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PEER empowers marginalized women (elmusharaf IFGH 2012)


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Peer empowers marginalized women elmusharaf ifgh presentation 2 feb 2012

IFGH 2012: participatory ethnographic evaluation research (peer) empowers marginalized women to engage in community directed reproductive health interventions

Irish Forum for Global Health | Conference Abstracts
Authors: Elmusharaf K.1’2, O’Donovan D.2

Author Affiliations:1Reproductive & Child Health Research Unit ‘RCRU’, University of Medical Sciences &Technology, 2 National University of Ireland Galway

Option 2 -Lessons from the field; project and programme evaluations; and syntheses or analyses
Presented as – Oral Presentation

This abstract demonstrates how Participatory Ethnographic Evaluation Research (PPER) can build the capacity, empower and engage local women in conflict affected hard-to-reach communities to participate in Community Directed Reproductive Health Interventions (CDRHI).

Fourteen marginalized women with no formal education were trained in PEER which included developing skills to design research instruments, conduct interviews, collect narratives and stories, and analyse the data. Twelve months later, 10 out of the 14 women were able to lead work on health communication with employees of local NGOs and local theatrical band members. They shared their information and data about the important issues related to women health in their community, developed action messages, created culturally appropriate health education materials, and delivered it to their community in form of pictograms, songs, and drama.

Lessons learned:
The women believe that PEER enhanced their credibility - when they returned to their social circles people were more accepting to what they said because they were perceived to know more than others. They are more confident about their ability to influence change. Participation in research design, data collection and data analysis was a particularly powerful tool to enhance their empowerment in post conflict settings. The approach adopted illustrates the developing of the capacity, mobilizing the community and increasing the level of readiness to participate in CDRHI.

Next steps:
By using PEER we not only gain an in depth understanding of the social, economic, and cultural contexts in which people live, but we also empower and engage marginalized women in hard to reach communities. Moreover, it gives a sense of ownership, ensures sustainability, and assists in planning, implementation, monitoring and evaluation of Community Directed Reproductive Health Interventions.

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PEER empowers marginalized women (elmusharaf IFGH 2012)

