Saúde reprodutiva

Health Made in Households (HMIH) is truly effective in transforming lives in households in San district. Program income from the distribution of Health Boxes and reinforced by donor funding ensures continuity of project activities. Moreover, a loan of $25,000 guarantees the execution of the project. HMIH builds partnerships and support from community associations and international organizations. With HMH, there is a funding plan to support a scale-up of the project in the district. However, barriers that might hinder success of the project are identified and plans to overcome are developed. Financial insecurity can limit access to equipment and supplies and the implementation of activities. Weak community support can to weak or no ownership of the project. Nurturing partnerships with communities and listening to them ensures stronger project ownership. Without the community, there is no feedback and hence no strong reasons to revise strategies to make sure objectives and targets are being met. Limited geographical coverage reduces the client-base for health services. Long-term plans must guide geographical coverage with services. Free services or no cost-recovery does not guarantee any long-term financial security. When there is no accountability, partnerships fizzle out. Timely trouble-shooting the project for transparency and making corrective plans helps. Restrictive cultural norms impede making more health. Policy and high regulatory environment limit access to health services and so policy-friendly environments are important for making more health.

The lack of trained health providers in health centers and communities limits knowledge about HEHPs. It blocks access to health and requires training to transform health providers, health committee members and community leaders into people set for making more health. High Illiteracy bars informed adoption of health practices. With top-of-the art and largely pictorial manuals that meet the needs of illiterate people, makes education on HEHPs crucial. Materials that capture the interest of illiterate people are handy in making more health. Restrictive cultural norms hinder the making more health. Access to and use of high health services, especially by women, is often barred. Engaging men in activities and clarifying the roles of men and women are important to reducing the barrier.

Core HEMIH Partners include the 220 women's community associations. Apart from implementing HEMIH activities in all 25 local government areas in San, they serve as health platforms and outlets for health services and products. COFEMali San has funding partners, such as USAID and UNICEF who fund the training of association leaders; production of Community Health monitoring tools, production of communication tools (HEHPs) and client referral slips. There is a local NGo that provides training on HEHPs and produce communication materials, develop community distribution of health products, including: contraceptives, water purification tablets (Aquatabs).
COFEMali San/HEMIH project has developed partnerships with for Profit Companies, such as, Hotels, and transport companies. For-profit companies that sell health products for Association Health Box are partners who offer some rebates. Hotels offer rebates to project staff and technical assistance partners. Two Community radio stations are partners who provide reduced rates or free airtime for public service announcements. Two international NGOs -- World Vision and "Sante Sud" carry out the training of women in community development, including environment, water and sanitation.

Friends and family provide social support to members who adopt HEHPs. Individually, they adopt and promote HEHPs adoption among peers. National NGOs train leaders of associations of men, women, youth, churches, schools, etc. as CRWs who promote HEHPs. International NGOs/Non-Profits provide technical assistance. The Academia/Universities include Georgetown University/Institute of Reproductive Health), Johns Hopkins University/JHU/CCP, University of North Carolina/INTRAH. Donors include USAID through its community health called Keneya Ciwara and UNICEF, through its district health program. Businesses resupply health commodities to the associations in the HMIH. District/Regional government and Communal offices facilitate the development and registration of the women’s associations. Communal officers are communication links between COFEMali/ Bamako and associations in remote areas. Some government members participate in monitoring household action plans after adopting a HEHP. The National government creates a friendly political environment for HMIH operations and provides service technical and policy guidelines. It supports through in-kind contribution including salaries paid to district health team for time spent with members of women’s association who attend monthly meetings on HMH or training sessions on HEHPs, lodging, transport to meetings. Clients including household members generate demand for health and contribute financially to procure health services and supplies through membership fees. Some clients transport health commodities to associations in remote areas.

Most hindrances really are of no real concern. Maintaining patient safety and essential services during the remodeling is the most difficult part of the whole project, however our facilities management, infection control, employee safety and nursing work together to make sure everything gets done in a compliant and correct matter.

Currently, this project enjoys no partnerships.

