Reaching Marginalized Groups: Towards Social Inclusion in Nepal

1
Reaching Marginalized GroupsTowards Social
Inclusion in Nepal
CommunityBased FP Strategies
Approaches Edson Whitney HCP Regional Director,
Asia May 16, 2006
2
Valued Behavior Healthy Family Project -
Towards Social Inclusion in Nepal
How a vibrant and effective partnership between
the Health Communication Partnership (JHU/CCP and
SAVE), the USAID-funded bilateral Nepal Family
Health Program (NFHP) and USAID/Nepal mission
improved access and equity to Family Planning
among the disadvantaged and marginalized
population.
3
Health Scenario of Nepal

• Total Fertility Rate 4.1
• Contraceptive Prevalence Rate (CPR) 39
• Unmet need for family planning 28
• 1.5 million women are not receiving FP services
• Poor and marginalized have higher unmet need than
  average Nepalese
• Maternal mortality ratio is 539 per 100,000
• Skilled Birth Attendants at birth 13
• Source Nepal Demographic Health Survey 2001

4
CPR IN NFHP Core Program Districts by Ethnicity

• Contraceptive Prevalence Rate (CPR) in NFHP Core
  Program Districts by Ethnicity
• Caste/Ethnicity/Religion in CPDs Any
  modern method
• Brahmin/ Chhetri 44.6
• Tibeto- Burman 49.7
• Tharu 63.5
• Dalit 40.5
• Muslim 14.0
• Other Terai origin 44.5
• Others 36.6
• Source NFHP Mid-Term Survey 2005

5
How the collaboration started

• USAID Flexible Fund providing funding through the
  Mission to the HCP partners JHU/CCP and Save the
  Children US
• Three year project (October 2003 September
  2006)
• HCP partners JHU/CCP and SAVE prepared
  implementation plan in collaboration with NFHP
• MOU developed between HCP and NFHP
• HCP located at NFHP Kathmandu and Field Offices
  
• NFHP would integrate HCP into NFHP field
  structure
• HCP would extend reach of NFHP by localizing
  effective media, materials and methods

6
Partnership contributions HCP Partners, CCP and
Save the Children USA

• HCP links marginalized communities with QI
  process at HF and outreach clinics
• HCP oriented NFHP FO staff, DHO and implementing
  partners to project
• Joint planning meeting with NFHP and DHO for FF
  activities
• HCP builds capacity of NFHP staff, government
  workers and NGOS in PDQ
• HCP includes NFHP staff in BCC training
• HCP monitors VSC and, BCC and RLG in their areas

7
Partnership Contributions NFHP

• Logistical support to HCP activities
• With DHO, assist HCP in identifying sites for RLG
• NFHP staff participate in PDQ and BCC training
• NFHP participate in planning and review meetings
• Joint monitoring visits with HCP, NGO partners
  (VSC, RLG, PDQ activities)
• Include HCP in NFHP regular project review
  meetings

8
FF Project Goal

• To help women / couples from disadvantaged
  groups achieve their reproductive intentions

9
FF Project Objectives

• Increase family planning use reproductive
  health practices among the poor and marginalized
  population through
• Strengthening delivery of quality services to the
  periphery
• Appropriately Linking potential clients with
  service providers
• Increasing community demand for services through
  BCC
• Increasing availability of services through
  extended comprehensive family planning services
• Strengthening capacity of NGOs

10
Project Objectives

• 2. Complement NFHP in strengthening
• expanding delivery and use of quality
• FP/MCH services at household and district level
• 3. Leverage partnerships with indigenous NGOs

