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NARIPOKKHO APCRSH 29 October 2007 Hyderabad, India

Demanding Accountability of Health Services: Lessons learned from local level monitoring and advocacy. NARIPOKKHO APCRSH 29 October 2007 Hyderabad, India. About Naripokkho. A membership-based women’s activist organisation.

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NARIPOKKHO APCRSH 29 October 2007 Hyderabad, India

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  1. Demanding Accountability of Health Services: Lessons learned from local level monitoring and advocacy NARIPOKKHO APCRSH 29 October 2007 Hyderabad, India

  2. About Naripokkho • A membership-based women’s activist organisation. • Working for the advancement of women’s rights and entitlements and building resistance against violence, discrimination and injustice. • One of the thematic areas of Naripokkho’s work is women’s health and reproductive rights.

  3. Concerns • High Maternal Mortality – 3.8 per thousand live birth • High Maternal Morbidity • High Infant Mortality-54 per thousand live birth • Poor governance and implementation failures

  4. Problem Implementation and delivery failures in the health sector due to lack of Accountability, Transparency, Monitoring and Supervision Leading to undesirable outcomes: • Women’s access to health services low • Widespread corruption in the health sector • Quality of service lacking and not ensured

  5. Naripokkho’s Intervention Accountability project -Ensuring accountability of local health authority and service providers to people specially to women • Action research project supported by Royal Tropical Institute (KIT) Netherlands • September 2001 – March 2003 • Working area Pathorghata, Borguna WHRAP project-Women Health and Rights Advocacy Partnership A South Asian Partnership project coordinated by ARROW supported by DFPA • Advocacy project, from April 2003 • Working area- Greater Barisal division in four districts. • 12 Upazila Health Complexes, 4 District Hospitals, 3 MCWC & a Medical College Hospital is being monitored • 28 CBOs are working in partnership

  6. Average number of both male and female patients per month in Pathorghata UHC (Indoor +Outdoor) Showing gradual rise of patients in the facility

  7. Average number of female patients per month in Pathorghata UHC (Indoor+Outdoor) Steady rise of women patients in the facility

  8. Accountability Project Implementation Framework MOHFW National Member of Parliament Pourashava Local Health Authority International / Fora Union Parishad Local Journalists Teachers UHAC Media UHC NARIPOKKHO Sankalpa Trust

  9. WHRAP Project Implementation Framework MOHFW National International Fora Pourashava/ Union Parishad Local Health Authority Local Journalists Women Leader UHAC Media Village Doctor, Dai UHC NARIPOKKHO Sankalpa Trust CBO CBO CBO CBO CBO CBO WG WG WG WG WG WG WG WG WG WG WG WG

  10. Implementation Strategy • Replication of the accountability model • Capacity building of partner organisations (CBOs) • Regular monitoring of local level government facilities by local CBOs • Collection, compilation and analysis of facility based information • Need assessment of facilities especially on EmOC • Engaging different stakeholders, in and outside the government • Campaign, Lobbying and Advocacy

  11. EmOC Policy • First Aid EmOC to be available in every Union Family Welfare Centre • Basic EmOC to be available in every Upazila Health Complex • Comprehensive EmOC to be available in some Upazila Health Complexes, all Maternal and Child Welfare Centres, District Hospitals and Medical College Hospitals

  12. The Situation in Pathorghata Out of 7 Union FWCs in Pathorghata Upazila, none are providing delivery services or first aid emergency obstetric care though each facility has 1 to 2 trained FWVs and FWA. In each union 25-40 deliveries take place every month. Yet, the service could be easily made available by the FWVs with the help of the 2-3 trained TBAs available in every union if the co-operation is established.

  13. Findings • Pathorghata Health Complex has comprehensive EmOC center but for the last four years no caesarian section or blood transfusion has taken place. So the number of referred cases is very high. • In rural Bangladesh women prefer not to travel to facilities for delivery except in emergency. So they manage to come to the facilities at the eleventh hour. At that time if they are referred to another facility far away it invariably results in death or disability.

  14. Findings on Pathorghata CEmOC Age Category of Women who attended UHC (n= 284) Majority are young woman

  15. Education Status of Women (n= 284) Most of them have some education

  16. Distribution of the respondents by source of treatment received before coming to health complex (n=262) Treatment received Frequency Percent Village doctor 43 15.1 Dai 81 28.5 Kabiraz/ Baidyo/ Ojha/ Panipora 24 8.5 Nurse/ HW/ FWV 8 2.8 Pharmacy 12 4.2 NS 4 .4 Total 262 100.0 Primary providers are Dais and village doctors.

  17. 31 different types of emergency obstetric patients were received in Pathorghata EmOC

  18. Distribution of the respondents by general condition at departure General condition at departure FrequencyPercent Fully recovered 216 69.7 Not much improved 14 12.0 Referred 48 16.9 Dead 4 1.4 NS 21 5.1 Total 284 100.0 A large number of patients were referred due to unavailability of comprehensive EmOC services

  19. Name of the Union under Pathorghata No of Women Attended Percent Pathorghata Sadar 174 61.26 Charduani 22 7.75 Kal Megha 49 17.25 Kathal Tali 11 3.87 Nachnapara 02 0.7 Kakchira 01 0.35 Raihanpur 00 00 *From other Upazilas 25 8.80 284 100 Distribution of the respondents by receiving EOC services by distance of UHC/EOC at Pathorghata (n= 284) Most of the respondents were from the adjacent area.

  20. Lessons learned • Decentralization of power and authority can improve local service delivery especially the doctors’ recruitment, the provision of medical supplies and logistics are decentralized. • CBOs can play an important role in monitoring health services • Media and local government can contribute to improve services through regular observation ad reporting

  21. Lessons …….. • Participation in the process of demanding accountability can empower local communities especially women • In the absence of a specific monitoring body, other local bodies can play a critical role for ensuring accountability and solving problems locally,

  22. Lessons……. • Few anesthetists in the country and the uncoordinated posting of obstetricians and anesthetists renders EmOC facilities useless and so this problem should be addressed. • Comprehensive primary health care should be prioritised over vertical programs. That’s why unification of department of health and department of family planning is a must.

  23. Thanks

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