SAHAN was the demand creation component of FCDO’s Somali Health and Nutrition Programme (SHINE). SAHAN was the first large-scale, dedicated demand-creation for health programme in Somalia. Unlike typical development projects with pre-determined activities and interventions, this programme aimed to first gain a deeper understanding of the primary target audience and the influential human actors surrounding her. The overarching programme approach used an evidence-based, participatory design to better understand the persistent barriers to uptake of health services and healthy seeking behaviour and develop and test innovations in demand creation that target the external factors in a person’s life that influence individual behaviour. The aim of the programme was to develop and pilot a set of interventions, which, when scaled, would have the potential to improve health service uptake and promote healthy behaviours of Somali women and children under five.
The Birth Preparedness Class is one of the interventions developed under SAHAN. In this intervention, a series of classes/sessions at health facilities were established to educate pregnant women, familiarise them with the facility and reduce fear; with the objective of increasing antenatal and delivery care uptake. During the pilot period, more than 50% increase in antenatal care attendance and 10% increase in facility delivery was achieved. The unpredictable timing of the latter meant it was heavily affected by distance and availability of transport. There also remained issues with lack of 24-hour maternity services at many facilities.