  1. 1. Participatory Ethnographic Evaluation Research (PEER) empowers marginalized women to engage in Community Directed Reproductive Health Interventions
  2. 2. Dr. Khalifa Elmusharaf, MBBS, PgDip, FRSPH (UK)PhD Researcher in health system & PolicyNational University of Ireland Galway (NUIG)Head of Reproductive & Child Health Research Unit RCRU’University of Medical Sciences & Technology (Sudan)
  3. 3. South Sudan
  4. 4. Maternal health indicators (SHHS, 2006)MMR in South Sudan 2054 per 100,000 live births10 % delivered by Skilled Birth Attendants23% get ANC by any qualified personnelAccessibility to Emergency Obstetric Care is low as indicated byCaesarean Section rate of 2%
  5. 5. The women in South Sudan face alarmingly lowmaternal health status to the extent that UNICEFsurvey found that:Girls in southern Sudan are morelikely to die in pregnancy andchildbirth than to finish primary school (UNFPA 2006).
  6. 6. Most of the efforts of Health System includingInternational and National NGOs have been done toreduce supply side barriersUSAID, 2007: “Most of the attention is focused at thefacility level -- waiting for clients to come into thefacility, and the facilities appear to be underutilized.”However, very low utilization of accessiblematernal health care facilities in South Sudan is one ofthe major obstacles to improve maternal survival,....which is much influence by DEMAND side barriers.
  7. 7. Research challenges
  8. 8. Research challenges Trust – A lack of mutual trust between the Illiteracy researcher (outsider) and the respondents remains the maincompetition TRUST challenge to obtain reliable information. –This research was done during the period of referendum and separationComplexity Overcome the lack of trust and sensitive issues
  9. 9. Research challenges Trust Power differences between researcher and participant: Illiteracy • The researcher alone contributes thecompetition ILLITERACY thinking that goes into the project, and • The subjects contribute the contents to be studied.Complexity Increase community readiness
  10. 10. Research challenges Trust – Competing with NGOs that Illiteracy provide services and Food COMPETITIONcompetition – Lack of motivation to participate in any research (low response rate)Complexity Engage communities
  11. 11. Research challenges Trust Illiteracy – Complexity of social institutionscompetition COMPLEXITY and cultures in which behaviour is contextualized.Complexity Listen to hard to reach population
  12. 12. PEER
  13. 13. PEER Participatory Ethnographic Evaluation & Research Research & Empowerment
  14. 14. PEERPEER is aninnovative, rapid, participatory and qualitativeresearch methodinvolving ordinarymembers of thecommunity to generatein-depth and contextualdata(Price and Hawkins 2002).
  15. 15. PEER14 women recruited by village leaders
  16. 16. PEER14 marginalized women with no formal1. Design research instrumentseducation attended a Four-day PEER2. Conduct interviewstraining workshop to develop their skills3. Collect narratives and storiesto: Analyse the data4.
  17. 17. PEER training workshop Concept of peer research1 Discussed important issues of maternal health in their community.
  18. 18. PEER training workshop2 Identified key themes and questions for the qualitative research
  19. 19. PEER training workshop Final themes and sub themes 1. Family & Determinants of Family Size, 2. Experiences of Pregnancy, 3. Experiences of Birth,2 (20 sub themes and Images)
  20. 20. PEER training workshop3 Developed images to remind them with the questions.
  21. 21. PEER training workshop3
  22. 22. PEER PEER Researcher
  23. 23. They returned to theirvillages to carry out in-depth interviews in thethird person format withthree of their friendsthree timesover three weeks
  24. 24. PEER Women asked to describe experiences of “women like them” or of other women in the village, not to tell stories about themselves.
  25. 25. De-briefing with PEER researchersResearcher visited them to collect their findings in a series of debriefing sessions
  26. 26. Researcher visited the womenin their villages,‘in hard-to-reach communities’
  27. 27. Researcher was making detailednotes of the narrative data thatwomen had collected.
  28. 28. PEER Analysis workshop Upon completion of three discussions, the women came together for analysis workshopIdentifyAct out Dramasfindings Developimportant the profile stories
  29. 29. PEER A dialogue between researcher and the women has been generated
  30. 30. 12 months later
  31. 31. CDRHI Community Directed Reproductive Health Interventions 10 out of the 14 PEER researchers were able to lead work on health communication with employees of local NGOs and local theatrical band members
  32. 32. 1. They shared their information and data about the important women health issues in their community.
  33. 33. PEERresearchers2. They developed action messages.
  34. 34. PEER researchers andLocal NGOs Employees3. They created culturally appropriate healtheducation materials.
  35. 35. Theatrical band members4. They delivered it to their community in form ofpictograms, songs, and drama.
  36. 36. We should reduce heavy work from pregnant
  37. 37. Do not hit pregnant womensolve your problems without violence.
  38. 38.
  39. 39. Lessons learned
  40. 40. Lessons learnedThe women believe that PEERenhanced their credibilityWhen they returned to theirsocial circles people were moreaccepting to what they saidbecause they were perceived toknow more than others.They are more confident abouttheir ability to influence change.
  41. 41. Lessons learnedParticipation in research design, datacollection and data analysis was aparticularly powerful tool to enhancetheir empowermentThe approach adopted illustrates thedeveloping of the capacity, mobilizingthe community and increasing thelevel of readiness to participate inCDRHI.
  42. 42. Conclusion
  43. 43. PEERCapacity
  44. 44. PEERCapacityBuild ownership
  45. 45. CapacityBuild ownershipEmpowerment
  46. 46. PEERCapacityBuild ownershipEmpowermentin-depth contextual data
  47. 47. PEERCapacityBuild ownershipEmpowermentin-depth contextual dataUnderstanding Local Context
  48. 48. PEERCapacityBuild ownershipEmpowermentin-depth contextual dataUnderstanding Local ContextStrengthening Society