increasing utilization of health services in a restrictive...
TRANSCRIPT
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Empowering Communities, Strengthening Systems, Saving Lives
Increasing Utilization of Health
Services in a Restrictive Society
Dr. Olugbenga Oguntunde, MNCH2
Dr. Irit Sinai, Palladium
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Empowering Communities, Strengthening Systems, Saving Lives
Who we are
Maternal Newborn and Child Health
Program (MNCH2)
• DFID funded
• 5-year project
• Six states in northern Nigeria
• Supply, demand, and operations research
outputs
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Empowering Communities, Strengthening Systems, Saving Lives
Northern Nigeria
• 13 states in North-east and North-west zones
• Population 55 million (2006) and growing
• Majority Hausa/Fulani
• Majority Muslim
• Very poor maternal child health indicators:
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– TFR in North-west region 6.7
– 3% of married women of reproductive age in North-
east region use contraception
– Majority of births at home, often unattended
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Empowering Communities, Strengthening Systems, Saving Lives
Session objectives
1) Describe aspects of northern-Nigeria
culture that inhibit uptake of health
services
2) Brainstorm ideas for increasing demand
for health services in northern Nigeria
3) Describe MNCH2 demand-creation
programs
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Empowering Communities, Strengthening Systems, Saving Lives
Aspects of
northern-Nigeria culture
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Empowering Communities, Strengthening Systems, Saving Lives
Cultural milieu
• Islam as a way of life
• Women uneducated, not
empowered
• Men make decisions at
home and in the community
• Women don’t do anything,
go anywhere, talk to anyone
without husband’s
permission
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Empowering Communities, Strengthening Systems, Saving Lives
Demand for family planning
Couples want to have many children:
• Increase the number of followers of Islam
• Improve chances of social/financial security
• Wives compete (increase inheritance)
• Only wives to prevent another marriage
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• Continue lineage
• Improve prestige
• Preference for male
children
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Empowering Communities, Strengthening Systems, Saving Lives
Demand for family planning
• Perceived societal
opposition
• Men only agree if
woman’s life is in danger
• Some covert use
• Poor spousal
communication
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Opposition to family planning:
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Empowering Communities, Strengthening Systems, Saving Lives
Demand for antenatal care and
Health facility delivery
• Pregnancy is normal part of married life
• Cultural preference for home delivery
• Belief that health is beyond human control
• Husband’s permission
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Empowering Communities, Strengthening Systems, Saving Lives
Demand for immunization
• Child health is in God’s hands
• Immunisation interferes with God’s plans
• Child is not sick
• Husband’s permission
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Empowering Communities, Strengthening Systems, Saving Lives
Who influences women’s health
decisions?
• Men
• Religious and traditional leaders
• Older women
• Who else?
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Empowering Communities, Strengthening Systems, Saving Lives
Interventions using influencers
• Men (education, fertility awareness methods)
– Male motivators
– Father’s clubs
– Male groups
– Fertility awareness
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• Sensitization of
religious and
traditional leaders
• Traditional birth
attendants
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Empowering Communities, Strengthening Systems, Saving Lives
So, what do you think can be
done to increase demand for
and uptake of health services,
for better health outcomes?
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Empowering Communities, Strengthening Systems, Saving Lives
MNCH2 strategies
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Empowering Communities, Strengthening Systems, Saving Lives
Increasing utilization of services
Emergency transport schemes
• Collaboration with National Union of
Road Transport Workers
• Training drivers at community level
to serve as volunteers
• Peer training of additional drivers
• Community awareness about the
schemes
• Link with other community groups
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Empowering Communities, Strengthening Systems, Saving Lives
Increasing utilization of services
Safe space initiative
• Health workers meet with married adolescent girls in small groups
• Discuss health information and barriers to access
• Run by health workers
• Community volunteers facilitate access of adolescent girls to health services (husband permission)
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Empowering Communities, Strengthening Systems, Saving Lives
Increasing utilization of services
• Group discussions around
– maternal, newborn and child health and family planning
– social factors that lead to poor health outcomes
– barriers to access to health care
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Women’s empowerment groups
• Promote access to health
services using songs and drama
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Empowering Communities, Strengthening Systems, Saving Lives
Increasing utilization of services
Men’s groups
• Discuss women’s and children’s health issues and
barriers to access
• Promote blanket permission
• Promote use of emergency transport schemes
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• Groups of:o religious leaders
(sermons)
o traditional and
community leaders
(role models)
o other married men
(peer educators)
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Empowering Communities, Strengthening Systems, Saving Lives
Increasing utilization of services
Traditional birth attendants
• trusted in the communities
• trained on basic maternal and child health
• talk to women about their health
• link women with health facilities
• Promote use of emergency transport schemes
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Empowering Communities, Strengthening Systems, Saving Lives
Thanks