Empowering Village Women in Promoting Health Care

African Church Information Service, 2 July 2001

Nairobi - The status of women in developing countries continues to be deplorable. In Kenya, the maternal mortality is 590/100,000 live birth while the IMR (infant mortality rate) and under five mortality rates are on increase, as access to basic health care remains inadequate.

Whilst women are generally the first to offer care at the household level, their role and potential is undermined both, at the health facility level and household level. Often women are not party to making decisions in organisation and delivery of health care services.

Community Health Department of Aga Khan Health Services has attempted to address this issue in an integrated manner within its Health Systems Strengthening Project in Kwale District in the Kenyan coast.

The project is being implemented in partnership with Kenya's Ministry of Health and the local community. The project aims at strengthening health systems by building capacity of the local community to govern and manage the dispensaries.

Local community is organised to form representative health committees both at the village level (Village Health Committee and the dispensary level - Dispensary Health Committee). The representation in these committees encourages equal opportunities for both men and women from each village within a dispensary catchment's area.

Once the committee was formed members were taken through a capacity building training programmes involving experiential learning on planning, managing and governing health care and were equipped with skills on consensus building, conflict and resolution.

The women members were counselled to improve the self-image and to build their confidence while men were sensitised to support them. The project assisted in developing Management and Financial monitoring systems and provided on site follow up support to track the progress.

A particular emphasis was made to encourage village women to participate and take leading roles in health interventions. The project went through different phases in getting the women to effectively participate in Village Health Committees and in Dispensary Health Committees.

In the first phase, the project exposed both men and women through training programmes, which included the training of trainers (TOT), Training of Facilitators (TOF), Community Workers, Leadership and Good Governance. This capacity building process adopted a participatory learning model, which helps the set priorities and explore possible solutions.

The gaps identified during the problem analysis revealed cultural practices and beliefs as key promoters of women discrimination. Women are marginalised among, for example, the Duruma community because of many factors.

This was because the roles and responsibilities of women are considered to be a child bearing and rearing; a woman does not own anything, even her own children; and poor self esteem among the women.

There was need for the project to create the awareness that problems arising from the systematic discrimination against women, were affecting the entire community. For example, a mother could not take her sick child to a health facility without the permission of her husband even when the husband was absent.

This situation had led to some ugly scenes of wife beating where a mother may have decided to take a child to a health facility without the consent of her husband.

It was important to create the awareness that the fact that a mother has made the decision to take her child to a health facility does not make her husband weak.

Other issues identified as discriminating against the women included; men not allowing their children to be immunised and women not participating in health committees.

There was also the question of women not being allowed to take leadership positions in health Committees; and men could not physically take their children to a health service for treatment in the absence of their wives.

To bridge some of these gaps, the capacity building process exposed those training both men and women to examine the prevailing beliefs and practices, and to realise that a transformation of roles, need not necessarily result in disruption of society.

With this understanding, it was easy for those who had already been exposed through training to set a good example and to convince others. To get the women to participate in committees, the first step was to encourage them to be present physically in meetings.

This was by encouraging committees to add a clause in their constitution, that at least 30 percent of the membership should be women. The presence of women in meetings gave them exposure even if they were silent observers.

The second step was to encourage them to raise their voices regarding issues of their concern. It was difficult for them to raise their voice because of fear to be viewed as dissident rather than being obedient.

The project team provided constant facilitation and encouragement.

Women were encouraged particularly to improve their self-image and confidence through discussion using local case studies.

In their initial stages it required the project staff to be present in meetings just to ensure that the male participants did not disregard participation and contribution of women. The third phase was to encourage the women to participate in decision-making positions in the health committees.

Through their participation in health committees and their involvement in health care activities, women have presently reached the level of influencing decisions. With time, women have gained social consent to participate in public decision-making, responsibility that once dominated by male.

Through this avenue of participation, women have brought their views and concerns into the public forums like village barazas (meetings).

With their new-found voices and successes, women have become active members of the their community.

This is evident in their participation in the various health committees. This participation of women in leadership positions has shown that accountability of revenue collection at the dispensaries has improved where there are women treasurers.

The average number of women participating at the health committees improved from 15 percent in 1995 to 56 percent in the year 2000, while women lead about half of the dispensary and village committees.

The immunization coverage was maintained at 77 percent (national coverage 58 percent). The family planning services uptake improved from 1,569 cases in 1997/98 to 5,295 in 1999/2000, while the coverage for antenatal services improved to over 2.5 times.

In effect, the model illustrated that village women can participate in governing health care if they are facilitated to improve their self- image and the male members are sensitised to support them.

SOURCE: Excerpts from the presentation of Mukunya E, Sohani S, M. Barasa, M. Kaseje and Rachael Nyawa titled 'Empowering Village Women in Promoting Health Care' at the Regional UNI-SOL (Universities In Solidarity For The Health Of The Disadvantaged) Congress in Nairobi during June 11-14, 2001