The hospital foundation is spearheading the fundraising efforts, in addition various fundraisers are held within the hospital to raise money from employees, friends and family.

The cervix, breasts and other reproductive organs are still very much not discussed in the Nepal community. Women suffer for decades with uterine prolapse and high degree cervical cancer before ever attempting to talk to a health professional, or even a family member. In many areas of Nepal it is still practised that the woman lives outside in a small hut (normally for the livestock) during her period.
As a result, running health camps catering for these sensitive issues is very difficult and requires some innovative procedures to assure a successful camp. Our methods to date have been to first contact the community and provide an awareness session for key community leaders and champions. This includes the men of the community, and key women leaders. By convincing them that cervical and breast cancer screening is an important health initiative for the women of their community, it is these key community leaders that act as advocates for the program.
Along with the fact that women’s issues are often stigmatised, it is also difficult to get the information to the potential beneficiaries about the health service we provide. To advise women in the community about the program, the community women volunteers use megaphones and walk on foot door to door to advise the women on the program, the date it will occur and the location.
Then, once the women attend the health camp on the day, our staff carefully explain the process that will occur so that the women feel comfortable with the procedure, and the key women leaders lead by example and are often the first to undergo screening so they can promote the experience to those in wait.

The Nepal Network for Cancer Treatment and Research (NNCTR) was formed in 2002 as the Nepal affiliate of the International Network for Cancer Treatment and Research (INCTR). INCTR have been supporting the NNCTR organisation since that day. We have completed a successful project with the UNFPA and IARC screening 5000 women in Nepal in 2002-2005.
We collaborate with PHASE Worldwide (particularly the UK), an organisation which promotes skill sharing and training. From this collaboration, UK doctors have visited Nepal and provided specialist training to our nurses and doctors. In addition, 6 Nepali doctors and nurses have travelled to the UK to complete cervical cancer screening and colposcopy training courses. We continue to collaborate with PHASE to this day.
In 2008 the Nepal Australian Cervical Cancer Foundation (NACCF) was formed, with Dr Surendra B Bade Shrestha the chairperson of both NNCTR and NACCF. NACCF is the Nepal affiliate of the Australian Cervical Cancer Foundation (ACCF) and with the support of ACCF, NNCTR/NACCF have been delivering the cervical cancer vaccine (Gardasil) to school girls in Nepal, with 4,300 girls vaccinated to date last year and an ongoing program of 10,000 girls in 2011.
Our organisations have continued to steadily screen Nepali women for cervical and breast cancer since 2002, and in recent years we have received funding from the Nepal-Australian Embassy Direct Aid Program (DAP) and the Australian Himalayan Foundation to continue this screening work. We have screened more than 20,000 women to date, but so many more women are in need.

Our organisation receives financial support from individuals, foundations and International non-government organisations. We do not collect any funds from our beneficiaries, nor from the regional and national government in Nepal.
We rely on private and non-government funding sources, and this has limited our capacity to reach many Nepali women for our services.
We do receive non-financial support from our participating communities and the regional government. To undertake a screening camp we ask that the community (after we have provided an orientation/awareness session) take the role of advocacy to draw participants to our camps. We also ask that they provide us with a location to perform the camp (usually a school/health centre), and if possible, lunch for our team of nurses and volunteers.
For our cervical cancer vaccination programs we receive support from the local district health offices in two districts. These district offices are providing cold-chain storage and manpower.

CHP has a dedicated long-term staff committed to bringing about effective changes in healthcare in Vietnam. At Oberlin, as is the nature of colleges, the GlobeMed staff completely turn over every four years. It could be difficult to establish continuity between consecutive groups of GlobeMed staff. We plan on overcoming this obstacle by recruiting every year and training the younger members of the organization how GlobeMed operates at Oberlin. We need a strong, committed team to achieve our goals and we plan on having effective leadership from year to year by training the upcoming students and actively recruiting no matter how established we become.

