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Explore the challenges faced by poor marginalized women in accessing healthcare services. Learn about discrimination and demand generation for improved health outcomes. Recommendations include capacity building, surveillance, and improving provider sensitivity.
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Gender, Equity, Community Participation and Demand Generation
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!
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
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
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
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
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
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
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
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