leadership for reproductive health (lrh-ii) · of population development and reproductive health....

Dossier Training Session on Citizen Participation and Reproductive Health

20th March, 2011

Leadership for Reproductive Health (LRH-II)

(Dossier Training Session on Governance and Citizen Participation in

Reproductive Health)

TRAINING REPORT

MARCH 20, 2011

La-Taska Village, Lodhran

Prepared by: Imtiaz Ali Shah


20th March, 2011

Table of Contents

Executive Summary ................................................................................................ 3

Resource Person Profiles .......................................................................................... 4

Introduction ........................................................................................................... 5

What is Community participation .............................................................................. 5

Governance and Health Care System ......................................................................... 6

Objectives of Governance Participation and formation of Citizen Committee ................... 7

Conclusion and Way forward .................................................................................... 7

Annexure -1 List of Participants ................................................................................ 8

Annexure -2 Case Study: Why Did Farida Die ........................................................... 11

Annexure -3 Presentation ...................................................................................... 13


20th March, 2011

Executive Summary

LEAD Pakistan conducted the last DTS (Dossier Training Session) on „Citizen Participation

and Reproductive Health‟ for the CLIG (Civic Leadership Implementation Group) Lodhran.

The Dossier Session was attended by 26 CLIG members.

The purpose of the Dossier Session was to enable the participants to:

Develop understanding of community and citizen

Understand the basic concept of community participation

Get sensitization on the importance of citizen participation

Understand health governance and health care system

The DTS was divided into different parts. The first part of the Session focused on introduc-

ing the concept of participation and approaches of participation, how one could stimulate

people to be actively involved for achieving any goal. The second part focused on gover-

nance, it also focused on how good governance can improve health care systems. The last

part of the session included the objectives of governance participation and techniques that

are used in making the governance more effective.


20th March, 2011

Resource Person Profiles

QAZI, Dr. Muhammad Suleman

Dr. Muhammad Suleman Qazi is Health Advisor for LEAD Pakistan since February 2010

where he advises the organization in the implementation of its agenda on Health. He guides

LEAD in defining the areas of interventions and targets from short-to-medium term action

plans; prepares policy briefs on Health; acts as resource person on need basis and re-

views/comments on LEAD documents, papers, briefs and workshop materials on Health.

Dr Qazi served at UNFPA, Balochistan as Provincial Coordination Officer [April 2006 - June

2009] working on MDGs at the provincial level and assessing provincial economic, social and

political situation in the context of its potential impact on the UNFPA‟s programs in the areas

of population development and reproductive health.

Dr Qazi has also worked in similar capacities with national/multinational development agen-

cies such as United Nations Program on HIV-AIDS; Mercy Corps, Oxfam, and Taraqee Foun-

dation Balochistan. He is a member of National Volunteer Movement and Population Asso-

ciation of Pakistan and has several professional publications to his credit.

Dr Qazi has a Master‟s in Health Policy and Management from Aga Khan University Karachi

and a Bachelor‟s in Medicine and Surgery from Bolan Medical College,

University of Balochistan.

SHAH, Imtiaz Ali

Young Professional Officer, Project Management Department (PMD)

Imtiaz, as YPO PMD since July 2009, Imtiaz lends his support to the department on a range

of activities including liaison with field offices and overall smooth functioning of projects and

their evaluation. He has also facilitated trainings at LEAD.

Imtiaz has been a Research Assistant with SDPI and an Intern Crime Reporter at The News,

Lahore. He has a master‟s in Educational Planning and Management from NUML and BS

(Hons) in Communication Studies from Punjab University Lahore.


20th March, 2011

Introduction

Introduction and case study

The training started with the welcome note. The welcome note emphasized on the need for

conducting such skilled training courses for CLIG of District Lodhran. After the welcome note, Dr Suleman Qazi instigated the participants with a case study to

read: why did Farida die? They were asked to discuss the possibilities of the death of

Farida, thus enabling them to identify the whole system, its social, economic, cultural, bio-

logical and moral aspects. Dr Qazi started from health care system and took them to a

much broader health system: highlighted the reasons, determinants and factors behind the

health outcomes e.g. maternal mortality. They were asked to identify and putting in col-

umns the factors responsible for Farida's death. Case study Annexure 2

What is Community participation

The first part of the dossier training session

highlighted some basic concepts of Communi-

ty participation. The concept of „Participation‟

was discussed in detail. Participation was de-

fined as „Mutual understanding for the

achievement of a common objective, having

sense of ownership, raising awareness for

problem identification, and optimum utiliza-

tion of available resources by adopting a

strategy that is implemented and analyzed‟.

Community Participation was elaborated in

detail through an elephant‟s picture sur-

rounded by the blindfolded depicting that the

community participation can be understood in

variety of manners.

The group was sensitized on the importance of

community participation in any development

project. It was emphasized that development is

impossible if there is no community participa-

tion and ownership of development objectives,

strategies & action plans.

Some of the benefits of community participa-

tion were listed as follows:

Achievement of self reliance at community

level. Exploration of hidden resources.

Better utilization of resources.

Better planning.

Contribution to development and progress.


20th March, 2011

Sharing responsibilities of different outcomes.

Development of sense of ownership of community members.

Sustainability of development initiatives.

Exploration of job opportunities.

Gender mainstreaming in the development process.

At the end, various types of participation such as active participation, passive participation,

participation by consultation, and participation for material incentives were explained to the

group.

