Guide for Community Assessments on Women's Health Care - ICRW

<strong>Community</strong>-oriented Solutions to Women’s Health Problems
Issue Detailed Description Possible Solutions
No or limited
in<strong>for</strong>mation provided on
women’s health issues
No/limited in<strong>for</strong>mation on pap smears, family planning, sexually transmitted infections and
HIV, ARV treatment, proper use of medication, medical risks <strong>for</strong> HIV-positive women of
getting pregnant. Results – women confused about what services are available; incorrect use
of medication
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<strong>Community</strong> awareness campaign on HIV and AIDS and sexual and
reproductive health, organized by HIV-positive women and civil
society organization.
Health staff spend more time talking to women – clear explanation
of medication and how to take it.
Lack of family planning
services
HIV-positive women don’t have support of health staff to make in<strong>for</strong>med choices about
having a child or not. ART & PMTCT staff too busy & lack skills to advise on family planning.
Health services only provide condoms, yet women find it difficult to get partners to use
condoms. Safe abortions are not available to HIV-positive women. HIV-positive women
afraid to use PMTCT fearing they will be stigmatized/judged by nurses <strong>for</strong> getting pregnant
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HIV-positive women to meet health staff as a group and explain their
concerns about stigma and inadequate family planning services.
HIV-positive women and civil society organizations to make links
with National Family Planning Association to provide a wider range
of contraceptives.
Health worker issues –
long hours, low pay,
burnout, etc.
Insufficient staff, heavy workloads, long hours, low pay, burnout, isolation and lack of
support. Stress of dealing with death & dying. No opportunities to deal with their own fears
about HIV. Lack of psycho-social support and counseling to deal with stress. High turnover
of community volunteers due to poor conditions and lack of support, resources, and
incentives.
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Establish support groups <strong>for</strong> health workers to help them cope with
their own health issues and stress.
<strong>Community</strong> to monitor the use of volunteers and provide
recognition and incentives.
Stigma and poor
communication by
health workers
Health staff rude, unfriendly, insensitive; breach confidentiality; and stigmatize women and
girls seeking HIV and family planning services.
Signs – “ARV Treatment Room” – expose patients to stigma
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HIV-positive women and health care staff to <strong>for</strong>m joint monitoring
group; and appoint HIV-positive women to community health
committee.
Make immediate changes to the signs.
Lack of services <strong>for</strong>
victims of gender-based
violence
Health staff are legally required to report cases of rape, but not required to report other
cases of violence. Police treat cases of domestic violence as “civil matters” to be solved
in the home. No shelters <strong>for</strong> battered women. PEP procedures are cumbersome and time
consuming (e.g. getting a police report) and this prevents women from using PEP after being
raped.
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<strong>Community</strong> campaign to create a “violence free home and
community,” with regular monitoring.
Involve all community leaders and groups.
Challenge men re: practice of controlling & abusing women, and
cultural justifications <strong>for</strong> this practice.
Encourage men’s groups to take up violence against women as an
issue.
Poor relations between
traditional healers &
clinics/hospitals
Lack of coordination and communication. Communities prefer traditional healers because
of their mobility and range of services, including psycho social support; but they lack
in<strong>for</strong>mation about HIV and AIDS and sometimes offer ineffective treatments.
●●
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Organize regular meetings between clinic staff and traditional
healers.
Provide training <strong>for</strong> traditional healers on AIDS and ARV therapy
literacy.
Chapter C: Facilitating <strong>Community</strong> Assessment Workshops 59