Salud Reproductiva

Estimates vary, but it is widely agreed that significantly less than 50% of Ugandan women seek care in a health facility for labor and delivery. While cost and access are factors, the behavior is also cultural and deeply ingrained. Women fear the labor ward. Recent press coverage has described the plight of women in the hospital left to die, usually bleeding to death. When we ask women directly why they avoid the hospital, the number one reason is quite consistent: they fear being treated harshly. In order to overcome the cultural resistance, we have to create an alternative experience, a place where women are treated with loving kindness. They have to trust their care providers, and we must not betray that trust.

Another significant potential barrier to success is political instability. Uganda is experiencing volatility, extreme inflation and devaluation of currency. President Museveni has been in office since 1986 and he has changed the Ugandan constitution to allow it. There is no freedom of speech or assembly. While once hailed as a strong democracy, the government is progressively more totalitarian. In order to prevent this situation from hindering our progress, we must at once cultivate a good relationship with the national government and with local powers that may be perceived as opposing government. We nurture our relationship with the central and local government through liaising with national licensing, medical reporting and drug authorities. This is a precarious situation, but a natural product of our policy only to work in very desperate places.

We enjoy partnerships with both government and private groups, and both are vital. To work in an area that is experiencing such a serious crisis in maternal/child health is to be in a place that also presents security challenges. In this volatile environment, making a clear contribution to the community, and really being part of the community, keeps everyone at the project safer - both the local staff and volunteers from other countries. Partnerships can wage peace in violent places. When government sees us as a partner rather than a competitor, more patients benefit. Our relationship with government not only allows us to work here, but also it makes government facilities more receptive to messages about best practices.

Our partners provide significant material support to the project. Private partners provide subsidized drugs and supplies, share training and community mobilizers, particularly in the area of family planning. We have seen a lot of success reaching women with birth control methods through our partnerships with two Ugandan groups: PACE (Program for Accessible health Communication and Education) and Uganda Health Marketing Group. Our Ugandan partner BeadforLife provides funding for our family planning program. Our partner The AIDS Support Organization (TASO) provides training to our staff and anti-retroviral drugs to our HIV positive patients when availability is low. We collaborate with children’s groups to provide to care to the orphans and vulnerable children they identify, we also provide medical care to children less than 15 years.

My selections represent sources of funding and supplies. The organization grew out of concerned individuals looking to send direct support to desperate areas, and is funded mostly by individuals. There are some family and friends among the earliest donors because they believed in me. But now as our fundraising efforts have expanded, the donor base has diversified well beyond that. We seek foundation support, but funding by individuals gives us maximum flexibility and the potential to educate thousands of needy people through outreach efforts. Funding this project allows them to have direct knowledge of where the funds are going and what is being done. Some donors prefer to provide specific things rather than funds, and their relationship with the clinic allows them knowledge of what we need. Recently I was free to ask an individual to fund a new microscope for the lab, for example.

From regional government we receive condoms, HIV test kits and anti-retroviral drugs (when they are available) and vaccines. From the national government we received clearance to receive vaccines from the district level, plus the proper refrigerator and cold chain supplies. From other NGOs (PACE, Uganda Health Marketing Group) we receive family planning supplies and community health workers trained and funded to help us with community sensitization. We are pursuing funding now from the local government to increase sustainability as we put more and more responsibility in the hands of the local staff.

The Project might also encounter the same common problems we have encountered in the communities, such as: electing popular but unreliable officers in the Cooperative; corruption of Cooperative funds; skeptics who might influence ordinary members; indifference among other recognized leaders; and, other practical economic concerns like the need to work. The time the leaders devote to the Project means lesser time devoted to their economic activity.

The Project hopes to prevent this by putting in place regular meetings and assessments, staff development training on team building and attitude formation. To counter corruption, the Project will put in place transparency and accountability. A Finance Collective will be put up to handle finance matters so it will not be handled by an individual only.

