The Role of Women s Groups in Health Promotion in Tajikistan

Transcription

1 Swiss TPH Spring Symposium 2015 Community Participation in Public Health: What s the Added Value in Research and Implementation? The Role of Women s Groups in Health Promotion in Tajikistan Rachel Eager, PhD Deputy Head of Impact, Innovation & Evidence - Save the Children U.K. Gulzira Karimova, PhD Community Activities Coordinator - Enhancing Primary Health Care - Tajikistan Project

2 Overview 1. Introducing Tajikistan 2. Save the Children operation 3. Women s Wealth & Influence project Project achievements 4. Enhancing Primary Health Care Tajikistan project Approach Implementation process Benefits, challenges and effects Conclusion

3 Country Overview Independence: September 1991 Population: 8 million (2013 estimate) 79.9% Tajik; 15.3% Uzbek; 1.1% Russian; 1.1% Kyrgyz; 2.6% others Densely populated river valleys separated by high mountain chains (only 5% of the land is arable) MAIN STATS: Life expectancy at birth: 68 years Infant mortality rate (under 1): 37% Total adult literacy rate: 99% 54% of the population under the poverty line Child poverty: 51% Poverty is becoming increasingly feminised

4 DFID-funded Women s Wealth and Influence project Central Asia Office: programming in Kyrgyzstan (since 1992) and Tajikistan (since 1994) SC projects: education, child protection, health and livelihoods, food security and disaster risk reduction WW&I History: pilot project in year implementation Overview of intervention: 17 districts 4,200 self directed women groups 65,000 women operational research

5 What is the project about? Independent decision-making and group consensus Discovering and utilising existing assets and abilities to create tangible benefits Access to pooled resources Creating of a robust empirical evidence base for the effectiveness of the WW&I methodology

6 Story book manual Together you can change the world Basic guidance on set up and running of group Examples of the success You decide methodology

7 Impact Outcomes Domains of change & outputs Progress towards Millennium Development Goals 1 & 3: poverty is reduced & women s empowerment is improved; improved gender equality Progress towards Millennium Development Goals 1 & 3: poverty is reduced & women s empowerment is improved; improved gender equality Wealth & economic resilience Increased income Personal empowerment Autonomy Interpersonal & household change Enhanced family interactions Self-confidence/ worth Participation in decisionmaking Enhanced access to & Understanding of own control over assets Mobility & control over subordination/injustice assets Sociocultural change Collective efforts & sustainability Gender norms Child well-being Improved well-being Influence in legal & political structures WW&I Input Current situation Women s group facilitation Coaches & group guidance Support to pool fund creation & management Poverty & insufficient economic opportunities for women; discriminatory gender norms, structures impeding women s participation in society & constraining their wealth & influence

8 Achievements Before we would not care, we just accepted life and its hardship passively. Now we take care of everything. We have discovered that we can manage lots of things Now I am respected. I have money, I have voice

9 INCOME GENERATION Achievements HEALTH SERVICES PROVISION BIRTH REGISTRATION AGRICULTURE SUPPORT

10 Operations Research Themes Creating robust evidence for the effectiveness of the WW&I approach Key themes Understanding women s empowerment, it s effects and the effectiveness of the WW&I methodology for empowering women Understanding the causal pathway for the project Understanding how child wellbeing is improved Replicability and scalability

11 Challenges Time requirement for coaches Providing support to a wide range of activities Quality of support vs demand for groups Monitoring of group activities Recommendations Programming options for group support Regional groups & peer support

12 Enhancing Primary Health Care - Tajikistan Project (Sino V) Project Sino active in Tajikistan since 2003 Funded by the Swiss Agency for Development and Cooperation A model for community involvement and health promotion, developed by Project Sino 1 1 Project Sino Community group involvement, Nov 2007 Technical Note #14: Community Participation and Health Promotion within Project Sino, 2013

13 Enhancing Primary Health Care - Tajikistan Project (Project Sino) Project duration Improving Primary Health Care service delivery through: better planning and management at district and local level more transparency greater involvement of the community Goal: Tajik population benefits from improved PHC services and health promotion activities at community level Empowering communities in health aspects through community groups 13

14 14 Community Empowerment through SC WW&I groups SC s WW&I Women's Groups are used as an entry point for Project Sino Community Empowerment Project SINO Community Groups are established by engaging Women s Groups in discussion of health topics Involvement of men in the groups for gender balance and mutual understanding (through local mahalla, school, Mosque members, health care staff and other active individuals) Same localities used as for WW&I Women s Groups Based on volunteer work Currently 780 community groups operational in 6 pilot districts

15 Approach Involving Key Partners PHC / FM Teams Healthy Life Style Centre Community Groups MODEL for linking community groups to Primary Health Care and Healthy Life Style services to encourage health promotion and disease prevention activities

16 Community empowerment in health: method/approach Health problems are prioritized in Participatory Reflection and Action (PRA) sessions 3282 PRA sessions in 4 districts Community groups discuss possible solutions and undertake actions together with PHC/FM and local health promotion centre services (Healthy Life Style Centre (HLSC)) 16

17 Activities and achievements Major health priority issues identified through PRA sessions by CGs up to present, on which health awareness activities have taken place: TB Breastfeeding Complementary feeding Diarrhea Immunization Acute respiratory infections Reproductive Health, etc Planned future topics: Hypertension Diabetes Obesity Anemia

18 Activities and achievements (2) Example: Breastfeeding: Actions to raise community awareness Developing IEC materials together with the national health promotion centre (RHLSC) Organizing Health Days and Health Campaigns Distribution of informational materials Role plays/sketch Sharing experience (exchange visits) Broadcasting video Breastfeeding promotion Use of video clips in health training sessions (2,000 video discs distributed), etc. 18

19 Activities and achievements (3) Collaboration with Healthy Life Style Centres (national and district levels) and PHC - a cascade training approach: HLSC at national level HLSC at district level Community-PHC and HLSC Integration of community health priorities in PHC business plans Emergency Transport Funds (ETF) Small Grants scheme Capacity building for CGs Small grant scheme: Initiative of CGs in constructing HH Gallazor, Vose district

20 Challenges Faced and Recommendations Challenges faced Complex network difficult to get everyone on the same level of understanding about the process and the aims of the approach High turnover in partner institutions Mentality / Tradition Recommendations Change in mentalities go slow do not expect changes to happen fast Focus on quality more than on quantity

21 Role of community groups: identify, bring forward health problems address local health priorities disseminate health information an important resource in FM promotion Conclusion Outlook Intensive focus on integration of community health aspects in PHC business planning Health awareness campaign on hypertension, diabetes, etc. in collaboration with local partners 75% population /villages covered Sustainability through: Institutionalization Empowerment Improving motivation in all stakeholders through collaboration Health promotion intervention is welladopted and relatively cheap Long term: Institutionalization and transfer of the community-based work to local government structures (HLSC, PHC staff)

22 THANK YOU! ANY QUESTIONS?