Session 7.2 – Community and Opinion Leaders in Priority Setting and Provision
Friday October 31 11:00-12:30
Implementing Disease/Illness Management and Control Programs in Zambia – Experiences from the Equity Gauge Zambia Program
(Abstract 0111)Mary M Tuba, Thabale Jack Ngulube
CHESSORE, Zambia
Background: MoH has been implementing a long-standing policy initiative of promoting community participation in execution of health programs. MoH has expanded this to increase degree and range of community involvement in provision of health care services. Since 2001, CHESSORE has been implementing an Equity Gauge (EGZ) Program in four districts.
Objectives: To strengthen relationships between the public health system and the community by undertaking an empowerment program with both the health system and community to provide and demand for equity and access based on the right to health approach.
Methods: Using a three-pillar approach of (a) advocacy, (b) public participation and (c) measurement joint teams of health workers and community volunteers were provided with skills and tools for undertaking community based, participatory research as a way to better understand their communities and health needs.
Results: This community-based participatory evaluation has shown that, to a large extent, most prioritized health programmes being implemented have low broad community participation. Also, there is comparable and adequate indigenous knowledge that could effectively compliment the “foreign” knowledge.
Policy Implications:
Overall, this work by Equity gauge Zambia is showing that:
- Bottom up information on mapped diseases/illnesses seldom exist in districts.
- Prioritised national health issues may be contrary to community prioritised health issues.
- Some non-communicable diseases/illnesses, which are not in the national health priorities are being managed at community level.
- Access, utilisation to available primary health care interventions are sometimes affected by contrary prioritise between the health system and the community
The Role of Faith Based Organisations in Improving Access to ART Services in Zambia: To What Extent can they Contribute?
(Abstract 0113)Paul Mbewe1, Mary M Tuba1
1Grace Ministries Mission International (GMMI), Zambia, 2CHESSORE, Zambia
Background: The government has signed several international agreements to enable the fight against national health priority areas addressed successfully. One such policy statement reads “to provide equity of access to cost effective, quality health care as close to the family as possible for all Zambians.” MoH seeks to engage diverse stakeholders to attain this goal. In strengthening partnerships between MoH and Civil Society Organisations (CSOs), the government advocates expanded wider stakeholder involvement in promotion and improvement of access to health services. Faith Based Organisations (FBOs) as CSOs, rarely actively participate in health issues. This proposal is a rare attempt to actively engage FBOs in the fight against HIV/AIDS as one aim for the MDGs. .
Objectives: To use an empowerment program as a strategy to promote behaviour change among members of Kalomo Centre, Grace Ministries Mission International who are orphans, widows and other vulnerable due to HIV/AIDS, with the view of promoting as well as improving access to Antiretroviral Therapy (ART) services provided by public health institutions in rural Zambia.
Methods: This project will use Outcome mapping (OM) methodology to detect and account for behaviour changes, with the primary sampling unit being Grace Ministries Mission International at Kalomo.
Results: The empowerment program which has social, economic, spiritual and medical notions, seeks to promote and improve access to ART services in public health institutions among Orphans, Widows and Vulnerable Children in Pentecostal churches, Zambia.
Policy Implications: Can government use FBOs as partners in promoting and improving access to ART services?
Contracting, Participation in Primary Health Care: Lessons from Indigenous Providers in Canada, Australia and New Zealand
(Abstract 0125)Josée G. Lavoie
University of Northern British Columbia, Canada
This paper is concerned with the emergence indigenous primary health care organisations in Australia, New Zealand and Canada. In Canada, First Nations primary health care services are a result of the Health Transfer Policy. In Australia, Aboriginal Community Controlled Health services first appeared in the 1970s as a result of community mobilization, aiming to provide some access to free health care to Aboriginal people. A more recent model, the Primary Health Care Access Program, aims at guaranteeing Aboriginal access to comprehensive primary health care services under the authority of Regional Aboriginal Health Boards. In New Zealand, Māori providers emerged as a result of the market-like conditions implemented in the 1990s, and now compete for primary health care funding alongside other providers. A comparison between these approaches suggests that indigenous providers derive some benefit from the mechanisms, both in terms of capacity building and potential health gains. The overall primary health care system creates as a result of these mechanisms is highly fragmented and inflexible. Efficiencies may be attained by rethinking the system as a whole. This paper will describe the context that led to the emergence of indigenous health providers in all three countries; use international research evidence to explore the contractual environment that resulted; explore the strengths of each model; and suggest areas where efficiencies may be gained.
Role of Religious Leaders, Community Leaders and Health Professionals as ‘Genuine’ Advocates of Family Planning in the Slum Areas of Karachi, Pakistan: A Qualitative Study
(Abstract 0020)Azmat Syed Khurram1, Brown Graham2
1Human Development Programme, The Aga Khan University, Pakistan, 2School of Public Health, Curtin University of Technology, Australia
Understanding opinion leaders’ views to contraception is a very important step towards developing successful family planning programmes. This study describes perceptions of opinion leaders; the religious, health, and community leaders and the barriers they identify for family planning in slums of Karachi, Pakistan. A qualitative study using semi-structured interviews and a purposive sample of 20 opinion leaders (8 religious, 6 health and 6 community) was conducted. Thematic analysis was used to generate themes. All leaders supported the central theme, that ‘mothers are treated as machines’ by the husbands and in-laws, and disapproved of consecutive pregnancies. Islam does not approve of acts of subjugation upon the weak, especially mothers. Further themes identified included ‘mutual decision making in childbirth and family planning as valued’; the benefits of family spacing and planning’; and ‘willingness of the people to accept new ideas and ways of treatment’. Some religious leaders viewed ‘spacing as conditional and considered family planning as a sin and a Western conspiracy’ against Muslims. Condom use was supported by all leaders but context varied. Nevertheless, building capacity for understanding and cooperation between opinion leaders was reported as a way resolve issues of family planning. Genuine ‘opinion leaders’ in Pakistan plays a powerful role as advocates for reproductive health programmes. Cooperation among religious leaders and health professionals in Muslim communities for the provision of information, counseling and advocacy on this issue may be an achievable way forward. These findings may be applicable to working with Muslims living in Asia and Europe.