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Mittal Shah, Kent Ranson & Palak Joshi

Reaching the poorest: SEWA’s experience with reproductive health camps. Mittal Shah, Kent Ranson & Palak Joshi. SEWA. SEWA is a trade union of women workers in the informal economy Started in 1972 by Ela R. Bhatt Provides services in Ahmedabad City and 11 rural districts of Gujarat state

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Mittal Shah, Kent Ranson & Palak Joshi

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  1. Reaching the poorest: SEWA’s experience with reproductive health camps Mittal Shah, Kent Ranson & Palak Joshi

  2. SEWA • SEWA is a trade union of women workers in the informal economy • Started in 1972 by Ela R. Bhatt • Provides services in Ahmedabad City and 11 rural districts of Gujarat state • Main goals: economic security and self-reliance • Major activities: organizing, banking and micro-finance, insurance, capacity-building, health care • 2003 membership in Gujarat: 4,69,306

  3. SEWA Health • Delivering services since 1980 • Aims to serve the poorest • Current services delivered: • Preventive: health education and training, ante-natal care, immunization, occupational and mental health activities • Curative: low-cost medicines, TB treatment, mobile RCH care, traditional medicines

  4. SEWA’s RH camps • Since 1999 • Partnership with UNFPA • Targets women of reproductive age in Ahmedabad City and select villages in 5 rural districts • 2003: 7,041 women received treatment • 6 part-time physicians and 50 barefoot doctors and managers • Fees: Rs. 5 consultation fee, medicines sold at wholesale price

  5. Research Methodology Phase I Qualitative Phase II Quantitative Phase III Qualitative

  6. Research Methodology Phase I Qualitative Objectives: • Explore barriers to RH camp utilization • Identify indicators of socio-economic status (SES) Activities: • FGDs with RH camp users & non-users, including wealth-ranking • In-depth interviews with service providers & managers

  7. Research Methodology Objectives: • Assess SES among RH camp users versus non-users Activities: • Exit-survey • Questions about households assets, utilities, dwelling and land ownership • Randomly selected 1 camp (of max. 3) per day, and interviewed all users • 535 interviewed Compared to: • Gujarat population, DHS 1998-99 urban N = 1,709, rural N = 2,223 • Used wealth index, principal factors analysis Phase II Quantitative

  8. Research Methodology Objectives: • Validate findings of previous phases, with a focus on “Why did the service reach (or fail to reach) the poor?” Activities: • In-depth interviews with service providers Phase III Qualitative

  9. Findings: barriers to utilization Demand • High perceived cost • Low perceived quality • Fear of doctors/procedures • Weddings, funerals • Not empowered to make own decision Supply • Timing of camps • Cost • Exemption policy unclear • Limited continuity of care • Door-to-door promotion misses some

  10. Findings: perceived cost as a barrier to utilization Respondent 1: …If someone doesn’t have a good financial situation, they would not come at all! Respondent 2: They would think that, “What if they ask for more money in the camp? What would I do?” FGD with RH camp users and non-users

  11. Findings: camp timing as a barrier The poorest women would go out and do work for daily wages. They would say that “I will have to lose my wages to be able to attend the camp”. FGD with SEWA Health rural grassroots worker

  12. Findings: Top 5 indicators of SES (DHS, urban Gujarat, 1998-99)

  13. Findings: Top 5 indicators of SES (DHS, rural Gujarat, 1998-99)

  14. Findings: Percentage distribution of SEWA Health urban service users by SES quintile

  15. Findings: Concentration curve, SEWA Health urban services RH Camps

  16. Findings: Concentration curve, SEWA Health urban services RH Camps TB DOTS Women’s training

  17. Findings: Percentage distribution of SEWA Health rural service users by SES quintile

  18. Findings: Concentration curve, SEWA Health rural services RH Camps

  19. Findings: Concentration curve, SEWA Health rural services RH Camps Women’s training

  20. Policy implications: summary of findings • SEWA Health’s RH camps services more effective in reaching the urban (vs. rural) poor • 71% urban users from lowest 2 quintiles • 43% rural users from lowest 2 quintiles • RH camps slightly more successful in reaching the poor, among 3 services studied

  21. Why are SEWA Health’s RH camps successful in reaching the poor? • Mobile approach: delivered to the “doorstep” in high-density urban and remote rural areas • Service delivery by poor, local women • Combined with efforts to educate and mobilize (create demand in) the community • Trust in SEWA • Costs are low

  22. How can SEWA Health’s RH camps better reach the poor? • Change timings to better suit poor, working women (e.g. evening camps) • Modify fee-policy to reach poorest • Develop an objective system for granting, for example, all holders of “below-poverty line” cards • Collaborate with government facilities, so as to access free medicines and physicians • Address barriers faced by women • Involve men and senior Hh members in education • Encourage experience-sharing by women who have been cured

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