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Nepal - Background <ul><li>Prides itself in never having being colonized </li></ul><ul><li>Was the only declared Hindu Sta...
<ul><li>March 12 th  2011 </li></ul><ul><li>CORE – Equity Session </li></ul><ul><li>CARE Nepal’s CRADLE Project </li></ul>...
Nepal
Project Districts
<ul><li>CB-NCP: In Doti </li></ul><ul><li>BPP: Kailali </li></ul><ul><li>CB-IMCI: In Kailali, and Doti </li></ul><ul><li>H...
Wealth and Assets Source:  Bennett, Lynn, Dilli Ram Dahal and Pav Govindasamy, 2008.  Caste, Ethnic and Regional Identity ...
Education <ul><li>Percentage of population with no formal education by cast/ethnicity and gender, Nepal </li></ul>Source: ...
Maternal Health <ul><li>Antenatal care </li></ul><ul><li>Economic barriers in accessing health care: </li></ul><ul><li>54 ...
Child Health Early childhood mortality rates by caste/ethnicity, Nepal (for 10-year period preceding the survey) Source:  ...
 
Child Health Stunting (percentage of children under 5 who are -3 SD below normal height-for-age) by caste/ethnicity, Nepal...
 
Women and men planning/plotting
Focus  Population <ul><li>Landless, Dalits, Janajatis, Kamaiyas, Haliyas,  </li></ul><ul><li>People Living With & Affected...
Self Applied Technique for quality Health (SATH) Framework Prioritized  VDC/HF On site coaching  (FCHV, Mothers, MIL, FIL,...
CRADLE’s  SATH Approach - Outcomes <ul><li>Where SATH is applied more women from marginalized communities are participatin...
Best laid plans of ….
Knowledge and practices on MH( %)   Ethnicity  4 ANC 2 BPP Know SDI Institutional  delivery  PNC ( 1-3 Days) Dalit 51 32 6...
CB-IMCI( %) <ul><li>EBF Measles  ARI    </li></ul><ul><li>Dalit   70 81   64 </li></ul><ul><li>  </li></ul><ul><li>Janjati...
Women Participation in  at least one IGA(%) <ul><li>Dalit   45 </li></ul><ul><li>Janjati 93 </li></ul><ul><li>  </li></ul>...
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Considerations For Incorporating Health Equity in Project Design_Roy_5.12.11

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Considerations For Incorporating Health Equity in Project Design_Roy_5.12.11

