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Diagnóstico rural participativo (Tanzania)
1. PRA Introduction Briefly history of MdM in TZ
Estimated population (Census 2002): 38,329,000 PHC (1995-2000)
Extension: 3 times Spain
Ethnic diversity: more than 120 ethnic groups Arusha Region (Karatu District)
Official language: Swahili and english
IDH 2007: 159 (177) HIV/AIDS (2000-2008)
IDG 2007 (Renta, Alfab, Esp.Vida):
138 (157) Pwani, Arusha and Zanzibar
Poverty. 57.8% de la población vive por debajo del
umbral de la pobreza (1$ día) SRH&R, since March 2009
Economy. Crecimiento anual PIB entre 6 y 7% Pre-identification process (10/2007-03/2008)
Agriculture. Criteria of MdM, extension, sub-sector
(50% PIB; 85% X; 90% trab.)
48 regions. 13 indicators (poverty, access to health and SSR)
Cultivable. 4% de superficie
Cultivos 13 district preselected (communication, logistic, knowledge)
Consumo interno. Maíz, arroz, trigo,
Questionnaires (neccessity, capacity, resources) to DMO
mijo, alubias
Exportación: café, té, flores, sisal, caña Selection of Same and Singida (March 2008)
de azúcar, cebollas
Otras exportaciones: tanzanita, oro, pesca,
Rapid rural appraisal on Same and Singida. April/May 2008
turismo Interviews with community members, focal groups, secondary data
Participatory Rural Appraisal (PRA). 3 months
Program cycle (Same Program) Characteristics of Singida Rural District
Year 2009: Opening of program and office
PRA = MdM works in 2 Divisions (Comarcas) among 7
IDENTIFICATION process May-July 09 divisions in the District (Provincia) (whole district cover
in 9 years by phases)
Revision of results and
reformulation in August 09
Population: around 80.000 inhabitants (census 2002)
collaboration with SDC
Different ethnic groups.
From Sept 09 Nyaturu majority
Implementation of Program Activities
High extension and low density
Continuous Evaluation From Sept 09 Singida Region is the poorest region in TZ
PRA LIMITATIONS Some PRA Techniques and Results
In the Community meetings Secondary data sources
Poor participation of women Population for every village range between 3500 – 4000
(1570 male & 1960 Female)
They have big expectation from Medicos del Mundo
VEOs doesn’t have data relating with health
Majority of participants ask what is next after PRA problems in the village.
Data from Health facility shows that the top five disease
Poor coordination between Village Executive Officers and are, Malaria, Diarrhea, ARI, Pneumonia and Anemia
community
In the village that doesn’t have health facility we fail to
In some village the participants were not the initial ones have statistical data of health problem from VEOs
Language barrier (kinyaturu vs kisuahili)
Cholera
2. Some PRA Techniques and Results Some PRA Techniques and Results
Interview to youth (FGD) Interview to PW: age range (19 – 48 yrs)
Age range (18 – 34) Delay to attend clinic during pregnant period, one with nine
month attend only two time
Lack of Knowledge on SRH & R (77% of youth interview
lacked SRH&R knowledge) Most of them deliver their previous pregnant at home and still
they are planning to do so. (65% under TBAs and 35% under
Sexual harassment done to the student by their teachers HCP)
Early pregnancy (85% responded on presence of early pregnancy) Workload of PW was very high, minimum they are working almost 14
to 17 hours per day
Lack of knowledge about Sexuality and HIV
Lack of support from their partners (only 46% receive support)
They know about condoms but never use it (96% knows, but only
27% use it) Distance to the nearest health facility rise between Half to 15 km
Parents are not transparent to them on issues related to SRH & R Transport fees range between 20000/= to 30000/=(11.4 to 17.14
Euro)
Behaviour, like using drugs, robbery, cigarette and alcoholism
Poor balanced diet
Some PRA Techniques and Results Some PRA Techniques and Results
Interview to TBAs: age range (45 – 75 yrs) Gender Resources Mapping and pictorial
Lack of support from government Gender Based Violence
Associated with unequal power relation & decision making
Women beaten with theirs sexual partner
Most of them are not using protective and delivery equipment Sexual abuse and harassment
Patriarchal system
Most of them attend 3 to 10 deliveries and even more women Sexual suppression
within a month (example Ghata Village)
FGM: (information were provided in a very secretly way)
Some refer the complicated case to nearest health facility
Still practiced very secretly to new born babies except Merya village
Most of them are aged In FGD they mention a lot of advantage and few disadvantages
Some wish to stop
Lack of knowledge on SRH & R (96% lack the knowledge)
Raping cases
They don’t have a skills on detecting complicated cases Marital raping were noted (happen when one spouse forces the other
to have sexual intercourse)
There are reported raped cases by more than one man
Some reported that even children are raped (example in Ilongero were
2 children were raped to death).
Pair wise ranking General impressions of facilitators
lack of HF in many villages, long distance from households to HF in
Need Num villages on Position
st
Comments/result 62 villages we have only 17 health facilities
1 position Shortage of skilled staff and equipment: discourages patients to
attend the HF
Education on SRH&R to the community 17 1 Early and unwanted Difficult access in some villages for emergencies due to bad situation
pregnancies of roads
Lack of safe and clean water 10 2
TBAs have an active role in their community but most feel
not recognized by authorities
Absence of Health facility 9 3 Most PW not attend clinic and Lack of motivation to VHC
Home delivery
Lack of Income generating activities
Diseases 8 4 Malaria, Pneumonia, Alcoholism, Drug abuse
Diarrhoea, Food insecurity
Out dated traditional and customs 7 5 FGM Illiteracy especially to women
As a result of illiteracy and lack of income generating activities
Poor infrastructure 6 6 Weather roads opportunities :
Poor health services 4 7 Human resources and Imbalanced decision making and resource ownership between
equipment men and women
Domestic violence 4 8 Patriarchal, Women beating,
Gender based violence: raping , FGM, biting women & children
Raping Lack of family planning: economic burden for families, lack of
opportunities
Poor Nutrition 4 9 PW and children are more
affected