incentives to motivate the workers. Bajenu Gox work as volunteers with few resources, and — until very recently — no official recognition.
“At some point they ran out of steam,” he says. “With no financial incentives, they worked when they could.” It doesn’t help that other programs run by nongovernmental organizations offer payment. Poor monitoring and inadequate reporting of their activities also hindered the program’s full acceptance by the country’s health system.
Providing new incentives
Supported by Canada’s Innovating for Maternal and Child Health in Africa initiative, the project to strengthen the Bajenu Gox program is led by the non-governmental organization Action et Développement in partnership with Cheikh Anta Diop University, Senegal’s Ministry of Health and Social Action, and the Institut national de santé publique du Québec. It is testing ways of addressing challenges such as the lack of financial incentives by anchoring the Bajenu Gox’s activities in a broader effort that would benefit the entire community.
“We thought that implementing a financial motivation system could encourage them to be more active,” says Camara. Providing the Bajenu Gox with an income and funds to pursue their work would contribute to the program’s sustainability, a government priority. It would also associate a form of remuneration to women’s care work that has traditionally gone unpaid.
Working in five communities, the project allocated funds for the women to launch small businesses. In one community, they chose to raise and sell small livestock. In another, they are launching a community shop. In the poor Nangan neighbourhood of Kaolack, women have chosen to process millet and corn. “In this way, they can continue to work,” says the neighbourhood leader Moustapha Guèye. “Processing millet into high quality products like flour and couscous is something useful because malnutrition is endemic in the district. The poor quality of available products is partly to blame.”
“This is the only project that has worked on social dynamics by implementing an income-generating activity to motivate Bajenu Gox’s sustainability,” says Cheikh Tidiane, Action et Développement coordinator, speaking at a May 2017 ceremony in Kaolack. As local Bajenu Gox received official badges and their association accepted funds for the project, Tidiane pointed out that the district prefect and the Kaolack mayor have also committed to supporting these social enterprises.
A multi-level tracking system
In its push to reduce maternal deaths to 70 per 100,000 births by 2030, the Senegalese government is now asking the Bajenu Gox to broaden their activities, including recording vital statistics like births and deaths. “We‘re asking them to take on new tasks,” says Camara, “but we haven’t been tracking what they are already doing. We’re not aware of their full impact.” The team recognized that their informal registers would need to be improved upon in order to accurately track Bajenu Gox activities.
The information tracking system proposed by the project is based on monthly planning meetings at the health centre, where participants identify the home visits that each Bajenu Gox is to make and the topics they will present in community information sessions. The Bajenu Gox also give an initialed ticket to each woman they refer to a health centre. These are tabulated at the end of the month, giving a clearer picture of each worker’s performance. Three of the five test sites have already implemented the new system.
The health centre coordinates its monthly plan with the district health committee and the research team presents its work every three months to a district working group formed of elected officials and representatives of local associations. To benefit from the lessons learned, the team also shares research findings with a national committee convened by the Ministry of Health.
By the project’s end in 2020, the research team aims to clearly identify sustainable ways to support the Bajenu Gox. The Ministry of Health has been closely involved in all aspects of the research. This close collaboration with Senegal’s health decision-making bodies bodes well for the project’s future and for the chances of being scaled-up nationally — ensuring that the Bajenu Gox initiative can benefit more of the country’s most vulnerable populations.
In Nangan, the goals are more modest. “We want more Bajenu Gox,” says Fatoumata Kanté, district deputy chief doctor. “There will never be enough.”