Better human health services starts with a healthy attitude to access for women and the world’s poorest

By Lisa Hadeed, CARE International senior communications coordinator

Access to basic things many take for granted -- healthcare, water, food, and a chance to work and earn a living, stand between a thriving society that can meet its needs while contributing to wider global stability. The plight of the poor affects us all and most of the world’s more than 1 billion people living in poverty are women whose health – including sexual and reproductive health – is compromised or neglected.  

Promoting equality, social justice and hope for the world’s poorest, among them women, CARE has been working for decades in countries with some of the highest unmet needs for family planning services and some of the highest maternal mortality. The figures are staggering: In 2015, approximately 303,000 maternal deaths occurred globally with 99 percent of these occurring in the developing world. Most maternal deaths are actually preventable and family planning services remains an unmet need for more than 200 million women worldwide. Moreover, women are disproportionately affected by systematic social or cultural denial of rights, for example, through child marriage, inadequate education, lack of land tenure and interpersonal violence.

The 2030 Agenda for Sustainable Development consists of 17 goals for achieving health, peace and well-being. As Europe’s leading forum on development, European Development Days (EDD) dedicates its tenth such event to the 2030 Agenda, facilitating sharing among the development community to inspire new partnerships and solutions to the world’s most pressing challenges.  Addressing the health challenges in developing countries and harnessing the potential of partnerships to fill health gaps is a priority as evidenced by the high-level panel on Sustainable Health Care for All by 2030: Shared Effort for a Common Goal - POLITICO High level panel in which CARE is participating at EDD. Health services and health infrastructure are lacking in developing countries. Where these services exist, access is either limited or unavailable, often to those most in need. So are more health systems and services the answer? Yes – in part. Because services must be accompanied by social change to address attitudes around gender inequality, policy barriers, and power imbalances that have an impact on health. Planning for health services must integrate resources, training and initiatives that stir social change away from a mind-set and values that currently hinder women from accessing much-needed services.

Agnes Kaka, 47, is the only trained midwife at the Pariang hospital. She helps five to ten women per week giving birth. Every day from 8:30 am till 5:00 pm she receives pregnant women and mothers in her small office. Photo Josh Estey/CARE

By 2020, CARE aims to help enable 100 million women and girls exercise their rights to sexual, reproductive and maternal health and a life free from violence. To address sexual, reproductive and maternal health (SRMH), CARE has taken a Social Analysis and Action (SAA) approach, and activated dialogue about gender, power and health, and engaged community leaders to advocate for gender equity. It is an approach that is focused on enabling communities themselves to determine the actions they will take to address the social norms that adversely affect their health and well-being. At the same time, CARE uses a number of proven curriculum packages and tools that provide young people with basic sexual and reproductive health information while simultaneously addressing underlying gender norms and power imbalances.

Between July 2011 and December 2015, CARE supported 93 primary health centres and referral facilities in Chad, Democratic Republic of Congo, Pakistan, Mali and Djibouti to deliver high-quality contraceptive services, family planning counselling and post-abortion care to an estimated combined population of 2,428,145 people, of whom 698,053 were women of reproductive age. In Bangladesh, CARE’s Community Health Worker Initiative is a unique public-private partnership between the government, the community and a new cadre of private, community-based, skilled, female health providers, a project supported by Glaxo Smith Kline (GSK). Private health care providers are recruited from remote, under-served local communities and receive accelerated, skills-based training using World Health Organizations and Bangladesh Ministry of Health accredited curricula. They are supervised by the government in collaboration with the community and negotiate fair and transparent rates for their services which families can afford and which fairly compensate women for their work while a government fund covers families who cannot pay. As of December 2015, this initiative had developed 169 new community-based skilled private health providers and improved utilization of pre-natal care and skilled birth attendance.

In Bihar, one of India’s largest and poorest states, innovative approaches are improving and saving lives. There, mortality rates for both mothers and their infants are among the highest in the country and one-third of people lack access to health care services.  Extreme poverty, gender and social inequality, low literacy rates and early marriage further compound Bihar’s reproductive health crisis. With funding from the Bill and Melinda Gates Foundation, in 2011 CARE developed a number of innovative approaches to empower and motivate health workers, and ultimately improved the quality of training and service delivery.  Many of the interventions have been simple but the results are remarkable. The project is now reaching some of the poorest and most marginalized women and families that previously had no access to services. Home visits by healthcare workers during critical times of care increased, meaning that more pregnant women, mothers and newborns receive life-saving interventions.

Women  in the arid Afar region of north-eastern Ethiopia where CARE supports WASH and women's empowerment projects. Michael Tsegaye/CARE.

CARE further works to end early marriage. Each year, 15 million girls around the world are married before the age of 18 years. Girls who become chid brides have their lives changed forever and they are more likely to drop out of school, have health and pregnancy problems, face domestic abuse and remain in poverty. To tackle child marriage, CARE’s work to ensure that girls are not under-valued and that they are valued as much as boys entails changing beliefs around child marriage by working with people at all levels of the community, from child brides and grooms to mothers-in-law, local authorities and civic leaders.

Obtaining a better picture of need and impact is important to filling gaps in quality and access in “real time.” CARE’s Community Score-cards (CSC) system is a citizen-driven accountability approach to improve coverage, quality and equity of SRMH and general health services. Conducted every six months, this approach brings together service providers, local authorities and citizens, helping to identify service delivery challenges and working with partners in developing a shared strategy for their improvement. Since pioneering the CSC methodology in 2002, the CSC has become an internationally recognized social accountability tool, spreading within CARE and beyond. CARE has been implementing the CSC across a range of sectors, including health, food security, water and sanitation, education and governance, in countries such as Cambodia, Tanzania, Malawi, Ethiopia and Egypt.

The quality of a society’s health services is often an important indicator of its overall success and stability. Looking at sustainable financing models for health, it is essential to invest in targeted funding for specific actions addressing gender and the specific needs of women and girls. As global health experts, CARE knows that the science around what to deliver in maternal and newborn health is well-established, but the ways to do it effectively and efficiently for the greatest impact, needs dramatic improvement. The availability, acceptability, accessibility and quality of health services are often limited by the health system and health service barriers, leaving individuals and communities without quality health services and with unfulfilled rights. Working in many countries around the globe, we see that service providers and actors within the health system often face barriers of their own to accessing quality equipment, infrastructure, and supplies. New sustainable, context-sensitive, approaches to understanding and overcoming the challenges to service utilization, quality and equity, in context, are required now.

 

A snapshot of CARE activities at EU Development Days: