Shaikh Babar Tasneem, Noorani Qayyum, Abbas Shazia
Aga Khan Foundation, Level 9, Serena Business Complex, Islamabad, Pakistan.
Arch Public Health. 2017 Aug 10;75:57. doi: 10.1186/s13690-017-0227-3. eCollection 2017.
In remote rural areas of Pakistan, access to the maternal, newborn and child health (MNCH) care provided by a skilled health provider is quite difficult. There are many reasons such as women's restricted social mobility, lack of education, disenfranchised in decision making and poverty. To overcome these barriers and impediments in district Chitral, which is the largest territory in terms of geography in province Khyber Pakhtunkhwa, local women of reproductive age, were mobilized to form the Community Based Saving Groups (CBSGs) at the village level. In these CBSGs, they pool-in their money, and then provide soft loans to the expecting mothers to meet the expenses of delivery. Simultaneously, young literate women were identified from the local communities; they were trained as Community Midwives (CMWs), using national MNCH curriculum, and later deployed in their respective villages within the district. This study captured their perceptions about the formation of CBSGs to overcome the financial and social barriers, and subsequent use of CMW services.
A qualitative enquiry was conducted with the delivered mothers and their husbands through gender specific separate focus group discussions, with CBSG members and with non-members in four different sites of District Chitral.
CBSG member women were far more aware on health issues. Information sought from these forums brought a noticeable change in the health seeking practices. Seeking care from a trained birth attendant in the community became easier. Women associated with the CBSGs as members, expressed an increased access to money for utilizing the CMW services, better awareness on MNCH issues, and empowerment to decide for seeking care. CBSG have been an instrumental platform for social networking, helping each other in other household matters.
Women have started using the services of CMW and the CBSGs have actually helped them overcome the financial barriers in health care seeking. Moreover, the CBSGs became a medium to improve the awareness of service availability, understanding the MNCH issues, and timely utilization of MNCH services.
在巴基斯坦偏远农村地区，由专业医疗服务提供者提供的孕产妇、新生儿和儿童健康（MNCH）护理很难获得。原因众多，比如女性社会流动性受限、缺乏教育、在决策中没有话语权以及贫困等。为克服这些障碍，在开伯尔-普赫图赫瓦省地域面积最大的奇特拉尔地区，动员当地育龄妇女在村级组建了社区储蓄小组（CBSGs）。在这些社区储蓄小组中，她们把钱集中起来，然后向孕妇提供低息贷款，以支付分娩费用。同时，从当地社区挑选出年轻的识字女性；按照国家孕产妇、新生儿和儿童健康课程对她们进行培训，使其成为社区助产士（CMWs），之后将她们部署到该地区各自的村庄。本研究了解了她们对于组建社区储蓄小组以克服经济和社会障碍以及后续使用社区助产士服务的看法。
通过分别针对已分娩母亲及其丈夫、社区储蓄小组成员以及奇特拉尔地区四个不同地点的非成员进行性别特定的焦点小组讨论，开展了一项定性调查。
社区储蓄小组成员女性对健康问题的了解要多得多。从这些论坛获取的信息使寻求医疗服务的行为有了显著改变。在社区向经过培训的助产人员寻求护理变得更加容易。作为成员加入社区储蓄小组的女性表示，她们有更多资金可用于使用社区助产士服务，对孕产妇、新生儿和儿童健康问题有了更好的认识，并且在决定寻求护理方面有了自主权。社区储蓄小组成为了社交网络的一个重要平台，在其他家庭事务中相互帮助。
女性已开始使用社区助产士的服务，社区储蓄小组实际上帮助她们克服了寻求医疗服务过程中的经济障碍。此外，社区储蓄小组成为了提高对服务可及性的认识、理解孕产妇、新生儿和儿童健康问题以及及时利用孕产妇、新生儿和儿童健康服务的一个媒介。
