Considerations For Incorporating Health Equity in Project Design_Talens_5.12.11

Closing the Gap by Design: Setting up a Maternal Newborn Health Program as if People Mattered.

The Peoples Institution Model

CORE Group Spring MeetingBaltimore MDMay 12,2011

Alan Talens, MD, MPH Nancy TenBroek, MA

Will Story , MPH Emdad Hoque , MD, MPH

Constituent Engagement

Relief and Development under Justice Umbrella

Building Country Capacity

STRATEGIC THEMESOf CRWRC

Sub district performance assessed by using the “Proportions of births attended by skilled birth personnel” indicator.

Netrokona District

Antenatal Care (4 or more visits)

0%

5%

10%

15%

20%

2005 2007

Bengali

Tribal

OR=2.06 [ns] OR=Undef.

Doer/Non-Doer for ANC

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Advantage -Completephysical

examination

Disadvantage- Male doctor

Disadvantage- Loss of

money andtime

Easier -Husband'scooperation

Harder -Superstition

of familymembers

Approves -Mother-in-law

Doer

Non-Doer

AdvantageComplete PE

Male Docs

WasteOf money

HusbandCooperation

Supers-tition

Mothers-In law approval

Qualitative Findings (PLA) • “Heavy work for

pregnant women is good”

• “Less food during pregnancy is beneficial”

• “Less food for moms after delivery will keep them fit”

Goal of Project to reduce mortality and improve health status among the most marginalized mothers and newborns

Study Questions: 1.Does the PI model lead to more equitable outcomes in

MNH compared to the status quo?

2. How does the Peoples Institution model reach the poor and marginalized women and children in their community?

Community Mobilization

Community-IMCI

+

PEOPLES’ INSTITUTION

CRWRC Child Survival

Project

Upazila Health Committee

(Nurses/FWVs/Doctors)

Peoples’ Institution Health Committee

Community Clinics (FWAs/HAs)

Local NGOs (PARI & SATHI)

CHVs TTBAs

Community leaders

Mothers-in-law

Hus-bands

DGHS Civil Surgeon/ DGFP Deputy Director

Ministry of Health and Family Welfare

Union Health & Family Welfare Centers

(Nurses/FWVs/Doctors)

Union Committee Health Team

Women’s Primary Group

Men’s Primary Group

WRAs

LEGEND = supervisory relationship

= public-private partnerships for health service delivery

= public-private partnerships for health policy reform

= community participation

Informal Service Providers

District

Village

Union

Sub-District (Upazila)

National

CHV

TTBA

PeoplesInstitution Health Sub

Team

Health

Facilities

Community

People

Child Survival Program

PRIMARY GROUPS

•savings- based credit

•health promotion

•literacy •agriculture.

Emergency Health Fund

• Monthly contribution of 2 Taka by members.

• Emergency

Treatment

• Transportation

Quantitative Equity Analysis

Characteristics Wealth Quintiles

N Lowest Second Middle Fourth Highest

Total 4,079 20.1 20.0 19.9 20.0 20.0

Area

Intervention 2,038 16.6 19.9 21.2 20.5 21.9

Comparison 2,041 23.6 20.1 18.7 19.6 18.1

Sub-districts

Barhatta 829 21.7 18.8 17.4 20.4 21.7

Durgapur 779 24.0 23.9 21.6 16.7 13.9

Kalmakanda 1,212 24.8 21.0 19.6 19.0 15.6

Kendua 1,259 12.0 17.4 21.0 22.8 26.9

Figure 1.

Qualitative Multi-case Study AnalysisEsytablishes the HOW

• Level of social Capital• Level of community

mobilization• Closeness of household

to health provider• Lay providers are

involved in care and referral

Community Mobilization/

Governance and C-IMCI as Equity

Strategies

Conclusion

1.Active Community Mobilization and C-IMCI appear to be an Effective combination for an Equity Strategy

2.Include equity in the design from the beginning

3. Incorporating Equity in our programs in the right thing to , a moral obligation .

Thank You