1. Decoding Healthcare Access under Climate Crisis: A Case Study of the Sundarbans FHS-India Country Presentation Uganda, 4-6 th June, 2012

2. Research Background Primary focus: Child health under Sundarbans area of India (4.4 million population), especially the core hard-to-reach areas Unique space for learning how people are excluded from health service delivery due to complex interplay of : Unique geo-climatic adversities Poverty –Inequality dynamics Communities’ potential to adapt Extra burden of ill health Weak existence of formal health care providers Need for a unique health service delivery model to reach the excluded

3. Main Research Question What would be the most feasible & sustainable strategy to reach the excluded children with quality and appropriate basic health care package? 3

4. Research Plan Scoping studies Knowledge to Policy to Action platform Enabling environment for innovative interventions in vulnerable islands Evaluate interventions and generate evidences on what works

5. KPA Platform A common knowledge/ learning platform Health Watch Report Capacity building of local stakeholders Translating local knowledge into global

6.  IRB approval clear for Scoping Study  Data collection for scoping studies completed (in one block).  Briefing with the policy makers, ministers as well as researchers.  Media buy-in: both state & local level  Dialogue started with STEPS center for complementary research What has been done so far?

7. Scoping Study Framework StudyMethodologySample Study 1: Analyzing the demand side of child health care system Household Survey 30 Villages-1170 HH Rapid Ethnographic Study 2 villages each from Deltaic & Non-Deltaic GP Study 2: Assessing existing supply side potential for protection and maintenance of child health Facility Assessment Sample of all formal and informal providers Exit InterviewsApprox. 200 users covering all sample providers GIS MappingAll providers Study 3 : Institutional Analysis-- Assessment of arrangements and network between various institutional actors Social Network Analysis a) Ego Network b) Whole Network Conducted in same villages as in Rapid Ethnography Study

8.  Significant difference b/w deltaic and non-deltaic in terms of supply, demand and institutional network  Informal providers: -Absolute dominance-good knowledge bad practice -Socially in a better position and well- networked-gaining political importance  The standard definition of distance and other access indictors often fails to explain inaccessibility. Some Preliminary Observations

9. Preliminary GIS Findings : Government Health Facilities in Patharpratima RMP and Nursing Home in Patharpratima -Concentration Zone (www.healthgis.org)www.healthgis.org

10.  UCC: Analyzing the link between community’s resilience, adaptive mechanism and child health care through ethnography and social network analysis.  CAS: Using Social Network Analysis to explain the complex relationships and its impact on child health care.  Learning by doing: Local stakeholders (NGO) are involved in the research process. Links to Cross cutting themes

11. Timeline going forward May, 12 Data collection for scoping studies completed July- August, 12 Sundarbans Health Watch Report published KPA platform – first workshop Sept, 12 First set of interventions designed Proposal drafted and pushed for funding (by NRHM / donors)

12. Challenges  Dealing with socio-political dimensions imbibed in community’s potential  Linking supply-demand-institutional analysis in a common framework  Sensitizing the local stakeholders’ on child health in less accessible region

13. Support desired from the group  Social Network Analysis  Paper writing

14. THANK YOU