“I don’t feel shy or embarrassed anymore, and I feel like I can call on anyone to help if I need it.” – Ozifa Khatun, pregnant woman
“All are committed to achieving the target and it’s not just in terms of the money. It’s also about ownership— the staff person feels a [sense of] accomplishment about what she did.” This is from a community health clinic that shares performance-based incentives with ALL the staff, from doctors to cleaners to volunteers. When the center gets recognized for good work, everyone benefits.
That’s what community members and local organizations can do if they get a little support that’s more about them than it is about donors. They find creative ways to build ownership, get community solidarity focused on critical issues, and change social norms. Ozifa said, “People are more friendly and helpful.”
From 2012-2017, CARE worked as a subgrantee to Pathfinder on the USAID-funded project. CARE’s budget was $1.9 million, and the CARE team reported a reach of 20,000,000 directly (16,000,000 women and girls) and 70,000,000 indirectly. A core part of the project’s success and reach was working with a network of 25 local NGOs and organizations that reached out to their own communities to provide services and support.
What changed?
- People had more control over the timing and spacing of births: Because of health visits, families were able to avoid 1.9 million unwanted pregnancies, prevent 2,000 maternal deaths, and avoid 10,000 childhood deaths because women could time births safely.
- Health providers were able to offer free services to people who need it most, and still stay financially viable: The health network was able to provide free or reduced price services to 51% of their clients, and still recover 40% of their costs—making for a sustainable business model.
- More people got access to services: There was a 42% increase in services provided to the poorest people in communities.
- Patients are more satisfied: 97% of patients were satisfied with the services they received, an increase of 14% between 2015-2017.
- Networks served massive numbers of people: The local groups provided 251.5 million service contacts—points where people could get appointments, advice, care, or medication. That included 42.5 million service visits for young people, 8.2 million pre-natal visits, and 176,928 safe deliveries in clinics.
How did it happen?
- Support local services: The project provided material and technical support to 25 organizations who served 399 clinics, 10,872 satellite clinics, and 11,842 health workers.
- Partner with the government at all levels: the project worked with 8 government ministries, and 96% of clinics in the project developed work plans in partnership with the local government.
- Keep data simple: At one point, the project realized that there were more than 11,000 people involved in data collection, and the only way for that to work was to simplify dramatically. They got the whole data collection form down to 1 page. Then they used digital tools to keep the focus on data analysis rather than just data collection.
- Put feedback at the heart of the work: The project developed strong AND diverse feedback systems to get as many perspectives as possible. This included patient exit interviews, surveys, suggestion boxes, and many more tools so everyone had a chance to participate.
- Get communities involved in targeting the most underserved people and communities: The project deliberately targeted the most underserved areas, and got communities to determine selection criteria. They also developed things like sliding fee scales so people who had the biggest need got the most support for the least cost to the patient.
- Have services support women: Women-friendly pharmacies that were specifically staffed by women and were open at times that worked in women’s day made it possible for women to access support. “Mothers’ banks” were a service that allowed women and their families to save up money for a safe delivery that the woman herself could decide how and when to spend.
Want to learn more?
Check out the evaluation.