Improving Service Accessibility for Least Advantaged Clients

1. NGO Service Delivery Program House NE (N), Road 88, Gulshan-2, Dhaka-1212 Improving Service Accessibility for Least Advantaged Clients

2. 35 NGOs • 61 districts • 85 municipalities • 6 city corporations • 317 Clinics • 8,302 Satellite Spots • 6,330 Depotholders • 1.7 million customer served/ month Basic Service Package Comprehensive FP & RH Services Child Health services TB in urban areas ANC and maternal health Limited Curative Care BCC activities Overview of NSDP

3. Study Objectives • To identify least advantaged clients (poorest of the poor) • To isolate and understand barriers they face in accessing services • To design ways to overcome barriers • To improve communication between the poor and NGO service providers

4. Methodology • Participatory Rural/Urban Appraisal applied with women • Social Mapping • Wealth Ranking • Venn Diagram • Meeting with Stakeholders • Study Coverage: • 8 NGOs • 24 Static Clinics • 826 Satellite Clinics spots

5. PRA Sessions and Participants • 390 stakeholder meetings and 694 PRA meetings conducted • 24,533 community members participated in PRA meetings • 6,556 stakeholders attended meetings expressing their commitment for serving poorest of the poor.

6. Rural Day laborers Depend on food collected door to door Cannot eat twice in a day No education Little income above expenditure Urban No land Begging Suffers from untreated diseases Works as house maid No work no food Who are poorest of the poor Poor community members identified context specific indicators in PRA session:

7. Services: Limited range of services inadequate number of satellite clinics and limited hours Information:Not informed about availability and types of services Poverty: High service charge and price of medicine No free treatment Barriers • Quality of service: • Diseases not cured • Incorrect treatment • Providers’ behavior: • Poor are neglected • Not allowed to speak • Proximity: • Distance of clinic • Clinic staff don't visit remote areas

8. Participatory appraisal (Urban and Rural) • Sharing of information/findings • Joint planning for reducing barriers • Partnership between providers and community Joint Planning Session

9. Strengthening Community Based Forums • Satellite clinic support group & static clinic advisory teams consist of community members and service providers • Very poor people are now involved in planning • Assigned tasks and follow up • 90,000 members are involved in these forums • SCSG/SCAT actively involved in planning & organizing satellite clinics.

10. Addressing financial barriers • Exemption policy for the very poor • Health benefit card • Pricing policy for able to pay customers • NSDP piloted incentive scheme in four NGOs • Fund diversification strategies adapted • Involving business for serving extremely poor people • 83 clinics of 13 NGOs generated Tk. 3,55,632 as community fund & using RDF profit for serving poor • Pharmaceutical companies are started to provide free medicine.

11. Percentage of Clients Who Are Poor

12. Some Changes • All concerned are highly sensitized and oriented to meet needs of the poor • NSDP incorporated the needs and expectations of the community in the work plan • Providers’ satisfaction enhanced because they are involved in planning process • Interpersonal communication strengthened • Service utilization increased by the poor • Pro-poor BCC strategy adapted.

13. Conclusion • NGOs learned the application of participatory techniques to integrate into their management. • SCSG/SCAT to be more active in promoting linkages with community groups and play advocacy role • NGOs need to focus on providers attitude towards poor in making service poor friendly • Continuous community feedback and consultation may help developing new strategic direction.

14. Thank You