Transparent and participatory approach seen as key in providing family planning services

Proposals have been made to health workers to employ more transparent and participatory approach when assisting clients to select family planning methods. The process should also include discussions around likely side effects.

Greater investment should also be made in educating adolescents to appreciate the benefits of modern family planning services. However, this ought to be done in a way that respects individual girls’ and parents’ desire for their daughters to delay sex.

Weekend discussion fora with adolescent groups are also being proposed as an avenue for enhancing the knowledge of adolescent girls around sexuality. This will also help to break down barriers around taboo topics like managing menstrual hygiene.

These proposals are part of recommendations contained in a scorecard report based on a community scorecard assessment and research conducted recently in the South Dayi district in the Volta region and the Akyemansa district in the Eastern region by two non-governmental organisations, the Alliance for Reproductive Health Rights (ARHR) and Women, Media and Change (WOMEC).

The research in the two regions, conducted during the last quarter of last year, is part of a programme aimed at catalysing leadership to improve Women, Newborn, Child and Adolescent Wellbeing (WNCAW) project directed at influencing public health policy across West Africa.

Five countries are benefitting from the three-year project within West Africa. The countries are Sierra Leone, Ghana, Niger, Burkina Faso and Côte d’Ivoire.

The project is made up of a Consortium for Mothers, Children, Adolescents and Health Policy and Systems Strengthening (COMCAHPSS), ARHR and WOMEC and the West Africa Health Organisation (WAHO) with funding from the International Research Centre (IDRC) of Canada.

The report documents the experiences and perceptions of citizens and health care staff in the eight communities where the research took place regarding the state of healthcare delivery with particular reference to sexual and reproductive health (SRH).

In the Akyemansa district the health personnel interviewed were from the Ayirebi Health Centre, the Brenase Health Centre and Kotokuom CHPS Compound and communities members interviewed were from the Ayirebi, Brenase and the Kotokuom local communities.

In the South Dayi district, the research was undertaken at the Peki-Adzokoe Health Centre, Wegbe Kpalime Health Centre, the Tsate CHPS Compound and the Abui Tsita CHPS Compound while the community members interviewed were from these local area: Tsate, Peki-Adzokoe, Abui Tsita and Wegbe Kpalime.

The research and interviews focused on key areas such as maternal, adolescent, sexual and reproductive health (SRH) issues and were based on indicators such as accessibility of SRH services, availability of medicines, equipment, cost of medicines, health insurance, respect for clients, promptness of service, confidentiality and privacy of care during SRH care.

Findings from the research in the two districts showed that the lack of ultrasound scanners significantly undermines clients’ confidence in the health system and discourages them from patronising antenatal services.

The research documented complaints about health facilities issuing receipts selectively. It was revealed that in areas where drug stores were not easily accessible, health workers set up parallel, unregulated medicine markets to spare clients the high transportation costs and the inconvenience associated with travelling to a drug store.

It report said creative ways should be explored to enhance access to other medical supplies and services because the research showed that when drugs and other supplies are deficient, citizens adopt a range of perverse and risky behaviours such as self-medication, sharing friends’ medicines, avoiding formal healthcare facilities and refusing to renew their health insurance subscriptions.

Other risky behaviours also identified include leaning on friends for medical guidance or turning to unproven and unlicensed spiritual and herbal remedies.

The research noted the need for the National Health Insurance Scheme (NHIS) to intensify its review and public engagement efforts to address the subscription-related issues raised by clients in the eight research communities. This is in view of some of the findings which showed the lack of drugs at health facilities, allegations of extortion and other challenges surrounding the NHIS registration process.

The report noted the strong beliefs among those with low education and income that diseases such as HIV, asthma and other communicable and non-communicable diseases have spiritual origins and could not be effectively treated by medicine. The beliefs explain patronage of various traditional medicines, sometimes with absurd claims that a single medication could cure several diseases, such as headaches, stomach aches, heart disease, diabetes, infertility, gonorrhoea, skin rashes, piles, constipation and dysentery.

On accessibility of services, the research recommended that efforts should be made to make health staff allocation more equitable in health facilities.

The research findings reinforced the importance of the CHPS compound concept that brings health to the doorsteps of community members and rural dwellers in particular. Evidence from the study suggested that it contributed significantly to improving citizens’ access to healthcare. A compound manned by two professionals was more functional as it ensures that services are always available.

Concerns were raised about the lack of confidentiality in the provision of sexual and reproductive health services at the health facilities.  In addition, the study showed that the design of some of the health facilities were too open and made it impossible for clients to consult in privacy.

Reacting to some key concerns raised in the research report in an interview with the, Dr. Charity Binka, Executive Director of WOMEC, said health workers have a critical role to play in ensuring that healthcare services are accessible to all.

She said the Sustainable Development Goal 3 (SDG3) cannot be achieved without the dedication of health workers and strong health systems.

“For example, it is not acceptable that any woman should die through child birth or a child should die at birth due to the failure of the health system”, Dr. Binka emphasised.

She noted that in spite of the numerous challenges bedeviling the National Health Insurance Scheme, it is still the easiest approach to providing affordable health service to the poor and the vulnerable.

By Eunice Menka

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