Gender, Equity, Community Participation and Demand Generation

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Gender, Equity, Community Participation and
Demand Generation
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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!

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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

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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

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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

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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

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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
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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
• Womens 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

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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

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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

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• Thank you