Our three major partnerships are with GlobeMed's national office, with CHP in Vietnam, and with the Oberlin community. We receive instructions, advice, and mentorship from the national office along with guidelines on how to run meetings, facilitate dialogue (both within the group and between the group and CHP), and fundraise. We strongly emphasize our partnership with CHP as we work together to design initiatives. They are our connection to healthcare issues abroad. We work with the Oberlin community to raise awareness about global health issues, specifically those felt by people at high risk of getting HIV in Vietnam.

We would like to spend over $500 on community events in Oberlin to raise awareness about our work and CHP's.
We plan on getting most of our financial support from Oberlin College, local business, and grants like these. The majority of our fundraising relies on professors, families, friends, and other individuals. The GlobeMed national office supports our endeavors and are there for mentor-like support in case of seemingly-insurmountable difficulties.

That some schools will not want to participate, with 50% of the schools, we still can develop the same project.
Parents oppose to their children participating in a campaign of public exposure refers to issues of sexuality, we will work with children who are allowed.

Secretaría de Salud de Pilar.
University of Quilmes
University of Luján
University of Buenos Aires
Centro de Estudios en Medicina Familiar (CEMF)

The project is supported from various sources: volunteers provide labor at various stages, companies make contributions with money and donations, and foundations fund the project.

The major barrier that might hinder the success of this project is lack of community acceptance and resistance to change. The community might not support young women's economic independence or young women's right to make reproductive health decisions. This can be overcome by working closely with community leaders and other stakeholders to understand the benefits that these changes will bring to their entire community. Another challenge is sustaining beneficiary interest in the project, which can be overcome by providing material incentives to the participants of the program.

This project works with several entities:
Primary Healthcare Centers (PHCs): These are the health providers at the community level and the project works closely with them to ensure that young women receive services when they are referred to those centers.
Micro-finance banks: The self help IGA groups have accounts with micro-finance banks, in order to increase their access to loans.
Local government authorities: the self help groups are registered at the local government level as cooperatives. This ensures their legal status and also increases access to grants and other resources from the local government.

The project is supported by the Irish Embassy (Irish AID) in Nigeria

To overcome the funding barrier, will use the founder's network, social media, corporate assistance in funding grant writers. To overcome staffing issues will utilize role substitution and working with Rwandan pharmacy school students as potential interns. To overcome finding adequate pharmacy sites, work with the Ministry of Health, colleagues in country, partner with other NGOs and even seek out other NGOs for suggestions. To overcome lack of buy in by native Rwandans, use pilot pharmacy personnel to help sell ideas and provide cultural competency for Prescription For Hope staffers. Finally, to overcome the customs barrier, allocate budget for hiring knowledgeable export shippers.

Our partners share a deep unbiding dedication to helping genocide rape survivors. Before we start working with a potential partner, we survey potential sites and ask a lot of questions. Since we do not supply medications, we check to see that there will be a steady stream once the pharmacy is completed. If possible we either pick out the site for the pharmacy or help assure that the area is secure. Finally, we try to meet the pharmacist running the facility to see how best to teach him/her the processes.

The founder's friends, family and individuals know first hand about his passions in this area. Since the founder's family has a for profit community pharmacy, he asked major vendors for donations - and for the most part they agreed to help.

An important obstacle will be the existence of local-level social, cultural, and political structures which can obstruct our strategy of sustaining short-term health improvements by empowering local organizations, and in particular organizations which give voice to traditionally under-represented social constituencies. Part of this obstacle can be overcome at the proposal review stage, when both in depth telephone interviews and, in many cases, preliminary site visits provide crucial background information on individual communities’ likely receptiveness to our development approach. To the extent that such obstacles remain, our experience is that they can be overcome with patient organizing methods, which will in turn require prolonged local residence and capacity building by one or more of our board members. Although requiring individual flexibility and sacrifice, this sustained and direct community presence is essential for effectively targeting aid resources, and also for helping to provide individual communities the necessary social and organizational capital to access and/or generate these resources on their own behalf in the medium-term. Gathering reliable and relevant data on health and social outcomes in settings characterized by extremely low levels of physical and public infrastructure constitutes an additional challenge moving forward. While hoping to extend our data-focused partnership with Nokia to new project sites, we will also make use of our training in the social sciences and public health to develop cutting edge measurement instruments for gathering data in low infrastructure environments.

