Community scorecards: addressing the maternal and newborn service related needs of the marginalized?
By Kakaire Ayub Kirunda, PIRU Officer
Caroline Namugwere (not real name) is a 27 year old disabled woman and resident of Kibuku District in Eastern Uganda. She is a single mother, having become pregnant and then abandoned by a man who refused to marry her, allegedly on the advice of his parents. Caroline received no support through her pregnancy from the father, and he remains uninvolved in their lives.
Caroline’s pregnancy experience was laden with challenges right from attending antenatal clinic appointments to delivery. She would crawl to the health centre for ANC appointments on a stony and dusty murrum road, and the situation wasn’t any different whenever she used the washroom at the health facility, which was usually filthy. Caroline would have to crawl in there.
Her pelvic examinations were usually performed on the floor as she was unable to climb onto the bed. Similarly, she would often sit on the floor as she waited to be seen by a health worker because she could not climb into the elevated seats.
“At times when I had a person to help me out I would climb and sit up like other mothers and in instances where I would fail to get a good samaritan, I would sit down on the floor and wait for my name to be read and crawl to the examination room.”
Without mentioning or knowing who should help or whose responsibility it is, during a formative interview, Caroline proposed that disabled mothers should have specific people to transport them right from their homes to health facilities.
“Then at the facility, they should make for us benches that are not raised. They can make something which we can also sit on without finding difficulty and the same should be apply to the delivery bed. It should be short such that a disabled mother can climb it even if there is no one to support her,” she says, adding: “There should also be separate toilets for disabled mothers because some of us use hands to move.”
To this, a number of questions arise: Is someone accountable for Caroline’s transport to and from the health facility? Who is responsible for ensuring that she accesses a clean washroom at a health as humanely as possible? Is someone answerable for her being examined on the floor unlike her non-disabled counterparts? Does her plight concern the community, local government, let alone the central government? Does she have a voice to air out her challenges? Does she even have a right to demand for equitable access to services?
Inquiry into the plight of the marginalised is part of what the Community Score Cards study of Makerere University School of Public Health in partnership with the Future Health Systems Research Consortium intends to explore over the coming months in Kibuku District in Eastern Uganda. Specific to the case of Caroline and other marginalised groups, such as adolescent girls who become pregnant, the following research question is being pursued: To what extent does a community scorecard process incorporate and address the maternal and newborn service related needs of marginalized populations?
In addition to addressing questions of how the CSC process might address the needs of the marginalised, the study seeks to develop a community scorecard that will include demand-side attributes so as to increase the accountability of not only the providers but also the clients, as explained in our CSC research study summary.
Also see related article.