11 Community Health Partners for Empowerment, Voice, and Accountability at Local Level (CHP-EVA)

Project Profile  Goal To strengthen voice of the citizens and communities for improved demand-side accountability of district health services and to strengthen engagement of Community Midwives (CMWs) for a sustainable networking and service provision at the local level  Project Duration : 2-year project –  Phase 1: 07 months (April – November) 2015  Intervention Area: District Lodhran 3-Tehsils  Lodhran  Dunyapur  KarorPacca 2

Beneficiaries  40 CMWs working in 3 Tehsils of District Lodhran  120 LHWs working in 3 Tehsils of District Lodhran  100 community members actively engaged through committee meetings and events.  55 members of high level community committees capacitated to raise voice and articulate demand for improved services.  500 community members informed through information products and communication materials  40 Health Officials engaged in events and activities. 3

SBA attended deliveries: 68 % <5 years Mortality: 94 Infant Mortality rate: 72/1000 Maternal Mortality rate: 222/100,000 Contraceptive prevalence rate: 45.3 SBA attended deliveries: 68 % <5 years Mortality: 94 Infant Mortality rate: 72/1000 Maternal Mortality rate: 222/100,000 Contraceptive prevalence rate: Existing Situation (District Lodhran) Supply Side Demand Side Skilled Birth Attendants: CMW: 45 LHW: 938 Doctors: 56 LHVs: 56 Public health facilities: 55 (DHQ; THQ; RHC; BHU) Privates Sector Low Health Indicators Disconnect Challenge CMW-Community Midwife; LHW-Lady Health Worker; LHV-Lady Health Visitor; DHQ-District Headquarter Hospital; THQ-Tehsil Headquarter Hospital; RHC-Rural health Center; BHU-Basic Health Unit; SBA-Skilled Birth Attendant

Existing Structure Village/Union Council Level Tehsil Level District Level Village Health Committees – an active platform for community engagement Involvement of health workers and community members Executive District Officer-Health, Integrated Reproductive Maternal Newborn Child Health program Tehsil / District Health Department

Filling the Missing Link 6 Village / UC Level Tehsil Level District Level District Health Department Tehsil Health Officials Village Health Committees Lady Health Workers District Health Support Committee Tehsil Health Support Committee Innovation Adaptation of Mappay Model Aggregating parental voice for improvement in education

7 Tehsil Health Support Committee Aggregating Voices of Community Members District and Tehsil Health Support Committees Health Committees at Village/UC Level Aggregating the voice of community at Tehsil level Aggregating the voice of community at District level District Health Support Committee

8 Community Health Partners for Empowerment, Voice and Accountability at Local Level (CHP-EVA) Supply Side Demand Side Strengthen system on referrals & establishing referral links Capacitate Health Support committees for oversight &support functions Demand Articulation & oversight of MNCH services Capacitate & mentor CMWs on EmONC services Establish Tehsil/District Health Support Committees

9 Decisions for better Health & Nutrition Decision support system DOH-Lodhran Community Groups THSC DHSC Health Department LHW’s M/F VHC 9-15 members: Community reps CMW LHW LHS Media representative members Community reps LHS CMWs Local leadership Others… Theory of Change Creating Decision Support System Services THSC- Tehsil Health Support Committee; DHSC- District Heath Support Committee

10 The Intervention in Tehsil Lodhran Supply Side Capacitate LHW on referrals & establishing referral links Capacitate & mentor CMWs on Basic EmONC services 13 CMW on Basic EmONC services and Orientation of LHS to referral mechanism Referral Flow Charts translated in Urdu. LHS oriented to referral mechanism EmONC – Emergency Obstetric Newborn Care

11 The Intervention in Tehsil Lodhran Demand Side Reactivation and Functionalization of Village Health Committees 40 Female Support Group meetings 20 Male Village Health Committee meetings 15 Functionalized male VHC

12 Community Health Partners for Empowerment, Voice and Accountability at Local Level (CHP-EVA) Demand Side Establish Tehsil Health Support committees Selection of THSC members from 65 participants Consultative meeting on Guidelines for Establishing Health Support Committees at Tehsil & District Level 15 Members of THSC selected

ACHIEVEMENTS 13

14 Demand Generation From THSC Clean drinking water availability Demand for ambulance for the RHC Placement of CMWs in more needed areas

Recognition from EDO-Health 15

16 Liaison With District & Provincial Dept. Of Health Liaison and Coordination with District Health Officials; (EDO-H; DCMNCH prog); and other stakeholders MOU with Provincial IRMNCH Program Punjab

Lessons Learnt & Challenges Demand Side:  Varied donor focus  Previous experiences of community with some organizations made them reluctant to cooperate  Effect of non functional and low functioning VHCs 17

Lessons Learnt & Challenges Supply Side  Reluctance of Community Midwives to attend training  Training in local language is well received by Community Midwives  Restriction to work for NGOs: Procedural delays in formal approval 18

Sustainability & Way Forward  Building upon the existing structure (Village Health Committee)  No financial incentives involved in mobilizing the community  Transforming community demand into administrative actions  Opportunities for alignment with government structure and plans i.e. District Health Committees  Availability of similar structures and opportunities in other districts and provinces of Pakistan 19

20 Thank You