Our success in El Páramo has been made possible by a diverse set of partnerships with local NGO’s and community organizations, international NGO’s, and private sector businesses. In 2001, construction of the El Páramo clinic itself was facilitated by our long-term international partner Foundation Human Nature (FHN), a German-based NGO founded by Dr. Martin Eckhart. Our organization itself was formed in 2003, to sustain the clinic’s ongoing operations, by a number of the volunteers who contributed to FHN’s original work in the region. Since that time, we’ve developed an ongoing and unique relationship with the local NGO MeHiPro and the quasi-public Health Committee in El Páramo. As our work has evolved from funding and staffing the clinic to promoting region-wide health and well-being campaigns, it is in conjunction with MeHiPro and the Health Committee that we’ve identified crucial needs and areas for improvement. Our personal relationships with members of the Health Committee have provided us access to the local level information and dynamics which have been crucial in developing and implementing our model of sustainable change, grounded not only in immediate health outcomes but also a broader commitment to organizational, institutional, and cultural development. Based on these successes, our newest partnership with Nokia will both establish for the first time a region-wide communications network, and use this infrastructure to improve the collection of previously non-existent health-related statistics.

One of our organization’s strengths, which comes in part from our board members’ mix of professional and personal profiles, is a diversified and multi-pronged approach to fundraising which has sustained our expanding activities for over seven years. Large scale fundraising events, organized by individual board members at the rate of 3-4 annually, as well as seasonal fundraising drives and online auctions, allow us to solicit contributions at the $25-$200 level from supporters among friends and family members. We are now developing contribution packages in which these same supporters can become organizational ‘members’ who, in exchange for annual commitments, will receive opportunities for more active involvement in our work. By promoting our work in larger circles, we have on more than one occasion received more substantial one-time donations from individuals outside our immediate networks. We were provided a grant by the ‘International Fund’ (non-profit foundation) to purchase El Paramo’s first effective ambulance, and we’ve received monetary contributions from religious congregations, baseball leagues, and other civil society groups. As for the public sector, we’ve received project support from the British Embassy in Quito, and since 2005 have received contributions of staff and equipment from the Ecuadorian Health Ministry. Finally, our recent telecommunications and data collection work in the region have been funded by a substantial grant from Nokia.

The main barrier is the lack of support for community organizations in their fight to have their voices heard and participate in governance in general, ad the lack of financial support for those organizations, sometimes very fragile. Part of our work is precisely build their capacities in both senses. We are joining urban governance movements that are fighting for more participation, transparence and good public management in public policies in Rio and Brazil.

Cedaps has implemented Shared Construction of Solutions on a large number of settings and programs, all in partnership with different organizations: the Ministry of Health (specially tje Brazilian HIV/Aids Program), State and Municipal Secretaries of Education, Social Assistance and Health, international agencies such as UNICEF and UNESCO, Ford Foundation, Synergos Institute, CORDAID Netherlands, Action Aid, and companies such as Danone, Johnson and Johnson, Ampla, Brazil Foods, and others. As a consequence of its results in community mobilization and empowerment for health using Shared Construction, Cedaps has participated in networks, such as the International Union for Health Promotion and Education, the Brazilian Task Force for Health promotion, the Network of Health Communities and Municipalities, the Global Consortium for Community Health Promotion, the International Society for Equity and Health and WHO’s High Comission for Social Determinants of Health (Knowledge Network on Urban Settings). The Dreyfus Health Foundation was a special partner, co-creating the program and its methodology and co-funding its initial implementation. After the good results in Brazil, the Foundation helped us bring our experience to the Dominican Republic, El Salvador, Nicaragua, Costa Rica, Mexico and Peru.

Another very important group of partners are the community grassroots organizations we have been working with for almost 20 years, as well as other NGOs in Brazil and abroad.

Please see partnersips above

To overcome the barrier of sustaining interest the CHLS after paid internship, we have launched the micro health enterprises where the CHLs manufacture and sell health related products like sanitary napkins or nutrition mixes and earn a livelihood for themselves.
The health savings and micro enterprise can be sustainable at scale but health education would need to be subsidized that is a barrier interms of funding.

