Download Reducing Maternal Mortality in Haiti’s South East Department

Outline
• Issue: Reducing Maternal Mortality in Haiti’s
South East Department
• UNICEF Action – Information, Education,
communication (IEC):  CLTS &
Corpovisionarios
• Adjustments to future work in Haiti
Advances in Social Norms and Social Change Course.
Joyce Brandful. University of Pennsylvania - July 2012
JOINT PROJECT (2009 – 2013)
2009
 Low utilisation of
health services
• Ministry of
Health
/CIDA
 High dependence
on local midwives
/TBAs
Policy &
Staff
 High death rate
due to
complications
and delay
 300350/100,000
births
• WHO
Equipment &
Supplies
&
Training
Guidelines
IEC for
Bhv.Chg.
• UNFPA
• UNICEF
•
•
•
•
Assessment
Priority Setting
Communication
Plan
Implementation &
Monitoring
Design Preparation & Implementation
Maternal Mortality Project
SIMILAR
External Project Managers
Community Led Total
Sanitation (CLTS)
Use of statistics (EMUSS)
CLTS, Coporvisionarios
(CPV) - violence against
women
Other techniques for
information collection
(KAP)
CLTS (Walk of Shame)
DIFFERENT
CPV : Focus Groups,
Interviews, Direct
observation, survey
Presentation of findings
(delayed)
CLTS : “Ah Ha” Moment
CPV: Diagnosis and
Community Prioritisation
Community Meetings to
adopt Communication Plan
for Behaviour change
CPV : Value Deliberations
CLTS: Collective decision,
commitment & public
declaration
Facilitation (Exclusively
External Team)
CLTS; (local Core Group
 Trust)
KAP Study Findings (Girls and women 15-49 yrs)
•
Knowledge (Factual Beliefs)
– TBA : repository for information on maternal health issues: They have mystical powers
and are knowledgeable in traditional medicine.
– Wrap bandage tightly around stomach to regain former shape
– Use hot bath & herbs to restore organs and genitals to original state after birth
– Bury the placenta and plant a tree. The baby will grow as strong as the tree.
– Health personnel are unfriendly. The also mock traditional rites and rituals.
•
Attitudes and Practices
– After first visit to health centre, consultations continue with TBA
– TBA bonding with entire family through visits and meals.
•
IEC Activites:
– Health centre interpersonal based sessions
– Mass media (radio and posters)
•
Normative Expectations*:
– Fully clad, windows closed after birth otherwise “womanhood” is compromised;
– Family celebration after the birth is a must.
Exclusive use of TBA services and Home Delivery
Custom or Social Norm?
Convenience
Necessity
Repeated
Action
Normative
expectation
Empirical
Expectations
Widespread
Conditional
Preference
Mutual social expectations
Bury the Placenta Incentive
(Belonging)
No party: Sanction (loss of
recognition)
HYPOTHESES:
 Social Incentive + Social Sanction both present, THEREFORE Reliance
on TBAs has become a social norm.
 The social sanction appears to be not severe or permanent effect,
THEREFORE is weak and unstable. It should be relatively less
challenging to shift or replace the social norm.
Implications for future work (1 of 2)
•
Opporutunity & Challenge
– Implementation :just about to start
– Time bound project
•
Focus & Linkages
– Shift from “population at risk” to community relations, and social norms
– Link individual with relevant networks in the community : Practices , Embedment,
structure relationships, interdependence, etc.
– Involvement of girls and women, as well as their family, women’s groups and larger
community
•
Information collection & monitoring
– Continue relevant network meetings in community with focus on beliefs and
expectations
– Initiate data on social networks to see possible links to other groups in the project
– Provide / or add to empirical work about Social Norms in Haiti
Implications for future work (2 of 2)
• Implementation
– Isolate the core values from peripheral ones
– Identify the core group / natural leaders
– Sustain community discussions  Common knowledge  value
deliberations  social learning
– Facilitate with relevant skills and competences
– Implement the C4D strategy holistically
• Creativity in Communication
– Hook on to core value
– Tie in with factual beliefs and empirical expectations
– Include all relevant reference networks
• Coordination
Conclusion: Why change?
•
Coordination
–
–
–
–
–
–
3 Partners + MoH;
Separate group focus.
Juxtaposition  Synergy
Reduce fragmentation and
segregation.
Identify potential
interdependent social
networks to advantage
Improve integration of
interventions through links with
potential social networks/core
groups
Reduce transaction costs where
possible.
WHO
N
N
UNFPA
G&W
N
UNICEF
N
•
Transformative Agenda of UNICEF (Human Rights Principles
for development)
Equity (including the voices of marginalised and minorities.)
Ownership
Capacity development of Rights Holders and Duty Bearers
Sustainability
Back to Basics
Let’s Walk the Talk !!