Methodological Aspects: Experiences in the Rural Set up

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Methodological Aspects Experiences in the Rural
Set up

Dr. Ragini
Kulkarni
Research Officer Department of
Operational Research National Institute for
Research in Reproductive Health
Mumbai
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Scope of the Presentation

• 1. Methodological issues
• 2. Experiences
• 3. Difficulties
• 4. Lessons learnt

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Methodological Issues

• Data collection team
• Environmental building and community mobilization
  efforts
• Special efforts to increase participation of
  women

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Data Collection Team

• Efforts
• Advertisement in local newspaper in Nasik
• Gynecologist and Field investigators were
  recruited from Nasik district

• Experiences
• This facilitated the interaction between
  respondents and interviewers and also
  interaction with local leaders

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Field Investigators in Study Area
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Environmental Building
State District level Health Officials
Support from staff at PHC/SC

• Household level
• Individual women
• Husband
• Mother-in-law

Clinical Exam
PHC MO Staff

• Stakeholders
• Local level Panchayats,
• Local leaders, Mahila Mandals,
• Anganwadi workers

• Community
• FGDs
• Group Meetings in which
• IEC on obstetric
• Morbidities

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District Health System Service Providers

• Efforts
• Letters and Personal Visits to explain about
  the study -
• Civil Surgeon and RMO
• District Health Officer
• Taluka Medical Officers
• To inform about the study, its objectives and
  purpose
• To build a rapport for referral cases

• Experiences
• Good response from all officials
• DHO provided approval for supply of Medicines
  for camps

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PHC and Staff

• Efforts
• Informing Medical Officer and staff at PHC
• Explaining the study to ANMs/LHVs and seeking
  their support for mobilizing women
• Also explaining to MPWs for male involvement to
  increase participation
• Experiences
• Good response from MOs
• Varied response from LHVs/ANMs/MPWs

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Interaction with Service Providers
Medical Officer and ANM at PHC
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Panchayats and Local Institutions

• Efforts
• Providing letters about the project to
  panchayat
• Seeking co-operation for mobilization of women
  through local stakeholders
• Experiences
  
• Overwhelming response from stakeholders
• They participated in FGDs and meetings taken in
  community

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Meetings with Panchayat Members
Sarpanch and Panchayat Members
Meeting with Mahila Sarpanch
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Community level FGDs and IEC activities
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Community Level

• House listing
• Women mobilization, Referral slip given
• Community Meetings
• Involvement of men
• HH interviews taken according to time suitability
  of women
• Days of the camp fixed according to the
  convenience of the women

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Special Efforts to Increase Participation of
Women

• Preparatory activities on day of camp
• Client friendly environment created
• Lady Gynecologists for exam. of women
• Symptomatic treatment during the camps
• Referral of the cases diagnosed during the camps
  
• Also examining women not in criteria
• Transport facilities for women

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Camps for Clinical Examination of Women
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Camps for Clinical Examination of Women
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Sustaining Camp Activities

• Mahila Sarpanch, Anganwadi workers got examined
  which set an example for other women
• Honorarium for LHVs/ANMs, Anganwadi workers,
  Aya/dai
• Refreshments
• Letters of appreciation acknowledgement to
  health workers and other panchayat members

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Reasons for drop- outs

• Asymptomatic women
• Few women not satisfied with PHC treatment
• Some were busy with work also had lack of
  awareness and knowledge
• Some women were not willing to lose their daily
  wages

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Reasons for Refusal

• Some women refused to undergo examination
  after reaching PHC/Subcentre -
• Afraid to get examined
• Due to shyness
• Asymptomatic hence felt no need

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Difficulties

• No adequate public transport facilities
• At subcentre, no facilities for autoclaving
  (electricity, water) and examination table
• Various festivals, jatras, local functions had to
  be taken into consideration
• Difficulty in mobilizing asymptomatic women

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Lessons learnt

• Data collection team must include local personnel
• Involvement of district level Officers, Taluka
  MOs, PHC staff, local stakeholders
• Formative research (FGDs) undertaken before
  initiation of data collection
• Special efforts need be taken to increase the
  response rate
• Symptomatic treatment and prompt referral of the
  diagnosed cases should be done
• Follow up visits by research team in all PHCs

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Thank You
Thank You