We believe that a greater partnership between NGOs, providers, educators, private companies and government agencies will not only foster innovative social marketing but also allow all to share best practices, achieve economies of scale and scope and utilize research to identify changes in community demographics and needs. We have partnered with various organizations to achieve our objectives by leaveraging on their strengths. Some of them are:
1. Technical Resource Partners
•National Institute of Nutrition, Hyderabad
•Indian Institute of Health & Family Welfare, Hyderabad
•Andhra Pradesh Mahila Abhivrudhi Sangha, Hyderabad

2)Implementation Partners
•Cashpor Financial Services, UP & Bihar
•Regional Rural Development Center, Orissa
•Velugu Groups, Andhra Pradesh

3) Audit Partners
a.External Financial Audit: Delloitte Haskins & Sells
b.Internal Financial Auditors: PMR & Sons consultants

The organization started with support from individuals and we have been constantly receiving support from individuals who believe our works makes a difference.
We had received a small grant from Christian Aid to do our intital surveys and come up with the micro health financing project. This was then followed with a 3 year grant from USAID to establish and implement the micro health insurance pilot.
Deshpande Foundation has given us a grant to do health and health financing needs research in north west Karnataka.
Sir Darobji Tata Trust is now supporting us in implementing the community health education and health savings program in three states in India
Severeal businesses like Intelligroup, Cognizant technologies, Orange Healthcare and Delloitte have supported us by giving us pro bono services in the areas of MIS, technology and financial audit.We have recently been awareded a grant by Indian Council of Medical Research for doing a research on the health and health financing needs of tribal population in Andhra Pradesh.

As our project is currently divided into to aspects: fundraising from the United States and work carried out on the ground in Ecuador, there are a lot of language and cultural barriers that need to be crossed effectively in order for our work to be successful. While we have been working well with these communication lines, we hope to eliminate these barriers by transferring all of our operations (fundraising) to the Fundación Pachamama office in Ecuador by the end of 2012. On another cultural level, the empowerment of women can only be achieved by working in solidarity with and empowering the Achuar men. As it is only a recent development that Achuar men are recognizing the importance of the role women play in the health of their communities and families, we have to be attuned and prepared for potential conflicts with male leadership along the way. Our current strategy to prevent and eliminate this obstacle is by increasing our partnership and alliance with the NAE leadership (see description below), which not only empowers the NAE leadership to complete its objectives of protecting the territory and its people, but will also garner legitimacy among the male Achuar population in communities that are significantly more prejudiced against female participation and leadership.

Jungle Mamas, a program of Fundación Pachamama, has a principal partnership with the Achuar Federation, known as NAE (Achuar Nationalities of Ecuador). NAE is the overarching governing body of the Achuar of Ecuador that coordinates with the communities throughout the territory in Ecuador. Without the support and commitment of the NAE leadership, Jungle Mamas would not be able to operate within the Achuar territory. Fundación Pachamama has a sister organization, The Pachamama Alliance, which has served as a primary source for contacts with other organizations for the Jungle Mamas program. Jungle Mamas also partners with the organization, EcoSan, based in Ecuador, which provides technical assistance with the education and implementation of urine diverting ecological dry toilets. Jungle Mamas has also collaborated with the Ecuadorian Ministry of Public Health and Intercultural Health in order to increase access and representation in the Achuar territory. Due to the limited budget of the Ministry of Public Health, access to healthcare to the Achuar is also limited. However, because of Jungle Mamas' focus in Achuar territory, we have collaborated with the Ministry of Public Health to make sure that they are indeed reaching the Achuar population. Jungle Mamas also partners with Aerotsentsak, the only entirely Achuar-owned aviation company based in the town of Shell, Pastaza.

The Jungle Mamas program within Fundación Pachamama has received funding from private donors who are members of the Pachamama Alliance. We have also received funding from the Good Works Foundation, and have held fundraising events. The fundraising element is largely conducted by Margaret Love in the United States with the Pachamama Alliance, while the work is being implemented on the ground in Ecuador by Fundación Pachamama.