Positive projection of the Project will neutralize the skeptics in the community. Actual delivery of services and concrete benefits from the project will counter their indifference and mistrust. The Project needs to come up with token remuneration for services rendered by the leaders so their absence from work would be compensated.

Serve-Net has the following networks which it has had partnerships:
1) The Municipal Government of Tublay, Benguet.
2) Concern – Center for Emergency Relief and Rehabilitation.
3) Kaisa Ka – A national women’s organization.
4) Committee on Women, Urban Poor and Social Services of the City Government
5) HIDS (Health Integrated Development Service) – a health NGO
6) Benguet State University Faculty Association, through its President, Prof. Gloria Lee
7) Philippine Nurses Association – Benguet Chapter
8) Pangisda – Fisher Folks Association of La Union, and has a national network
9) Teacher Center of the Philippines – an NGO for education workers
10) SALT Foundation – an NGO and Program for the urban poor community of Payatas in Quezon City
11) Community Development Society of the Philippines – a national organization of community development workers

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The main target is the rural woman initially whos has little in come. a casul labourer earns 0.9 dollars/day with no job assurance Cost 2.5 dollars in a public facility and 7.5 dollar with NGOs. Negociate for subsidary cost due to numbers, self financing for those who can afford.
Cultural appropriate practices
Fear
Lack of insurance

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The Ministry of Health through the local District hospital they have thhe laboratory facilities.
NGOs i will specificall target Marie Stoppes who deal with reproductive health.

The success of this project may be hindered by lack of funds to procure kitchen equipment, lack of space within the hospital to set up a new kitchen and lack of funds to pay a stipend for volunteers operating the farm and the kitchen.
Partnership with the Global Alliance for Clean-Cookstoves is expected to contribute the kitchen equipment needed at no cost to the Healthy and empowered women project, however in the event of inability of clean cookstoves to fund the entire kitchen, the existing hospital kitchen will be refurbished.
If the hospital does not have space to create a new kitchen, the old kitchen will be expanded onto available space.
Volunteer stipend will be leveraged from bob a job fund raising by members of the support group of persons living with HIV, pregnant women benefiting from the program will also assist in fund raising campaigns within the community. The local government agriculture department is also committed to providing farming equipment, fertilizers and improved seedling. Excess Farm produce may be sold at subsidized rate to persons in need of vegetables but who are not enrolled in the program.

Partners for this project are: The Godiya support group of Persons Living with HIV in Borgu Local Government district, The Government General Hospital, New Bussa Borgu LGA, The global alliance for clean cook stoves, The Local government of Borgu district health department, social welfare department and agriculture department, the Emirate council and all community leaders in Borgu Emirate.
Management Sciences for Health through USAID funding for the LMS-PROACT project has been supporting the Godiya support group and is responsible for the Anti retroviral therapy and HIV treatment and care at the Government hospital.
These partners/stakeholders, some of whom are already working together to initiate this project, e.g the farm land for the vegetable farm was donated by the Emir who heads the emirate council of community leaders. Community Health Education Foundation is merely a concept designer and project lead.

Community Health Education Foundation was borne out of the passion of a public health nurse desiring to give back to her community in Nigeria. The foundation received a family donation of $5,500 in 2006 to set up its office, get registered by government and begin micro projects focused on women and girls at the community level.Its staff are majorly volunteers who for about four years have majorly carried out free health education in communities, with donations of honorarium and fund raising from community members, friends and family. Other sources of funding for Community Health Education Foundation are consultancy fees, and a micro grant from another local NGO to carry out a community based intervention

Complacent attitudes of the government officials and their natural instinct to resist changes could be a hindrance. Since NRHM in India encourages innovations and we are already working with the key officers in Arunachal Pradesh, we hope to influence others as well.
The approaches of the technical staff of the PHC – doctors, nurses, pharmacists, laboratory technicians and health assistants, due to the nature of their training are more curative in nature. Their roles as teachers have to be developed. We have successfully done that in Sille and hope to do that in other facilities as well.
Health, for the poor people, are not the primary concern. They, especially the women, are more concerned about their day to day existence. It would be hard to persuade them to attend the PHC for fifteen days. However, we have seen that increased social recognition that comes with capability is a powerful motivator. We have been successfully motivating women to attend trainings for the last 12 years now.
Funding could be hurdle, but the present model makes use of the existing manpower and infrastructure with minimal additions.

