Abstract
BackgroundIn remote rural areas of Pakistan, access to the maternal, newborn and child health (MNCH) care provided by a skilled health provider is quite difficult. There are many reasons such as women’s restricted social mobility, lack of education, disenfranchised in decision making and poverty. To overcome these barriers and impediments in district Chitral, which is the largest territory in terms of geography in province Khyber Pakhtunkhwa, local women of reproductive age, were mobilized to form the Community Based Saving Groups (CBSGs) at the village level. In these CBSGs, they pool-in their money, and then provide soft loans to the expecting mothers to meet the expenses of delivery. Simultaneously, young literate women were identified from the local communities; they were trained as Community Midwives (CMWs), using national MNCH curriculum, and later deployed in their respective villages within the district. This study captured their perceptions about the formation of CBSGs to overcome the financial and social barriers, and subsequent use of CMW services.MethodsA qualitative enquiry was conducted with the delivered mothers and their husbands through gender specific separate focus group discussions, with CBSG members and with non-members in four different sites of District Chitral.ResultsCBSG member women were far more aware on health issues. Information sought from these forums brought a noticeable change in the health seeking practices. Seeking care from a trained birth attendant in the community became easier. Women associated with the CBSGs as members, expressed an increased access to money for utilizing the CMW services, better awareness on MNCH issues, and empowerment to decide for seeking care. CBSG have been an instrumental platform for social networking, helping each other in other household matters.ConclusionWomen have started using the services of CMW and the CBSGs have actually helped them overcome the financial barriers in health care seeking. Moreover, the CBSGs became a medium to improve the awareness of service availability, understanding the MNCH issues, and timely utilization of MNCH services.
Highlights
In remote rural areas of Pakistan, access to the maternal, newborn and child health (MNCH) care provided by a skilled health provider is quite difficult
Data collection tool After a thorough review of the literature, we developed a question guide comprising probes to record the contextual insights about the role and benefits of Community Based Saving Groups (CBSGs) membership, especially with regard to health awareness, health seeking practices, their experience in the last delivery and the costs incurred, and use of MNCH services offered by the newly deployed Community Midwives (CMWs)
Majority of the participants of FGDs were aware of a CMW working in their area, and most of them had already sought assistance from the CMWs during the last pregnancy
Summary
In remote rural areas of Pakistan, access to the maternal, newborn and child health (MNCH) care provided by a skilled health provider is quite difficult. There are many reasons such as women’s restricted social mobility, lack of education, disenfranchised in decision making and poverty To overcome these barriers and impediments in district Chitral, which is the largest territory in terms of geography in province Khyber Pakhtunkhwa, local women of reproductive age, were mobilized to form the Community Based Saving Groups (CBSGs) at the village level. In these CBSGs, they pool-in their money, and provide soft loans to the expecting mothers to meet the expenses of delivery. Global as well as local experience shows that delays in seeking care, reaching care, and receiving care are related to inadequate knowledge, logistical and financial constraints, gender insensitive health policies and programs, gaps in the health service provision and coverage, and low levels of family and community support [3, 4]
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