MOBILIZING JOINT PLANNING, ACTION, AND MONITORING IN ORURO, BOLIVIA WITH LOCAL HEALTH INFORMATION

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• MOBILIZING JOINT PLANNING, ACTION, AND MONITORING
  IN ORURO, BOLIVIA WITH LOCAL HEALTH INFORMATION
• This work was supported by the USAID-funded
  JHU/PCS4 Project

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Intervention Approach

• Strategy to bridge the gap between local health
  system providers and communities.
• Opportunity to share information and
  responsibility for local health and health
  services.

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Sharing Local Health Data

• Could a community-based health information system
  help to build partnerships between communities
  and their local health system?
• Types of health information systems
• Facility-based/National (NHIS)
• Community-based (CB-HIS)

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Barriers between local health system providers
indigenous communities

• Social status, culture, language
• Geographic distance
• Cost, availability and quality of services
• Limited use of health services

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Opportunities

• Decentralization
• Law of Popular Participation
• National Maternal and Child Basic Health
  Insurance
• MOH need for better health information
• Tight-knit communities with participatory
  planning traditions

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SECI Process

• Volunteer health promoters collect data in their
  community.
• Local providers help promoters combine community
  and facility data.

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SECI Process--contd.

• Promoters and providers share the data with the
  community.

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SECI Process--contd.

• Communities analyze and discuss the information.
• Citizens and providers agree on priorities,
  develop plans, and monitor strategies.

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Community Action Cycle
COMMUNITY ORGANIZING
EXPLORING NEEDS SETTING PRIORITIES
EVALUATING TOGETHER
PLANNING TOGETHER
ACTION
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Formative Research and Design Phase 1997-98

• Involved service providers and communities.
• Developed and pre-tested culturally-appropriate
  materials for illiterate adults.

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SECI at the District Level

• SECI software for health staff at district level
  
• Prints reports in easy-to-read graphics
• Can compare community data and analyze trends
  over time.

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SECI Pilot ActivitiesJune 1998 to June 1999

• 10 self-selected communities
• Evaluation June 1999
• Active 6 to 11 months, average 7 months

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June 1999 Evaluation Methods

• A. Qualitative
• SECI records for all 10 SECI communities
• Ethnographic study in 3 SECI communities
• B. Quantitative
• Household survey comparing 7 SECI and 7 control
  communities

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Qualitative Results I

• Participants adopted more self-reliant and
  responsible attitudes toward their health.

Now, this year, the doctor is coming twice each
month to visit us. We are responsible to care for
ourselves and if we dont attend it is our own
fault. Mother speaking at SECI meeting
about prenatal care, Chojñohuma
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Qualitative Results II

• Nine of the ten SECI communities planned and
  implemented their own health promotion strategies.

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Qualitative Results III

• Health personnel who participated built better
  working relationships with SECI communities.

...the treatment now is more communicative, to
gain trust/confidence, one shouldnt be so
distant, or believe that one is more than them
Health provider, Cañohuma
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Qualitative Results IV

• At least 8 of the 10 SECI communities acted to
  make local health services more responsive and
  accountable.

We have realized, it seems, that we have to
take our proposals from here. The more we ask for
a particular change for a particular reason, the
hospital will improve a little, no?
male citizen,
Tarucamarca
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Qualitative Results V

• Information from the CB-HIS motivated and
  empowered communities.

Before we were careless and almost never spoke
of the problems of the community. Now it is
different, we can do our part and everyone with
their opinions can improve the system and the
conditions of living.
promoter, Tarucamarca
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Reducing Barriers to Use of Practices and
Services

• Awareness of health problems, new practices and
  services.
• Communication and trust.
• Better access, availability, and quality of
  services.

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Household survey Use of MCH Practices Services

• Compared 7 SECI communities with 7 control
  communities
• 218 households, 344 children

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Use of Health Services

• OR Rate
• Completely vaccinated 4.78 (11 vs 3)
• Polio 3rd dose 3.04 (30 vs
  12)
• Measles vaccine 2.59 (39 vs
  20)
• Have a health card 2.12 (45 vs
  28)
• Received vitamin A capsule 1.96 (59 vs 42)
• (Data from health cards. N292 to 342, p value
  

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Child-feeding Practices
OR Rate Breast-feed within 1 hr postpartum
2.62 (26vs 12) Put oil in young childrens
food 1.95 (68vs 52)
(Breast-feed N134, Oil N144, p values 25
No Significant Impact Detected For

• Diarrhea ARI
• Care or care-seeking for sick children
• Use of MH practices and services (except
  contraceptive use).

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Follow-up Results and Expansion

• 23 more communities in Oruro district, June 1999
• Coverage rates are increasing
• District health system now rewards promoters
• PLAN pilot in Tarija, Bolivia 2000
• SC Two more districts in 2001

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Lessons Learned

• CB-HIS for illiterate communities
• Complementary health education
• Womens participation
• Promoters role and compensation
• Providers participation
• Sustainability factors

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Conclusion

• A CB-HIS mobilized communities and linked them
  with their local health system.
• Dialogue led to sharing of knowledge and
  resources for mutual benefit.
• Community assessment, planning, and monitoring
  improved equity and utilization.