Communities with whom the project works are our most important partners. At present, they comprise of the Adi and Mishing tribes at Sille. It will be the Nyishi tribe in Deed and Miji tribe in Thrizino.

Government of Arunachal Pradesh initiated the Public-Private Partnership (PPP) project in 2005 under National Rural Health Mission. The worst performing PHC in each of the 16 districts were handed over to NGOs for management with a view to improve services. Future Generations Arunachal was one of the four NGOs participating in this project and has been managing the PHC in Sille since January 2006. From August this year, we have been given two more PHCs, one at Thrizino and the other at Deed.

Apart from Arunachal Pradesh in India, Future Generations works in Peru, Afghanistan and China.

NGO: Till now, Future Generations has been supporting the project. We have receive $ 3000 for the financial year 2011-12.
Regional Government: The Government of Arunachal Pradesh contributes 90% of the fund to manage the PHCs. The main expenditure heads include personnel, medicines, supplies, infrastructure maintenance, furniture equipments.

Community will be our barrier here in Pakistan on this topic no one is willing to say something instead of that We are taking this challenge to make it Happen and we know that we will do it in a great style to aware maximum peoples of Pakistan.
We can overcome it with the help of educated peoples and officials who will definitely help us to overcome this issue.

WFP-Rutgers Pakistan are the partners of us here in Pakistan, We hope that more Partners will come to us & join hands with us.

For any project, an identification of the risks associated with it in its present operational condition and the risks that may arise in the future have a significant impact on its success.

The barriers that might hinder the success of our project along with their solutions are as follows :-

•ACCESSIBILITY
Since slum women are usually hesitant to go out and ask chemists, who are generally males, for sanitary napkins, our product becomes more accessible to them with fellow slum women as sellers, engaging in door to door selling.

•INFLUENTIAL SELLERS
All our sellers have been strategically chosen, keeping in mind the authority and position that they enjoy in their localites.

•CREATING ENTERPRISE
Besides the contributions to the cause of hygiene, we also intend to develop enterprise for the slum women.

•GROWTH
The major expenditure in the first two years will be on EXPANSION into newer slums in Delhi NCR and on DEEPER PENETRATION within the slums. In the third year, we seek to expand the PRODUCT OFFERING to other products of hygiene and have kept a budget of USD 20,000 for carrying out this plan.

Our competitive advantage lies in the AFFORDABILITY and ACCESSIBILITY of our product. Since the market is highly price sensitive, the price has been kept keeping in mind the nearest competitor.

Our partnerships exist both at the operational level, as well as the strategic level. Strong partnerships with local NGOs working at the grassroots level help percolate to the deepest parts and often, most neglected part of Delhi slums, backed by a long-standing partnership with our manufacturers.
At the strategic level, we are assisted by a Business Advisory Board, consisting of mentors across industry and education. We have on our board, partners from KPMG, CEB, FMS and SSCBS, who constantly mentor us and assist us in fine tuning our project in response to community and environmental needs.

•NGOs
NGOs like ASHA, Mobile Creches, Kalaakar Trust, Children's Hope Prayas, Discipleship Centre etc. have helped us in establishing our business models in the various slums of Delhi. They also provide us with infrastructural support at times and help us in organising regular awareness camps.

•BUSINESSES
Corporates like KPMG, HSBC etc. act as our mentors and have been instrumental in connecting us to corporate leaders.

•OTHER
Other indicates the competitions organised by various institutions and corporates. The grants we receive by winning these competitions provide us with financial security.