11
Program Districts
Bajura
Kathmandu
Kanchanpur
Lalitpur
Kailali
Gorkha
Bardiya
Kaski
Rasuwa
Dang
Rupandehi
Nawalparasi
Banke
Chitwan
Makwanpur
Parsa
Rauthat
Sarlahi
Mahotari
Bara
Morang
Jhapa
Saptari
Dhanusha
Siraha
Sunsari
12
FF Program Organizational Chart
USAID/Washington Victoria Graham
HCP/Baltimore Caroline Jacoby
HCP/Nepal Savita Acharya
USAID/Nepal Sita Ram
SAVE/US Angela Brasington
SAVE/Nepal Neena Khadka and SAVE FO Staff
HCP Nepal BCC Activities Saroj Nepal and FO staff
NFHP Kathmandu
Local NGOs linked with NFHP FOs and District
Health Offices
UNESCO Club
Community Family Welfare Association
Indreni Sewa Samaj
Kirat Yakthum Chumlung/ Punarjivan Kendra
13
Intermediate Results

• IR 1 Increased knowledge and interest in FP
  services
• through NGO involvement
• NFHP weekly radio drama serial and materials
  localized/ adapted for Muslim and Dalit culture
  and languages
• A total of 374 PLA/Radio Listener Groups (RLG)
  centers operating with a total of
  9,321participants
• Muslim leader speaking in favor of family
  planning
• Community Based BCC ( Miking, Postering, IPC
  etc)

Implementing NGOs Kirat Yakthum
Chumlung/Punarjivan Kendra, Community Family
Welfare Association, Indreni Sewa Samaj and
Unesco Club
14
PLA RLG Centers
15
Ethnic Composition of PLA/RLG Participants
16
Intermediate Results

• IR 2 Improve Quality of Services
• Partner Defined Quality (PDQ) Process developed
  by Save the Children and implemented in 36
  Health Facilities
• Quality Improvement Committees Formed
• Mobilization of local resources to fulfill
  quality improvement need as identified by PDQ
  exercise
• Client Exit Interview
• FP Counseling Training to NGO Staff

17
PDQ implementation
Before PDQ
After PDQ
18
Intermediate Results contd

• IR 3 Increased access of communities to FP
  services.
• Extended VSC services to 1,731 potential clients
  in coordination with DHO/DPHOs through static and
  mobile services
• Provided transportation to clients who otherwise
  were unable to reach static sites
• Organized mobile comprehensive family planning
  services in collaboration with PSI in Siraha
  district. Total of 163 clients received services.
• Facilitated interested Clients to receive
  services from Institutional Family Planning
  Clinics ( Supported by FHD/NFHP)

19
Use of FP Contraceptives among PLA/RLG
Participants
20
Intermediate Results contd

• IR 4 Improved social and policy environment for
  FP/RH services and behavior
• Coordinated with district RH coordination
  committee and quality assurance committees
• Strengthened capacity of NGOs research
  (LQAS), report
• writing, supervisor's training and USAID
  Population
• Policies (Tiahrt, Helms Amendment and Mexico
  City
• Policy) PLA/RLG TOT and Facilitators Training
  
• Mobilized religious leaders and stakeholders
  in the
• program e.g. to promote FP and provide
  batteries for
• radios

21
Lessons Learned ( Programmatic)

• Focused Intervention such as PLA/RLG helps to
  reach the poor and marginalized communities with
  health messages and influence behavior change.
• Better coordination and linkages helps to expand
  the reach of quality services to the poor and
  needy.
• Mobilization of Religious leader helps to foster
  family planning use among Muslim communities
• PDQ process builds strong partnership between the
  community and health facility in improving
  service quality
• Demand creation and provision of services should
  be addressed in a synergistic manner to bring
  impact
• Comprehensive FP mobile services ensures clients
  right to informed choice

22
Lessons Learned (Institutional)

• Key to Partnership was a clear Memorandum Of
  Understanding from the beginning
• Technically mutually beneficial relationship
  NFHP/HCP RLG and HCP BCC and PDQ approaches
• Link with PSI, NFHP and other locally available
  resources extended access to FP services
• Mutually Beneficial relation HCP reached
  specific population that NFHP had been unable to
  reach
• Regular partners meeting is very important

23
THANK YOU