Approaches for Understanding and Addressing Barriers

Background/Introduction: 

Services may be inaccessible to their intended users for multiple and complex reasons: in Madagascar inaccessibility is often due to remote locations and seasonally navigable roads; in Bolivia, facility rules were rigid and culturally inappropriate for women.

The Manoff Group’s approach to revealing barriers and supports for health-promoting behavior, Behavior-Centered Programming, aims to develop locally appropriate programmatic responses to barriers.  The first step is a situational analysis.  Next, unanswered questions are addressed through formative research.  Results, organized by behavior in strategy matrices, clarify the most effective steps to address barriers.  The presentation will show how the process generated strategies and activities to improve accessibility of MNCH services in Madagascar and Bolivia.

Purpose:

To describe a method which may be used anywhere that results in different, locally appropriate programs.

Strategic approach (Methods):

The process of Behavior-Centered Programming is described, as well as its impact on health systems and health outcomes.

Findings:

Madagascar’s literature review revealed gaps in what is known about MNCH/FP; a stakeholders’ workshop provided information on others’ programs; barrier analyses and additional formative research provided an evidence base for program development.

Formative research in Bolivia found rural women did not access birth services due to perceived mistreatment and disregard for Quechua-Aymara health customs. The program trained providers in traditional supportive care, organized community-provider dialogue, and provided culturally sensitive BCC. NGO clinics saw MCH attendance increase from 17% to 100%.

 

Conclusion:

The Madagascar program combined research methods to tailor programs to different locations; results are pending. The Bolivian experience suggests that biomedicine must listen to indigenous medicine and community and providers must negotiate for better outcomes.