addressing cultural barriers to health service access for mangyan indigenous women in the...

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CulturallySensitive

Maternal

and

NewbornCareProgram:

AddressingBarriers

to

Health

Services

AccessforMangyanWomen

Dr.NoelEspallardo

EmikoMasaki

The views expressed in this paper are the views of the author and do not necessarily reflect the views or policies of the Asian Development Bank (ADB),or its Board of Governors, or the governments they represent. ADB does not guarantee the accuracy of the data in this paper and accepts no

responsibility for any consequence of their use. The countries listed in this paper do not implay any view on ADB's part as to sovereignty or independentstatus or necessarily conform to ADB's terminology.

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InJune2006,shewas

admittedtoinaprimary

carefacilityinMansalayfor

childbirth.

An

immediate

caesarean

sectionwasneededdueto

complications.Shewas

transferredthenextdaytoa

hospitalin

Calapan

city

by

Jeepneyfor46hoursof

journey.

MalingIsoy

Uponarrival,theoperation

wasdoneninehourslaterin

thehospital.

Duetobloodloss,shedied

in

recovery

room

a

few

hourslater.Shewas

approximately40yearsold

whenshedied.

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Barriersto

Accessing

Health

Services

Supplyside

Geographicfactors,

such

asdistance

Availabilityof

services

Demand side

Financialfactors

Socioeconomicfactors

Culturalfactors

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CulturalBarriers

to

Health

Services

Traditionalcultural

beliefsare

considered

as

barriers

Ethnic

women

are

made

toadapttothesystem

Utilizationofhealth

servicesis

generally

low

amongethnicminorities

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TA

6143

REGPromotingGenderEqualityand

WomensEmpowerment(PHI:

Indigenous

People

Community

Maternal

andNewbornCareProgramSubproject)

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OrientalMindoro

In2008statistics

totalpopulation

744,573

Annualgrowthrateof1.8%

crudebirthratewas22.1per

1,000crudedeathratewas4.0per

100,000

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TheMangyans

Mangyanisthegeneralnameforthe

indigenouspeoples

found

in

Mindoro

totalpopulationmaybearound100,000

ethnicgroupsare:

Iraya

Alangan

Tadyawan

Tawbuid

Buhid

Hanunoo.

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ProjectObjectives

Developmentofculturallysensitivematernalandnewbornhealthcareservices

ImprovedutilizationofRHUmaternalandnewbornhealthcareservices

Installed

mechanisms

for

sustainability

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EthnographicStudies

andSurveys

Developmentof

Culturallysensitive

Maternaland

Newborn

CareProgram

TrainingandRetraining

ofHealth

Workers

KeyActivity

Area

(1)

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KeyActivity

Area

(2)

TrainingofMangyanhealthworker

volunteers

BehaviourChangeCommunications

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ImplementationandMonitoring

InstallingMechanisms

for

Sustainability

KeyActivity

Area

(3)

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GeneralStepsinProgram

Implementation

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Resultsof

Ethnographic

Study

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Resultsof

Ethnographic

Study

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HealthWorkers Attitudeand

Perception

Peaceloving,hospitable,humble

and

good

natured

people

Takeagreementsseriouslyandusuallyreportduringagreed

meetings

Theyusuallysticktothehealth

workerassigned

to

them

and

wouldhesitatereceivingservices

fromothers

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TagalogPatients Attitudesand

Perception

DescribeMangyasasuntidy

and

smelly

ThedistancefrommostMangyancommunitiestohealthfacilitiesis

avery

important

barrier

to

the

utilizationofhealthcenter

services

Mangyansshouldbeattendedtofirstinhealthcenterservices

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ImplicationofRapidEthnographic

StudyFindings

Culturalbeliefsandpracticeshouldnotbeconsideredas

barrier SocialpreparationforMangyanstorecognizethebenefitsof

RHUbasedmaternalandnewbornservicesshouldbedone

TheRHUstaffmustallowahusbandassisteddeliveryinthe

facility

Healthworkersmustbetrainedonculturesensitivecommunicationskills

Trainingof

Mangyan

health

volunteers

must

be

part

of

the

program

TheRHUmaydevelopvariationsofhealthservicesdesignedforaparticularculturalbeliefofpatientsi.e.Mangyansor

Tagalogs.

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GeneralStepsinProgram

Implementation

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Componentsof

CMNC

Program

Appropriatefacilitiesmannedbytrained

andculturesensitivehealthworkers

Equitable,evidencebasedandculture

adaptedmaternalandnewbornhealth

interventions

and

services

Behaviourchangecommunicationsto

encouragehealthserviceutilization

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GeneralStepsinProgram

Implementation

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Culturesensitive

Workforce

Mixedcultureworkforce

Mangyanculturalbrokermaybenecessary

Mangyanhealthvolunteers

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LEARN Listen tothepatientsperspective.

Explain yourownperspective.Makesureyouspeakthelocaldialect.

Acknowledge thedifferences

and

similarities.

Dont

criticize

norargueagainstthebelief.Emphasizeacommonobjective.

Recommend atreatment

plan

after

setting

acommon

objective.

Negotiate foramutuallyagreedtreatmentplan.

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TrainingWorkshops

MHOandNurses

Nov2224,2009

Midwives

Nov2527,2009

MangyanHealthVolunteers

Dec810,

2009

NursesandMidwivesRetraining

Feb1617,2010

Trainingof

hospital

personnel

May2728,2010

Trainingonadolescentcounselling

Aug25

27,

2010

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GeneralStepsinProgram

Implementation

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BalayMangyan

(Traditional

Birthing

Facility)

MedicalequipmentandsuppliessupporttoBEMONC

BalayMangyan

(Mangyan

House)

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GeneralStepsinProgram

Implementation

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CommunityOutreach

Visits

Communityoutreachvisitsmustbedesignedtoprovideprenatalcaretoasmanypregnantpatientsandasmany

frequenciesas

possible

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EducationalMaterials

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GeneralStepsinProgram

Implementation

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Resultsof

the

Program

Impact

Reducedmaternal

and

neonatalmortality

Outcomes (withtargets)

Increasedutilization

22facilitybased

deliveries

3CEMONCdeliveries

Zone Number

North 0/0

Central 0/2

South 0/0

Total 0/2

Zone Number

North 29

Central 38

South 40

Total 117

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Resultsof

the

Program

Increasedcapacityofhealthcareproviders

Zone Baseline Shortterm 6months 12months

North 8.70 9.78 10.07 8.78

Central 8.29 9.29 9.88 8.54South 8.84 10.58 10.04 9.86

Total 8.63 9.90 9.90 8.93

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Resultsof

the

Program

Satisfactiontohealthservices

95%of

105

Mangyan

women

who

responded

to

the

surveybelievethatgivingbirthinthehealthcenteris

goodforthemotherandchild

Zone Satisfactionto

HealthService

AwarenessLevelof

Mangyans

North 4.62 6.00

Central 4.81 7.27

South 4.05 6.42

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Thankyou