Principles into Practice - Handicap International

Principles into Practicesame exclusion and denial of basic human rightsfor which documentation is indispensable. Movinggovernment services to be more closely located tothese women is equally relevant elsewhere.2.8 INNOVATIONS ON RIGHTSDIRECTED TO PROMOTION OFMATERNAL HEALTHCARE GuatemalaContext: The majority of the population in theDepartment of Baja Verapaz are Achí, K´ekchí andPokomchí. High levels of illiteracy and povertyprevail amongst the women. Girls have limitedopportunities for primary education or to attendany type of schooling. This, in turn, determinestheir access to information on self-care, health,and knowledge about their civil rights or how toexercise and claim them. The disadvantagedposition of indigenous women accounts for highmaternal mortality rates. Innumerable barriersdelay the quality care a woman needs duringpregnancy and through to delivery. CAREGuatemala decided on a project to promotematernal health in five districts (Salamá, Rabinal,San Miguel, San Jerónimo y Purulhá) of BajaVerapaz in collaboration with the Ministry ofPublic Health (MPH) by improving access to andquality of essential obstetric care.The initiative and its application: The projectfirst undertook to explore what restricted women’saccess to Emergency Obstetric Services. This wasdone through an analysis and participativeplanning approach with central and local MPHstaff, piloted in the district of Salamá. Otherinstitutions were also invited to participate.The investigation and the subsequent design ofstrategies to improve the health of women andtheir newborn babies was structured around “the4-Delays Model.” The aim was to highlight andthen overcome the obstacles to obtaining propercare. The first delay could be attributed to thepregnant woman and her family not recognisingdanger signs. The second delay often resulted, forexample, when a woman was denied her right todecide the care she needed. The decision wasoften made by her father or another male relative.The third delay could be due to inadequatetransport and the fourth delay could relate todeficient, incompetent, and/or disrespectfultreatment by health care providers. The results ofthis inquiry process with the women werepresented to health personnel – the solutionsproposed came from the women, midwives, healthpromoters, leaders, and health service providers.The 4-Delays ModelDelay #1:Delay #2:Delay #3:Delay #4:Delays in problem recognitionDelays in deciding to seek careDelays in reaching the health facilityDelays in receiving treatment ata health facilityResults to date: The methodology using the4-delays model permitted men, women, andcommunity leaders to design, validate and start toimplement strategies to reduce maternal mortalityfrom the community standpoint. Women whoparticipated in the analysis had input intocommunity action plans. Community councils anddevelopment committees formed withrepresentation of women who were aware of theproblems they face. Community committeesobtained seed money to transport women withobstetric emergencies to referral centres. Toimprove their knowledge and practices, midwiveshad the opportunity of rotations in the regionalhospital of Salamá. Innovation process: The pilot project linked theobstetric needs of under-served women withhealth providers, including midwives, andcommunity institutions whose role and obligationit was to deliver quality services to this clientpopulation. Since it began in April 2003, the projecthas made progress in facilitating a change in healthcare provider attitudes. Once involved in thecommunity, health care providers began to act onthe recommendations they were given on how toimprove services. The learning process made gooduse of the wisdom and experience of the communities,created a voice for women, gave them control overtheir own and their children’s lives, and broughtabout recognition of women’s right to health andthe responsibility of health institutions.Suggestions for building on the learning:Following this pilot in Salamá district, the Ministryagreed that the model would be institutionalisednationally as the strategy to reduce maternalmortality. It is expected to invite broadparticipation of different sectors and favourcommunity involvement.Page 27