Soul Fathers as Health Educators: A Pilot Project to Improve ANC and PMTCT Uptake in Gondar, Ethiopia

Background: High rates of vertical transmission and maternal mortality reflect the poor state of women’s health in Ethiopia. In 2011 only one in three women (34%) received antenatal care (ANC). Only in ten (10%) delivered with a skilled attendant. Faith-based interventions are culturally appropriate methods of engaging hard-to-reach populations, particularly in Northern Ethiopia where priests outnumber doctors 250 to 1. This project aimed to increase ANC and PMTCT uptake by integrating religious leaders into Gondar’s health care delivery system.

Methodology: The North Gondar Diocese selected eight religious leaders who we trained to refer their constituents for HIV, ANC, and assisted birth services in July and August 2013. Project participants distributed referral cards used to track women attending care as a result of this intervention. We conducted key informant interviews to evaluate the projects’s effects on care-seeking behavior.

Results: ANC use increased by 20% compared to the same time period in the previous year. Qualitative analysis corroborated these findings, suggesting religious leaders’ outreach broke down typical barriers to ANC access and increased understanding of the importance and availability of ANC services. Key informant interviews reflected changed attitudes among community members regarding HIV stigma and the importance of ANC access.

Conclusion: This project is positioned to address limited knowledge, low partner involvement, fear, and past negative experiences. Because qualitative data reflect HIV as a moral issue, incorporating spirituality and compassion into outreach may be a cost-effective method of drawing hard-to-reach populations into antenatal care and ultimately improving health outcomes.