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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