  1. 1. Nepal - Background <ul><li>Prides itself in never having being colonized </li></ul><ul><li>Was the only declared Hindu State in the world </li></ul><ul><li>Nepal, a part of the subcontinent, follows the caste system </li></ul>
  2. 2. <ul><li>March 12 th 2011 </li></ul><ul><li>CORE – Equity Session </li></ul><ul><li>CARE Nepal’s CRADLE Project </li></ul><ul><li>Sept 2007- Sept 2011 </li></ul><ul><li>And two earlier CS projects </li></ul>
  3. 3. Nepal
  4. 4. Project Districts
  5. 5. <ul><li>CB-NCP: In Doti </li></ul><ul><li>BPP: Kailali </li></ul><ul><li>CB-IMCI: In Kailali, and Doti </li></ul><ul><li>HIV AIDS: In Both, Doti and Kailali </li></ul>Technical Interventions
  6. 6. Wealth and Assets Source: Bennett, Lynn, Dilli Ram Dahal and Pav Govindasamy, 2008. Caste, Ethnic and Regional Identity in Nepal: Further Analysis of the 2006 Nepal Demographic and Health Survey. Calverton, Maryland, USA: Macro International Inc. Caste/ethnicity Indicators Hill Brahman Tarai Janajati Hill Dalit National Wealth quintile Lowest 9.5 11.5 45.9 20.2 Second 11.3 30.7 19.5 19.9 Middle 12.0 31.3 15.4 20.0 Fourth 26.0 16.9 10.9 20.1 Highest 41.2 9.5 8.4 19.8 Household facilities Electricity 75.8 38.3 32.7 51.6 Private latrine 66.3 18.6 23.2 38.6 Improved drinking water 81.1 91.0 70.3 82.1 Radio 83.7 54.6 53.3 62.7 Television 45.8 23.4 13.3 29.4 Any means of transportation 41.3 74.1 13.6 37.5
  7. 7. Education <ul><li>Percentage of population with no formal education by cast/ethnicity and gender, Nepal </li></ul>Source: Bennett, Lynn, Dilli Ram Dahal and Pav Govindasamy, 2008. Caste, Ethnic and Regional Identity in Nepal: Further Analysis of the 2006 Nepal Demographic and Health Survey. Calverton, Maryland, USA: Macro International Inc.
  8. 8. Maternal Health <ul><li>Antenatal care </li></ul><ul><li>Economic barriers in accessing health care: </li></ul><ul><li>54 % of Dalit and 28% of Brahman women cited lack of money as a problem in accessing health care </li></ul><ul><li>High cost of institutional delivery (Rs.49,000) vs. lesser but still significant cost of using SBA at home (Rs. 13,600). </li></ul>* Source: Bennett, Lynn, Dilli Ram Dahal and Pav Govindasamy, 2008. Caste, Ethnic and Regional Identity in Nepal: Further Analysis of the 2006 Nepal Demographic and Health Survey. Calverton, Maryland, USA: Macro International Inc.
  9. 9. Child Health Early childhood mortality rates by caste/ethnicity, Nepal (for 10-year period preceding the survey) Source: Bennett, Lynn, Dilli Ram Dahal and Pav Govindasamy, 2008. Caste, Ethnic and Regional Identity in Nepal: Further Analysis of the 2006 Nepal Demographic and Health Survey. Calverton, Maryland, USA: Macro International Inc. Brahman Janajati Dalit National Neonatal mortality 34 36 44 37 Post-neonatal mortality 25 24 25 19 Infant mortality 59 59 68 55 Child mortality 18 22 23 13 Under-five mortality 76 80 90 68
  10. 11. Child Health Stunting (percentage of children under 5 who are -3 SD below normal height-for-age) by caste/ethnicity, Nepal Source: Bennett, Lynn, Dilli Ram Dahal and Pav Govindasamy, 2008. Caste, Ethnic and Regional Identity in Nepal: Further Analysis of the 2006 Nepal Demographic and Health Survey. Calverton, Maryland, USA: Macro International Inc.
  11. 13. Women and men planning/plotting
  12. 14. Focus Population <ul><li>Landless, Dalits, Janajatis, Kamaiyas, Haliyas, </li></ul><ul><li>People Living With & Affected by HIV/AIDs (PLWHAs), Sex Workers, Conflict- and Disaster-Affected People </li></ul>Women, children and youth cut across all the categories.
  13. 15. Self Applied Technique for quality Health (SATH) Framework Prioritized VDC/HF On site coaching (FCHV, Mothers, MIL, FIL, PW, PNM Husbands, Peoples Org,) in MG meeting <ul><li>Ward categorization </li></ul><ul><ul><li>Social mapping </li></ul></ul><ul><li>HMIS data analysis </li></ul>VDC/HF prioritization at district level Ensure regular MG meeting and increase utilization of health services Feedback/Reflection Analysis of HMIS data, interaction among HF staff, HFOMC members, MG representative, WRF, WAF and other community members, stakeholders Feedback/reflection Documentation and dissemination of processes, learning and changes Capacity building of FCHV & HWs Include RBA, Advocacy and Social Inclusion Issues Key MNH messages based on BCC strategy Self assessment and evaluation Healthy and prosperous family / community Improvement in maternal and neonatal health by reducing morbidity and mortality
  14. 16. CRADLE’s SATH Approach - Outcomes <ul><li>Where SATH is applied more women from marginalized communities are participating in the mother groups and accessing health services </li></ul><ul><li>Some of the HFOMC members are concerned and committed to upgrading their respective health facility to birthing center. </li></ul><ul><li>There is a greater demand for quality health services </li></ul><ul><li>Re-organization of outreach clinics which has increased coverage of key health indicators in the poor performing clusters </li></ul><ul><li>Greater participation of Dalits and other PVSE, they have utilized services more than before </li></ul><ul><li>Inclusion of PLHA </li></ul><ul><li>Inclusion of MIL, Husbands and FIL – changed perception towards women’s health, increase in supporting behavior for MNH care </li></ul>
  15. 17. Best laid plans of ….
  16. 18. Knowledge and practices on MH( %) Ethnicity 4 ANC 2 BPP Know SDI Institutional delivery PNC ( 1-3 Days) Dalit 51 32 69 26 60 Janajati 73 4 40 70 24 Others( Brahmin/Chetri/Equivalent 48 36 77 25 65
  17. 19. CB-IMCI( %) <ul><li>EBF Measles ARI </li></ul><ul><li>Dalit 70 81 64 </li></ul><ul><li>  </li></ul><ul><li>Janjati 75 98 74 </li></ul><ul><li>  </li></ul><ul><li>Upper Caste 73 87 76 </li></ul><ul><li>  </li></ul>
  18. 20. Women Participation in at least one IGA(%) <ul><li>Dalit 45 </li></ul><ul><li>Janjati 93 </li></ul><ul><li>  </li></ul><ul><li>Upper Caste 57 </li></ul>

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