|
Conference Proceedings 2000
Findings On Reproductive Health Of Refugees
And Displaced Populations
Washington DC | December 5-6, 2000
Improving Service Delivery Systems in Post-Conflict Settings
| Moderator: Ron Waldman, Heilbrunn Center for
Population and Family Health, Columbia University |
Presentations:
| Susan Igras |
Revitalizing health services in northwestern Somalia:
CARE's experience |
| Doris Bartel |
Responding to Kosovo's reproductive health crisis |
Melissa Sharer
Jesse Rattan |
Participatory assessment of women's issues in East
Timor, May 2000 |
|
| Revitalizing health services in northwestern Somalia: CARE's
experience Abstract revision date: December 5-6, 2000
|
| Authors |
Wairimu Gakuo, Senior Program Officer, CARE International,
Somalia
|
| Presenter |
Susan Igras, CARE, Atlanta
|
| Background |
The health system in the North West Zone/Somalia is
struggling to re-establish itself as a public sector institution
after years of civil war. The current health services,
particularly preventive services, are underutilized by
communities due to social and economic factors.
|
Purpose of study
or program |
The 2-year CARE Somalia Maternal and Newborn Care pilot project
has been designed to build on the 4 key interventions
that can have the greatest impact on maternal mortality:
family planning, antenatal care, clean delivery and essential
obstetric care. The project will strengthen the links
between the interventions, and between communities and
MCH centers (3 rural and 3 urban) serving an estimated
population of 30,000 women of reproductive age in North
Western Somalia, to improve the demand for, access to
and quality of Maternal and Newborn Care services. Support is being
provided to community health educators and TBAs to create
demand for and help restore confidence in the health care
system. In this way, the project will address the key
problems of limited access, demand and appropriate use
of Maternal and Newborn Care services in clinic and home settings.
|
Data collection
methods |
A baseline KAP survey was conducted in October 1999;
additional information is being collected as the project
progresses.
|
Study or
program findings |
The October 1999 baseline KAP survey confirmed the poor
status in the provision of and access to Maternal and Newborn Care
services in the target area of Somaliland. Though UN statistics
had set the maternal mortality ratio at 1,600/100,000
live births and the infant mortality rate at 125/100,000
live births, the baseline survey found these figures to
be 826/100,000 and 103/100,000 respectively.
Use of modern contraceptive methods
was 1% while the total fertility rate stood at 7.9.
The baseline established the need to target rural areas
more than urban areas as the situation in these areas
indicates lower access to services and knowledge of safe
motherhood practices. The challenge is to increase acceptance
of child spacing methods in an environment that is resistant
due to religious and cultural beliefs.
Training of health staff is a
priority for the project. Centralized training has proven
to be a difficult strategy to implement due to high (financial)
expectations by trainees. On-job training is being used
and has proven to be more effective in improving the skills
of health staff in the target MCH centers.
A referral (coupon) system was
established by the project, and emergency cases are being
referred to the main referral hospital. However, villages
that are far from the centers have no access to this facility.
|
Conclusions
and program
implications |
The Maternal and Newborn Care Project continues to face many challenges,
the least of which are the religious and cultural biases
of the target communities. Creative mechanisms to meet
the challenges are being continuously explored and it
is anticipated that the IEC campaigns, support to MCH
mini-projects and increased skills of health staff through
on-job training will enable the project to meet its objective
of increased access and use of Maternal and Newborn Care services.
|
For further
information |
Wairimu Gakuo, CARE Somalia, P.O. Box 2039, KNH Post
Office, Nairobi, Kenya
Email: wairimu@care.or.ke |
|
| : |
| Responding to Kosovo's reproductive health crisis
Abstract revision date: December 5-6, 2000
|
| Authors |
Doris Bartel, Iinternational Medical Corps
|
| Presenter |
Doris Bartel
|
| Background |
Refugees who returned to Kosovo following the conflict
faced significant barriers to reproductive health (RH)
services, in part due to the lack of health professionals
trained in appropriate clinical skills. Fewer than 150
gynecologists provided RH services to Kosovo's 1.8 million
people. Kosovo has one of the highest infant and maternal
mortality rates in Europe.
|
Purpose of
study or program |
The goals of the program were to increase community-based
health promotion and demand for reproductive health
care services, to improve access to quality reproductive
health care for women, and to increase the knowledge
and clinical skills of health care providers in primary
care settings.
|
Data collection
methods |
The program followed a three-part approach to health
sector reform. The first was direct reproductive
health service provision via mobile clinics to women
in underserved areas. The second was on-the-job reproductive
health clinical skills training of the staff who work
in primary care clinics. The third was health
promotion and outreach to communities without access
to health information. Data collection included basic
demographic data from the clinic clients and qualitative
data on rural women's reasons for coming for care.
|
Study or
program findings |
Outreach to the community was undertaken through the
formation of women's groups in each village which met
regularly with lay health educators to discuss health
concerns. RH services were introduced via mobile clinics
with small teams of trained general practitioner doctors,
nurses and midwives in October 1999. The number of women
utilizing the new services grew to over 1200 visits
per month within one year.
