USF team applies lessons learned from Senegal health care project

Can helping women of a small, poor African country with a high illiteracy rate also benefit others beyond its borders?

Researchers at USF’s College of Public Health (COPH) believe so and their work in Senegal last summer has both local and international implications. USF has collaborated with the government of Senegal in a project called Bajenu Gox to improve maternal and child health through essential services and raising awareness about issues such as vaccination and birth spacing.

“We have an ethical duty to engage in global citizenship by helping others who need it, regardless of national borders or identity,’’ said Dr. Richard Powis, assistant professor of maternal and child health in the Department of Community Health Sciences. “Bajenu Gox is a model of social mobilization that I want to learn from and then take those lessons to help my own community here in the United States.’’

Bajenu Gox is a Wolof-language term that translates to “neighborhood godmothers,’’ respected women who share their knowledge in their community. Since the project began in 2009 in Senegal's 14 regions, it has grown into a team of 8,600 volunteers who are trained in reproductive and child health.

They act as intermediaries between the country’s health system and its population of 18 million people − half of whom are female – with a goal of reducing infant, neonatal and maternal mortality and to educate women about all aspects of health care.

“The state provides some resources, but the Bajen people themselves are the engine of it all,’’ Powis said.

That “engine’’ is making a difference. Since the project’s inception, mortality rates have declined through a combination of factors. More pregnant women are going to their prenatal screenings, preparing for hospital births and delivering newborns in clean health facilities. These steps contribute to the steep decline in mortality, according to the Senegalese Ministry of Health.

In 2023, that organization asked Powis to conduct an evaluation on the program in both an urban and rural environment. He looked at maternal and child health metrics, mortalities, childhood diseases, nutrition, and growth and stunting. Powis brings significant knowledge to the project in his specialty of global health, political economy of health and feminist perspectives on family health. His most recent work follows another Senegal project summarized in the scholarly article “Making Sure She Eats Right: Absent-Presence, Articulation, and Surveillance-Care in Senegalese Men's Maternal Support,” which appeared in the journal Medical Anthropology. 

“Educating women about their own health and that of their children is intended to empower their decision-making,’’ he said. “But the purpose of Bajenu Gox is also about connecting women and families directly to health services and resources and to each other, and to familiarize them with the state-run health system.’’

If such a community-based health effort can work in a west African nation, its lessons can be applied most anywhere, said Kanur Raïssa Minkilane, Powis’ research collaborator in Senegal.

“For me, the impact goes far beyond Senegal,’’ she said. “Working closely with women in small rural or urban communities teaches us what real public health looks like when resources are limited and when people rely on trust, solidarity and local leadership. These lessons stay with you. They shape the way you think about health, equity and community care − no matter where you are in the world.’’

Bajenu Gox is based on a number of key points:

• Home visits: The volunteers go directly to women’s homes, where they build trust.
• Community discussions: Public gatherings address topics related to reproductive health, maternity, nutrition or protection of young girls.
• Support for difficult cases: Volunteers mobilize resources or their personal networks to assist women in critical situations, especially when formal structures cannot intervene immediately.
• Vaccination and nutrition campaigns: Women and girls are encouraged to be vaccinated and taught the importance of healthful eating.
• Social mobilization: Despite the program’s institutional origins, its success relies almost entirely on community engagement.
• Basic human rights: By supporting access to health information and care, volunteers empower women to make informed decisions about their lives.

“If we take a reproductive justice approach, it absolutely is about human rights,’’ Powis said. “Reproductive justice is premised on the right to choose to have children, the right to choose to not to have children, and the right to parent in a safe environment. Bajenu Gox is fully committed to all three of these rights.’’ 

Minkilane cites the need around the world to strengthen awareness among women regarding reproductive and child health and to keep maternal and neonatal mortality rates as low as possible. To achieve this, each new generation of mothers and adolescent girls require guidance, information and support.

“By documenting the work of the Bajenu Gox and understanding how they manage to support women despite so many challenges, we create knowledge that can inspire other communities globally,’’ she said. “Whether it’s in another African country or even underserved neighborhoods in the United States, people everywhere can learn from these models of resilience, creativity and grassroots health leadership. The value is universal.’’

In addition, the program gives USF a stronger global perspective on the health of women and their children while providing insight into different models of community engagement.

“It strengthens the international mission of the USF College of Public Health while offering students and researchers comparative expertise that indirectly benefits the United States,’’ Minkilane said. “What motivates me the most is seeing how research can highlight the work of these women and strengthen local initiatives that are truly transforming lives.’’