Changing Behavior with Women, Girls, Boys, and Men: How Gender and SBC Connect_Angie...
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Transcript of Changing Behavior with Women, Girls, Boys, and Men: How Gender and SBC Connect_Angie...
MCHIP/Egypt: Community-based SBC and Gender Interventions for Maternal, Newborn and Child Health
Angie Brasington, Community Health and Social Change Advisor, MCHIP/Save the Children on behalf of MCHIP/Egypt team, especially:Dr. Issam El Adawi, Chief of PartySamah Said Helmy, Gender Advisor
MCHIP/Egypt Context
2-year funding to address high rates of malnutrition and newborn mortality
Atmosphere of political turmoil, rise in religious conservatism.
Unable to work with Ministry of Health (post revolution)
Deep experience working with local Community Development Associations (CDAs)
BUT, CDAs from the neediest places had limited experience, especially in MNCH-focused programming.
Start-up - November 2011Community-based Implementation starts – November 2012CB-implementation ends – Nov/Dec 2013Endline survey – Jan/Feb 2014
1 Umbrella CDA / District
5-10 Local CDAs / Umbrella CDA
12 CHWs / Local CDA (Total ~1,200 CHWs)
6 Governorates
12 Districts(2 per Governorate)
Egypt
120 Villages(1 Village /CDA = ~15-20,000 pop)
Target Population = 2,041,725Pregnant Women = 57,168
U2 = 112,295Newborn = 51,043
Maternal Nutrition and
Birth Preparedness
Newborn Health
Child Spacing
Infant and Young Child
Nutrition
MCHIP TechnicalSupport
SBC and referral by CDA-trained and
supported Female CHWs
Capacity Strengthening of CDAs
Technical Focus
Tran
sfor
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ve g
ende
r-fo
cuse
d st
rate
gies
Core Approach Geographic Coverage
CHWs provide IPC focused on the 1,000 day period.Home visits and group antenatal and birth preparation classes for all pregnant womenPP home-visits for counseling and referralCommunity GMP for 6- 23 month olds (bi-monthly), followed by nutrition-focused home visits and classes.Dialogue sessions with men and women on the influence of gender and social norms on key health practices – Family Solidarity Modules
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MCHIP’s key CB-MNCH Interventions
Family Solidarity - new & appealing
Sessions interwove popular media - Egyptian movies & songs, sayings and mottos that reflect culture
Critical incidents sparked reflection on local customs and discussion about connection between gender, human rights and health
Health messages and gender concepts interlinked social roles and health, including violence against girls and women.
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Hot Topics
Participants liked discussing:Islam and genderGender and leadership Women’s dress codes - changes over time and how dress reflects one’s identity. Shifts in gender and social norms over time.
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Roll out process
1. MCHIP trained and supported CDA board members and staff to conduct Gender Analysis that informed their program strategies and Family Solidarity Modules (Nov 2012)
2. Gender Advisor developed FSMs (Dec 2012)
3. MCHIP supported CDAs to train CHW trainers on FSM content and facilitation skills (Jan – March 2013)
4. CDAs trained and supported CHWs to conduct FSMs, focusing on engaging mothers, fathers and grandmothers of children under two (April – Nov 2013)
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81.9
55.7
70.965.2
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
Endline Endline Endline Endline
Intervention Comparison Intervention Comparison
Upper Egypt Lower Egypt
Husbands went to doctor with their wives for ANC
41.9
22.9
44.938.3
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
Endline Endline Endline Endline
Intervention Comparison Intervention Comparison
Upper Egypt Lower Egypt
Men received advice on Spacing
Results from endline surveyUpper Egypt Lower Egypt
Men participated in group sessions 31.8 19.3
Results from endline survey
52.345.8
30.6 28.6
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
Endline Endline Endline Endline
Intervention Comparison Intervention Comparison
Upper Egypt Lower Egypt
Knowledge of atleast three newborn danger signs
38.5
16.4 17.9 15.1
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
Upper Lower Upper Lower
Men who participated Men who did not participate
Knowledge to breasfeed more during diarrhea
40.1
12.920.9
16.9
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
Upper Lower Upper Lower
Men who participated Men who did not participate
Joint decision on purchase and selling of animals
Results from endline survey
Learning
CHWs found Family Solidarity content relevant to their outreach work and their own lives
Implementation strategies varied based on levels of religious conservatism
Family Solidarity delivered mid-cycle, + and –
Some sessions conducted jointly, but mainly conducted for women and men separately.
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Learning
Build trust in communities -- health as a non-controversial entry point – then start FSMs
Be flexible and rely on local organizations to refine process and activity plans
Work closely with Village Health Committees Invite participation of religious leaders – and
be prepared for their inputs Train and support male and female facilitators Develop women’s leadership skills
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Thank You