Gender, Equity, Community Participation and Demand Generation

1. Gender, Equity, Community Participation and Demand Generation

2. Who are we concerned about? • The Poor • Women who are poor • Women who are from socially marginalised groups – SC/ST/Minorities • Women who are SC/ST/Minorties living in remote areas Not the average person!

3. What is the experience of such a person? • Ill informed about programmes and schemes • Poor autonomy and mobility • Keen on financial incentives due to poverty • Easy targets for programmes which have targets • Easily sidelined by the system / providers • Fear / earlier bad experience of institutions and service providers • Easy target for being cheated by multiple people including providers and babus

4. Equity DISCRIMINATION • Economic – Poor • Gender - Women • Social groups - SC / ST, Minorities , Urban Slum, • Geographic isolation - resident of inaccessible areas • Within service provider categories Hierarchical relations: • In the context service provision – provider - client • In the context of societal relationships – women – family/community • In the system – Managers – Doctors – ANM - ASHA

5. Community Participation • PRIs not involved/trained to health related issues • Lack of knowledge / awareness about schemes and entitlements especially among the marginalised • Poor/marginalised women have many adverse experiences from formal health systems – dissuades others in the community • On-paper VHSCs and RKS in most places • ASHA –still unclear about her key association – system or community • Providers have very low respect for marginalised esp. marginalised women – reflected in behaviour – poor quality of care/denial of services – adverse outcomes/experiences • Cannot be facilitated effectively by the health system

6. Key issues of concern • Experience of women during institutional delivery – dignity/quality/outcome • Capacity and empowerment and identity/ identification of ASHA • PRI / VHSC /RKS clarity of roles and empowerment • Health managers/providers sensitivity towards social marginalisation – and its impact on health services and outcomes • Current Indicators inadequate to pick up discrimination and QoC service provision to the marginalised – focus on numbers may promote coercion

7. Equity - Demand Generation – CP - Improved Health outcomes Appropriate /Quality services available with dignity +ve outcomes Demand Generation Adverse outcome / experience mgmt Entitlement Awareness Planning Monitoring Good Health Outcomes

8. Recommendations..1 Awareness and promotion – Move from BCC to Entitlement awareness Involve NGO/VOs in these activities Increase IPC ASHA Empowerment/Capacity building to be speeded up Clarify her linkage – community/VHSC or System PRI Capacity building / role in enforcing accountability Women’s Groups Link them up with VHSC/Community Monitoring( MS/SHG) Extend Community Monitoring – up to Dist / State from VHSC/RKS to State Planning and Monitoring Committee

9. Recommendations ..2 • Review existing data/information for service provision / outcomes by marginalisation • Move from Monitoring to Surveillance • Decentralised planning and fund allotment/ service delivery based on social mapping/ surveillance • Promote community based mechanisms for entitlement identification (JSY – BPLcard) • Formulate appropriate indicators including scale-based to identify equity in health seeking / service delivery/ health outcomes • Move beyond NSV for male participation

10. Recommendation …3 Training of Providers / Managers • Sensitivity / Consciousness towards equity • Incorporating soft issues within the quality of care framework Accountability and Grievance redressal mechanism – including VHSC/RKS –fact finding not fault finding( not provider focussed) - but focussed on the client/ community disadvantage / adverse outcome/experience Promote dialogue between Community and Health System – village upwards – Com Monitoring provides the forum / opportunity – upto state level

11. Thank you