considerations for incorporating health equity in project design_roy_5.12.11
TRANSCRIPT
Nepal - BackgroundPrides itself in never having being colonized
Was the only declared Hindu State in the world
Nepal, a part of the subcontinent, follows the caste system
March 12th 2011CORE – Equity Session
CARE Nepal’s CRADLE ProjectSept 2007- Sept 2011
And two earlier CS projects
Nepal
Project Districts
• CB-NCP: In Doti• BPP: Kailali• CB-IMCI: In Kailali, and Doti• HIV AIDS: In Both, Doti and Kailali
Technical Interventions
Wealth and AssetsWealth and AssetsCaste/ethnicity
IndicatorsHill Brahman
Tarai Janajati
Hill Dalit National
Wealth quintile
Lowest 9.5 11.5 45.9 20.2
Second 11.3 30.7 19.5 19.9
Middle 12.0 31.3 15.4 20.0
Fourth 26.0 16.9 10.9 20.1
Highest 41.2 9.5 8.4 19.8
Household facilities
Electricity 75.8 38.3 32.7 51.6
Private latrine 66.3 18.6 23.2 38.6
Improved drinking water 81.1 91.0 70.3 82.1
Radio 83.7 54.6 53.3 62.7
Television 45.8 23.4 13.3 29.4
Any means of transportation
41.3 74.1 13.6 37.5
Source: Bennett, Lynn, Dilli Ram Dahal and Pav Govindasamy, 2008. Caste, Ethnic and Regional Identity in Nepal: Further Analysis of the 2006 Nepal Demographic and Health Survey. Calverton, Maryland, USA: Macro International Inc.
EducationEducationPercentage of population with no formal education by cast/ethnicity and gender, Nepal
Source: Bennett, Lynn, Dilli Ram Dahal and Pav Govindasamy, 2008. Caste, Ethnic and Regional Identity in Nepal: Further Analysis of the 2006 Nepal Demographic and Health Survey. Calverton, Maryland, USA: Macro International Inc.
Maternal HealthMaternal HealthAntenatal care Economic barriers in accessing health
care:• 54 % of Dalit and 28% of
Brahman women cited lack of money as a problem in accessing health care
• High cost of institutional delivery (Rs.49,000) vs. lesser but still significant cost of using SBA at home (Rs. 13,600).
* Source: Bennett, Lynn, Dilli Ram Dahal and Pav Govindasamy, 2008. Caste, Ethnic and Regional Identity in Nepal: Further Analysis of the 2006 Nepal Demographic and Health Survey. Calverton, Maryland, USA: Macro International Inc.
Child HealthChild Health
Brahman Janajati Dalit NationalNeonatal mortality 34 36 44 37
Post-neonatal mortality 25 24 25 19
Infant mortality 59 59 68 55
Child mortality 18 22 23 13
Under-five mortality 76 80 90 68
Early childhood mortality rates by caste/ethnicity, Nepal(for 10-year period preceding the survey)
Source: Bennett, Lynn, Dilli Ram Dahal and Pav Govindasamy, 2008. Caste, Ethnic and Regional Identity in Nepal: Further Analysis of the 2006 Nepal Demographic and Health Survey. Calverton, Maryland, USA: Macro International Inc.
Child HealthChild HealthStunting (percentage of children under 5 who are -3 SD below normal
height-for-age) by caste/ethnicity, Nepal
Source: Bennett, Lynn, Dilli Ram Dahal and Pav Govindasamy, 2008. Caste, Ethnic and Regional Identity in Nepal: Further Analysis of the 2006 Nepal Demographic and Health Survey. Calverton, Maryland, USA: Macro International Inc.
Women and men planning/plotting
Focus Population• Landless, Dalits, Janajatis, Kamaiyas,
Haliyas, • People Living With & Affected by
HIV/AIDs (PLWHAs), Sex Workers, Conflict- and Disaster-Affected People
Women, children and youth cut across all the categories.
Prioritized VDC/HF
On site coaching (FCHV, Mothers, MIL, FIL, PW, PNM Husbands, Peoples Org,) in MG meeting
Ward categorizationSocial mapping
HMIS data analysis
VDC/HF prioritization at district level
Ensure regular MG meeting and increase utilization of health
servicesFeedback/Reflection
Analysis of HMIS data,
interaction among HF staff, HFOMC
members, MG representative,
WRF, WAF and other community
members, stakeholders
Feedback/reflection
Documentation and dissemination of
processes, learning and changes
Capacity building of
FCHV & HWs
Include RBA, Advocacy and
Social Inclusion Issues
Key MNH messages based on
BCC strategy
Self assessment and evaluation
Healthy and prosperous family / community
Improvement in maternal and neonatal health by reducing morbidity and mortality
Self Applied Technique for quality Health (SATH) Framework
CRADLE’s SATH Approach - Outcomes• Where SATH is applied more women from marginalized
communities are participating in the mother groups and accessing health services
• Some of the HFOMC members are concerned and committed to upgrading their respective health facility to birthing center.
• There is a greater demand for quality health services• Re-organization of outreach clinics which has increased coverage
of key health indicators in the poor performing clusters• Greater participation of Dalits and other PVSE, they have utilized
services more than before• Inclusion of PLHA• Inclusion of MIL, Husbands and FIL – changed perception towards
women’s health, increase in supporting behavior for MNH care
Best laid plans of ….
Ethnicity 4 ANC 2 BPP Know SDI
Institutional delivery
PNC ( 1-3 Days)
Dalit 51 32 69 26 60Janajati 73 4 40 70 24Others( Brahmin/Chetri/Equivalent
48 36 77 25 65
Knowledge and practices on MH( %)
CB-IMCI( %)
EBF Measles ARI
• Dalit 70 81 64 • Janjati 75 98 74 • Upper Caste 73 87 76
Women Participation in at least one IGA(%)
Dalit 45
Janjati 93
Upper Caste 57