Module 5 Session 3 Demand and Accountability February 27, 2014 1.
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Transcript of Module 5 Session 3 Demand and Accountability February 27, 2014 1.
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Module 5Session 3
Demand and Accountability
February 27, 2014
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Contents of the session
Purpose & Objective
Presentation of Concepts
15 minutes
Examples of Demand
20 minutes
Group work
20 minutes
Feedback 20 minutes
Relevance of demand to
DCST members
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Purpose & Objective
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Purpose
The purpose of this session is for DCST members to consider and reflect on the patient perspective regarding access and uptake of health care services targeted to maternal and child health.
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Overall Objective of the Session
Consider demand side issues in MCH and how this relates to the supply side work of DCSTs
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Presentation of Concepts
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What is supply?
The supply slide of MCH concerns the health systems perspective on how to overcome barriers within the health system.
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7 Elements of Supply
Provision - Supply Side7 system elements
Governance (administration)
Human Resources (staffing – nurses, doctors etc.)Information
Utilisation – access and uptake
Quality and coverage
Community Engagement
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What is Demand?
The demand side of MCH pays attention to the community and patient perspective on MCH and the barriers that they face.
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Barriers to demand – core message
Patient behaviour in the use, access and uptake of MCH services informs demand side barriers
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Three Dimensions of Patient Behaviour
Use & Access - Demand Side 3 Dimensions of Patient Behaviour
Patient Behaviour Knowledge (about health services
they need & the facility providing it)
Belief and Attitudes (about the appropriate response)
Action ( actions/activities taken)
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Demand Side Barriers – Types and Examples
Type Example
Socio – cultural - social norms and conventions - beliefs and practices
Practice of “hiding” a pregnancy Use of traditional healers and
herbs
Context - conditions e.g.. poverty and levels of education, location
Poor road and limited transport options
Lack of household income to cover the costs of accessing services
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Demand Side Barriers – Key Features Level of Operations Illustration Individual Family
Limited confidence and self advocacy Tendency for families to “punish”
pregnant teenagers/ young mothers
Local leadership / representative Community / community institutions Society as large
Traditional healers not well integrated into health system – poor referral system
Preference for using traditional healers in combination with clinic care
Practice that men do not accompany women to clinics
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Challenge - Reduce / Remove Demand Side Barriers
Key message:
To improve MCH outcomes, demand for service must increase. Actions must be taken to identify and overcome demand side barriers.
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Barriers to demand
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Related to the health system Related to the context outside the health system
Lack of / poor ambulance service Lack of knowledge on what they should access
Shortage of staff Socio- cultural norms – e.g.. hiding pregnancies, use of traditional medicines
Poor staff attitudes and treatment Preference for using traditional healers in combination with clinic care
Lack of confidentiality Stigmatization of AIDS
Long queue and waiting times lack of familiarity with appointment system
Absence of maternity homes Difficulty in getting access e.g. transport
Clinic hours Teenagers and workers not able to go during normal hours
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Some Actions to Increase Demand:• Ensuring that poor women and their families understand the
importance of accessing healthcare services and learn how to take responsibility for their health
• Overcoming cultural barriers to the use of MCH services• Offering services tailored to special groups• Improving the approach & frequency of communicating the
importance of accessing MCH services and linking to behaviour• Working with healthcare workers to help them to understand steps
they can take to create an enabling environment for patients to access MCH services
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Examples of Demand
“what if and just because statements”
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Statement # 1
Different strategies can make sure that family planning methods are readily available but will young people come and get it and furthermore use it consistently? What might stop them?
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Different strategies can make sure that family planning methods are readily available but will young people come and get it and furthermore use it consistently? What might stop them? • Stigma around having sex means young people find it hard to
discuss contraception at a facility• Power dynamic makes it hard for girls to negotiate condom use,• Myths around the impact of contraception on the women and baby• Use contraception with regular partners but not others• Power dynamic between the HCW and the teenager• Young people don’t like waiting in queues• Fear of being tested for HIV/AIDS
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Statement # 2
If you provide EANC, post natal services and advice on nutrition or breastfeeding to women, what might be some reasons why they don’t use them?
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If you provide EANC, post natal services and advice on nutrition or breastfeeding to women, what might be some reasons why they don’t use them?
• Cultural norm of hiding a pregnancy• Belief and practice that only go to clinic if you do not feel well• Fear of being shamed or scolded (teens)• Prefer to discuss breastfeeding with other mothers – so if HCW is not a
mother….• Partial to taking advice on nutrition within the family not at a clinic• Poverty and can’t afford the transport
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Statement # 3
Making HIV counseling and testing a routine part of the ante-natal care screening process done by health workers is a clever way to target women age 15-24 . But why might this strategy not always work?
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Statement # 3
Making HIV counseling and testing a routine part the ante natal care screening process done by health workers is a clever way to target women age 15-24 . But why might not always work?
• Young women resist testing for fear of testing positive and lack of confidentiality
• Fear of judgment by the community• Dislike isolating HIV patients in the clinic so they “stand out” – drawback of
the fast tracking service • What do they do? - “avoid” routine checks
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Statement # 4
Even when ToP is legal, free and available in public hospitals what could stop people from using this service?
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Even when ToP is legal, free and available in public hospitals what could stop people from using this service?
• Social norms on abortion are entrenched and carry a heavy stigma
• Young women don’t know about it• Fear of being shamed and “preached” at • Long queues and abrasive treatment can drive
girls to “the back street” and “Dr. Love”• Get herbs from traditional healer to terminate
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Statement # 5
If the queues get shorter and levels of respect, privacy and confidentiality increase why might patients still not be satisfied with MCH services?
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If the queues get shorter and levels of respect, privacy and confidentiality increase why might patients still not be satisfied with MCH services? • Appointment system is not liked – not clear why?• To be taken seriously, young women believe they must be treated
“roughly”• Hard to get confidentiality in a small waiting room… risk of people
waiting for ARVs to have status disclosed publically• Fear from young people that nurses will share their effort to get family
planning with others – family / community members
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Statement # 6
Just because a new facility – such as a maternity waiting home is built, would women automatically use it? What could get in the way of this?
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Just because you build a new facility – such as a maternity waiting home, would women automatically use it? What could get in the way of this?
• If food is not provided (new DoH policy) then women are discouraged from using it
• Negative attitude of HCWs/preference for particular HCWs• People shop around
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Group work and plenary feedback
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TASK:On a flip chart list the barriers to service delivery that you are aware of from the demand side (community and user perspective).
Now, prioritise which ones you would focus on first given your position on the DCST. Then think about what steps you would take to address the barrier and the stakeholders you would engage.
Capture this information in the template provided.
Present group work to a plenary using a flip chart.
Exercise 1
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TemplateBarrier to demand
Step / action to address the barrier
Stakeholders to engage with
Priority Intervention
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Relevance of Demand to DCST members
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Why is it important to take demand into account?
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How do you see demand issues fitting into your work?
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What do you need from us?
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To effectively implement and operationalize supply side improvements, barriers to demand have to be reduced.
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Thank You
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Contacts
• Ellen Hagerman – Demand and Accountability Advisor/Project Manager, [email protected]; t: 072 981 0668
• Mario Classen - CSO Capacity Building Advisor, [email protected] t: 071 1515 142
• Shuaib Kauchali – Deputy Lead: Technical, [email protected]
• Marie-Therese Mukayiranga – Grants Manager. [email protected]
• Dr Gugu Ngubane – Team Leader [email protected]
• Caroline Mbi-njifor - Deputy Lead: Operations and Finance [email protected]
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