CUSTOMERS
Our project creates a for-profit business model for our women entrepreneurs, involving trading of sanitary napkins. It is strengthened by the customers who purchase these sanitary napkins.

There is no question regarding the large and compelling need for the outcomes that Nurse-Family Partnership produces, but two issues must be answered if NFP is to achieve its growth goals:
1. Will the Federal and state governments understand NFP’s value?
2. Will governments direct scarce public funds preferentially toward NFP based on its superior, proven, enduring, multi-generational outcomes?

NFP is distinguished from other programs by the fact that it focuses exclusively on low-income, first-time families and first children and it has a solid foundation of scientific research that provides compelling evidence of its efficacy in that context. The case for government funding of NFP replication is greatly enhanced by third party endorsements and by increasing executive and legislative branch actions aimed directly at funding NFP. NFP has created a scaling plan to accomplish its growth objectives through the following components: Program Development, which deploys program development specialists regionally to work directly with state, county, and community agencies to assess and prioritize opportunities and build state-wide initiatives; Federal and State Policy, a persistent, focused campaign to build support for evidence-based policy and practice and, in particular, for NFP; Marketing Communications, a sustained and expanding program of communication intended to build a strong, compelling image of integrity and value in the brand name “Nurse-Family Partnership:”; and Infrastructure Development, which anticipates and prepares for growth with fidelity to the research model.

The Nurse-Family Partnership National Office currently supports 32 states and 392 counties within the United States, with approximately 170 agencies with approximately 1225 registered nurses who carry a Nurse-Family Partnership case load of not more than 25 clients at a time; these nurses are supported by approximately 250 Supervisors. The NFP National Service Office contracts with and provides support to these implementing agencies that in turn provide services at the local level. These agencies are administered by a range of public and nonprofit entities, including state and county public health departments, community-based health centers, nursing associations, and hospitals.

Range of organizations that implement NFP:
o County health department 47%
o Hospital 14%
o Nonprofit 8%
o Community-based org 8%
o Visiting Nurse Association/Visiting Nurse Service 7%
o City health department 7%
o Federally-qualified health center 7%
o State health department 2%

Nurse home visitors bring a wealth of experience to NFP, with an average of 7 years in nursing and backgrounds in maternal child health, OB/GYN, labor and delivery, community health, pediatrics, psychiatric nursing, special needs/early intervention, NICU/PICU, home health nursing, social work, emergency medicine and surgery. Some NFP nurses had been doulas, certified lactation consultants and/or midwives.

The research, development, and replication work of the Nurse-Family Partnership have been supported by The Robert Wood Johnson Foundation, National Institute of Mental Health, The Edna McConnell Clark Foundation, The Colorado Trust Foundation, National Institute of Nursing Research, William T. Grant Foundation, Administration for Children and Families, Smith Richardson Foundation, US Department of Justice, The David and Lucile Packard Foundation, The Doris Duke Charitable Foundation, The W. K. Kellogg Foundation, and many others. They remain committed to helping us bring the Nurse-Family Partnership to every eligible low-income, first-time family.

Currently, the NFP NSO is on track to raising $50 million from a ‘Growth’ Capital Campaign, where the balance will be raised from ongoing philanthropic efforts. To date we have 100% commitment of the funds through the support of our Co-Investors: the Edna McConnell Clark Foundation; the Robert Wood John Foundation; the Bill and Melinda Gates Foundation; the W.K. Kellogg Foundation; the Kresge Foundation; and the Robertson Foundation.

Combined our Co-Investors have contributed $42 million toward the Growth Capital Campaign. As of March 31, 2011, the NFP National Service Office has raised $5.6 million for our Board’s $8 million commitment to the Growth Capital plan. The belief is that significant and long-term investment in nonprofit organizations with proven outcomes and growth potential is one of the most efficient and effective ways to meet the urgent and unmet needs and well-being of low income families.