Governance and Health Care System

Governance is about rules that distribute roles and responsibilities among societal actors

and shape interactions among them. These rules can be:

Formal, embodied in institutions (e.g., democratic elections, parliaments, courts, sectoral

ministries) and

Informal, reflected in behavioral patterns (e.g., trust, reciprocity, civic-mindedness)

Considering this, the session was

designed to explain various com-

ponents of Governance including,

health governance and power in-

equalities, governance levels, good

health governance and objectives

of governance participation.

The complete process of health care system along with it‟s over all goals and outcomes

were explained to the participants. Each component of this model was explained through

various local examples.

The trainer elaborated health governance and power inequalities and explained good health

governance in detail:

• Responsiveness to public health needs and clients/citizens

preferences

• Responsible leadership to address public health priorities

• The legitimate exercise of clients‟/citizens‟ voice

• Institutional checks and balances

• Clear and enforceable accountability

• Transparency in policymaking, resource allocation, and per-

formance

• Evidence-based policymaking

• Efficient and effective service provision arrangements,

regulatory frameworks, and management systems


20th March, 2011

Objectives of Governance Participation and formation of Citizen

Committee

After the brief discussion on governance and

health care system the trainer discussed the

importance of governance participation and

the role of citizen committee. Trainer briefly

discussed the effectiveness of technical input

and effective voice for governance participa-

tion.

He further shed light on the importance of citi-

zen committees to overcome the governance

challenges.

Conclusion and Way forward

The session concluded with the focus on CCRH (Citizen Committee for Reproductive Health).

The trainer emphasized that CLIG (Community Leadership Implementation Group) in Lohran

is an example of CCRH. It can bring together local leaders, government officials, health ser-

vice providers etc to address issues related to health service quality.

Participants and trainer unanimously agreed that CCRH can most readily help to improve

the quality of below mentioned dimensions of health care system

• Access to services

• Utilization of services (through community mobilization)

• Interpersonal relations

• Physical infrastructure


20th March, 2011

Annexure -1 List of Participants


20th March, 2011


20th March, 2011

Annexure -2 Case Study: Why Did Farida Die

This is story of Farida, 35 years, who lived in a village along the coastline with her hus-

band, five children and her mother-in-law. Like other girls from the village, she had nev-

er gone to school. At the age of 14, she got married to Allah Rakhio. Allah Rakhio was a

poor man who worked on a fishing boat, owned by a local lord. His monthly earnings

were Rs900 and since the whole family could not survive with this amount, Farida also

worked at the lord‟s house as a maid and also took care of his cattle. Though she used to

work until the night, she only received Rs300. Farida had three sons and two daughters

and this was her ninth pregnancy. She had two miscarriages and her one-year-old

daughter had died of diarrhea. She had no desire for more children. Farida never used

contraceptives. She wished to, but her husband forbade her and threatened to divorce

her if she did. He believed that Allah gives and provides for children. In this belief, he

follows the teaching of his “pir”, or spiritual guru. Lady health visitors (LHV) from nearby

rural health center (RHC) had also advised her not to have any more children because

she was too weak and was severely anemic.

At this point she was seven months pregnant. A week before giving birth, she felt very

weak and told her mother she feared she would not survive this birth. At the time, her

anemic condition, which later became obvious, was not recognized by her family, and

especially by her husband. One day, while she was cleaning the floor at the lord‟s house,

she felt pain and started bleeding. The husband held a great deal of faith in local village

doctor (actually a quack). When he was called, he prescribed aspirin for the relief of

pain. Her condition deteriorated further. She was taken to Dai (Traditional Birth Atten-

dant), who had recently been trained by RHC. She immediately identified that Farida had

to be taken to the hospital. By then, Farida‟s husband was gone out on a fishing trip to

the river and village people were not supposed to take her without her husband‟s per-

mission. The MCH clinic in the village was consulted which could offer only analgesics,

and not the blood transfusion. Transport to the RHC was to be the family‟s responsibility

according to the official policy. Farida‟s family could not afford to pay for the transport.

Dai had assisted Farida in giving birth to all her children and she considered her a daugh-

ter. Dai decided on her own to go to the RHC to bring the doctor or the LHV, so that Fa-

rida‟s life could be saved. The hospital was across the river, which was four kilometers

away from the village.

Dai traveled on foot for three hours, but when she reached there she found out that the

LHV was no more there because she had been posted in the minister‟s village. The lady

doctor was gone to the secretary health‟s office to request her transfer to the city district

hospital. The male doctor refused to accompany her because there was no one else to

look after the hospital. Dai remembered that this RHC was built after so many hardships,

through community funding and international donations. Land was provided free of cost

by the villagers, who desired that at least women and their children should have a health

facility. With tears in her eyes, Dai returned to her village, she was given the terrible

news of Farida‟s death an hour before, due to loss of considerable amount of blood, after

giving yet another birth.


20th March, 2011

Farida‟s mother confirmed how late the husband became aware of his wife‟s critical state.

Mention was also made of how hard she worked and how little she ate after her husband and

children had been fed. She knew how to bear her sorrows in silence. Her husband always

praised her because she was uncomplaining

Discussion:

Identify specific reasons for Farida‟s death.

What factors contributed to her death at the household and community levels, the

health system level, and in sectors outside the health system, including policies?

What measures would you suggest for improving things so that other women like Fa-

rida might have a better chance of surviving pregnancy and delivery?


20th March, 2011

Annexure -3 Presentation

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