Role of Community-Based Savings Groups (CBSGs) in Enabling Greater Utilisation of Community Midwives in Chitral District of Pakistan
CBSGs(Community Based Savings Groups) are a simple, transparent, cost-effective and sustainable means of providing entry level financial services and a forum to interact, educate and positively influence women's health seeking behaviour and birth preparation plan. Groups of self-selected women make deposits, pool their savings, and lend to others in the group at a pre-defined, mutually agreed upon interest rate. In remote areas of Chitral, the MNCH programme trained and deployed 24 Community Midwives (CMWs) to serve a population of 55,013 with low-cost, reliable, and easily accessible antenatal, delivery and post-partum care. CBSGs were established, composed of 10-30 women. This cross sectional study assesses the impact of CBSG membership on members use of MNCH services particularly those provided by CMWs. 908 women and their husbands were interviewed via focus group discussions(FGD) held in four selected communities representing the geographical, ethnic, religious and economic diversities of Chitral. In each area, the FGD interviewed women and their husbands, regardless of whether or not they were members of a CBSG. Results: Almost one-fourth of the respondents belonged to households that had incomes below the poverty line. Only 16% of the respondent's had husbands who had studied till grade 10 or above and were holding small jobs or were doing unskilled labour work. 65% of the respondents were illiterate and only one-fifth had completed grade 10 or above. One-third of the respondents were associated with a CBSG either directly or through an immediate family member, and about 38% of the respondents contacted CMWs for health care. The data collected showed that women, who were younger, better educated and with fewer children were more likely to be associated with a CBSG. The data also showed that 72% births occurred at home and local birth attendants were most often used because they were easily available and charged low fees. As a result of the CBSG, women accessing antenatal care (ANC), delivery and postnatal care (within 2 days of delivery) from a skilled provider increased to 23%, compared to 1% at baseline. Women associated with CBSGs had 4x times more often completed the continuum of care from a CMW and other skilled health care providers. CBSG membership and mother-in-law as decision maker to visit health care provider were found to be factors associated with completing continuum of care by CMWs. CBSG membership gave respondents and their husbands, a degree of financial autonomy, and enhanced their ability to consult healthcare providers in a timely manner. The CBSG at the community level provided an enabling working environment to the CMWs to interact, educate and influence health seeking practices around birth preparation. Communities were appreciative of the CMWs as it helped them to overcome the constraints of harsh weather, long distances and lack of transport. Conclusion: deploying CMWs and simultaneously establishing CBSGs proved to be effective in increasing utilisation of MNCH services from skilled service providers. This experience can be replicated widely in KPK province, and at the national level, in vitalising the health committees with due representation of both male and female members of each village to support and sustain the role of CMWs.
Noorani, Q.; Azam, I.; Shaikh, B.T.; Ranasinghe, T.; Abbas, S.; Wali, S. Role of Community-Based Savings Groups (CBSGs) in Enabling Greater Utilisation of Community Midwives in Chitral District of Pakistan. Aga Khan Foundation, Pakistan, (2013)