Women reported that they came
for RH services because they were convenient to home,
free, and were provided by empathetic female service
providers who emphasized client-centered care.
A survey of medical staff working
at the primary care setting revealed that over 70% were
eager to learn new clinical skills as provided by the
mobile team models. On-the-job clinical skills training
is currently underway.
|
Conclusions
and program
implications |
Health education and outreach was successfully implemented
in rural Kosovo via women's groups. RH services
provided in traditional primary care settings by nontraditional
staff were found to be acceptable to recently returned
Kosovar refugee women. After observing this model via
mobile teams, a majority of the primary care staff stated
they wanted similar on-the-job RH skills training. The
success of the program was enhanced by a community-based
approach to health sector reform.
|
For further
information |
Doris Bartel, 6111 44th Avenue, Riverdale, MD 20737
USA
Email: D_bartel@hotmail.com
|
|
| Participatory assessment of women's issues in East Timor,
May 2000 Abstract revision date: January 15, 2001
|
| Authors |
Melissa Sharer, Milena Vilanova, Jesse Rattan; IRC
East Timor
|
| Presenter |
Melissa Sharer and Jesse Rattan
|
| Background |
Announcement of the referendum results on August 30,
1999, when 78% of the population voted for independence,
sparked an explosion of violence in East Timor.
Ensuing massacres by paramilitary militias, destruction
and chaos forced approximately 250,000 people to flee
the country. The health infrastructure was nearly
totally destroyed, including a loss of drugs, equipment
and supplies specific to reproductive health.
There is evidence that women were subjected to many
types of sexual and gender-based violence, both over
the past 25 years and most recently during the emergency
phase following the referendum.
|
Purpose of study
or program |
IRC's program has worked to address both immediate
emergency needs through Minimum Initial Service Package
(MISP) provision and emergency condom distribution,
and longer-term needs through a participatory assessment
of sexual and gender-based violence (SGBV) and facilitation
of collective action by international and national reproductive
health stakeholders.
|
Data collection
methods |
The reproductive health assessment.
The participatory assessment for SGBV utilized quasi-focus
group settings. Fifteen trainers were trained
to deliver participatory workshops to 456 self-selected
women (between the estimated ages of 14-70) in 9 towns/villages
and in 6 out of 13 districts in East Timor.
|
Study or program
findings |
The reproductive health assessment found inadequate
numbers of physicians, destroyed and looted clinics,
a history of coercive family planning, anecdotal evidence
of sexual and gender-based violence and heightened risk
of HIV transmission from expatriate humanitarian and
military groups. The participatory SGBV
assessment discovered common themes from the group
discussions.
1. Category One: Problems related
to women's rights, gender issues and violence against
women in East Timor. The issues the women discussed
fell into 5 themes. These included physical
abuse, cultural factors, psychological abuse, economic
factors and special issues related to young women.
2. Category Two: Solutions related
to the community-identified problems related to women's
rights, gender issues and violence against women in
East Timor. The issues the women discussed fell
into 2 themes: individual solutions (e.g. communication
skills in partnership) and community and organizational
solutions (e.g. small business start-up).
3. Category Three: The immediacy
related to this critical, transitional time in the
history of East Timor. East Timorese women believe
that now is a crucial time to advocate for change.
Women felt they deserved the opportunity to let their
voices be heard during the rebuilding of East Timor.
The program found: - challenges in transition from the emergency
to rehabilitation phase, specifically defining the
NGO role vis-à-vis the emerging health authority
within a UN transitional authority;
- a need for strong RH leadership with adequate
human and technical resources in a post-conflict
situation;
- the political nature of HIV interventions,
specifically condom distribution;
- the inherent need for family planning
despite a history of coercive national program focused
on population control.
|
Conclusions and
program implications |
- Local participation is crucial from the beginning.
- Advocacy is an important component to communicate
women's voices and needs which are often neglected
in post-conflict situations.
- An expert lead agency or group needs to present
reproductive health as a relevant component of the
humanitarian response during and after emergencies.
- Condom distribution can be politically sensitive.
- NGOs can play a key role in post-conflict reconstruction
by working at the community level, but also in the
building of national level systems and structures.
|
For further
information |
Melissa Sharer
215 North Park Avenue IRC-East Timor
Geneseo, IL 61254 USA 90 Mitchell
Street
309-441-5430 Darwin, Australia NT
0800
melissa_sharer@hotmail.com
irceasttimor@octa4.net.au |
|
Next: HIV/STDs - What Do
We Know and What Can We Do?
Back to Contents
|