Health Infrastructure and unavailability of required drugs
UHC situated at one corner is not accessible to all the people living in 18 slums and poor slum people cannot buy drugs and afford clinical tests. So UHC sub centres nearer to the slums will be established and Mobile clinics will be conducted in each slum. By approaching funding agencies, diagnostic laboratories will be established and required drugs will be procured for free distribution.
Participation of community
Community members who have been sensitized about services required to benefit their family or wider community will provide their time and energies to render such service without any monetary compensation. These transformed communities will in turn have addressed these challenges in a sustainable way. This is also one of the most cost-effective, appropriate, and sustainable approach of implementing community based program.
Formation of Community groups
All the adolescent girls, Women Self Help Group members(SHGs) are motivated to enrol as members in Mahila Arogya sangams(MAS).These MAS are linked with the SHGs. With the capacity building of the members they will be in a position to continue activities.
Involving Community Health Workers
Trained CHWs who gained experience will be motivated to continue extending health awareness and referring the necessary cases to STEPS Health Centre without any monetary benefits.
Health Insurance
National Insurance companies, Government and Funding agencies will be contacted to provide support for health insurance of the poor slum people.

1. Dept of Health and Family welfare, Govt of Andhra Pradesh, INDIA.

With special consultative status in the United Nations Economic and Social Council (ECOSOC)
Partnerships:1. White Ribbon Alliance for Safe Mother Hood, 2. The Partnership For Maternal New Born & Child Health, 3. Global Health Council, 4. . India CCM for the Global Fund. 5. STOP TB Partnership, 6. Women Deliver 7. Malaria Foundation International. 8. ChildStatusNet

1.Dept of Health and Family welfare, Govt of Andhra Pradesh
STEPS society is running Urban Health Centre in18 slums of Srikalahasti Municipality covering a population of 25,000,Funded by Department of Health and Family Welfare, Government of Andhra Pradesh.
The urban Health Centre provides:1.Mother and Child Health (MCH) Services 2.Family Planning Methods and Operations 3 creating awareness on various issues related to Health and Family Welfare
General Information: Five Mahila Aarogya Sangams(MAS)were formed and actively participating in all the programmes of STEPS Urban Health Center.UHC Advisory Committee was formed.They work out the guide lines for functioning of the UHC.Conducting antenatal checkups and immunization camps in all the sub centres.
Health Education and Motivational Activities: Health education through counselling,demonstration,exhibition,and literature distribution during festivals being carried out to create awareness about health issues.
Health Awareness Campaigns for Women and Adolescents: onducting Health awareness campaigns for women and adolescents focusing on disseminating and creating on nutritional awareness, hygiene,immunization,care during pregnancy and child birth, STI and family planning methods.
School Health Program: Conducting Medical Examination in all the UHC area schools and distributing free medicines .
Achievements: Implementing Government programmes. 3. Achieved 100% motivation of family planning cases every year.
2. White Ribbon Alliance for Safe Mother Hood: Funded for collecting stories of Mothers saved

The roll out up of the project will require a substantial amount of support and funding. But it is envisaged that the subsequent years of the project will be self sustaining. The project will select and train health educators who are self motivated and committed to work with minimum financial support by the project.

Recruitment from within organizations that also have a stake in sexual health education of young people will also help to ensure that SHEs are facilitated by the organizations to which they are affiliated.

The project works in partnerships with organizations and institutions with interest and stake in the promotion of better quality of life of young people with particular reference to achieving SHIP goals and objectives. These include government institutions, line ministries like Ministry of Education, Ministry of health and Ministry of Finance and bilateral agencies, NGOs, corporate bodies, and other well wishers.

Implementation of the activity is also done in collaboration with district local governments and sub county authorities.

The project is housed in the Population Secretariat which is a semi-autonomous government institution under the minstry of finance, planning and economic development. The secretariat provides office space, furniture, and staff time and expertise of trained experts.

The project has also been generously supported by the Government of Israel who provided three technical experts from Israel to conduct the trainings of Sexual Health educators in Uganda using the Israel model of sexual health education.