Improving Service Accessibility for Least Advantaged Clients

NGO Service Delivery ProgramHouse NE (N), Road 88, Gulshan-2, Dhaka-1212

NGO Service Delivery Program (NSDP) Slide # 2

Overview of NSDP

35 NGOs35 NGOs61 districts

85 municipalities 6 city corporations

317 Clinics 8,302 Satellite Spots6,330 Depotholders 1.7 million customer served/

monthBasic Service PackageBasic Service PackageComprehensive FP & RH Services Child Health services TB in urban areasANC and maternal healthLimited Curative CareBCC activities

NGO Service Delivery Program (NSDP) Slide # 3

Study Objectives

• To identify least advantaged clients (poorest of the poor)

• To isolate and understand barriers they face in accessing

services

• To design ways to overcome barriers

• To improve communication between the poor and NGO

service providers

NGO Service Delivery Program (NSDP) Slide # 4

Methodology

• Participatory Rural/Urban Appraisal applied with women – Social Mapping– Wealth Ranking– Venn Diagram

• Meeting with Stakeholders

• Study Coverage: – 8 NGOs – 24 Static Clinics – 826 Satellite Clinics spots

NGO Service Delivery Program (NSDP) Slide # 5

PRA Sessions and Participants

• 390 stakeholder meetings and 694 PRA meetings conducted

• 24,533 community members participated in PRA meetings

• 6,556 stakeholders attended meetings expressing their commitment for serving poorest of the poor.

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Who are poorest of the poor

Poor community members identified context specific indicators in PRA session:

Rural• Day laborers• Depend on food collected

door to door• Cannot eat twice in a day• No education• Little income above

expenditure

Urban• No land• Begging• Suffers from untreated

diseases • Works as house maid• No work no food

NGO Service Delivery Program (NSDP) Slide # 7

• Services:– Limited range of services– inadequate number of

satellite clinics and – limited hours

• Information: Not informed about availability and types of services

• Poverty: – High service charge and

price of medicine– No free treatment

• Quality of service: – Diseases not cured – Incorrect treatment

• Providers’ behavior: – Poor are neglected

– Not allowed to speak

• Proximity: – Distance of clinic

– Clinic staff don't visit remote areas

Barriers

NGO Service Delivery Program (NSDP) Slide # 8

Participatory appraisal (Urban and Rural)

• Sharing of information/findings

• Joint planning for reducing

barriers

• Partnership between providers

and community

Joint Planning Session

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Strengthening Community Based Forums

• Satellite clinic support group & static clinic advisory

teams consist of community members and service

providers

• Very poor people are now involved in planning

• Assigned tasks and follow up

• 90,000 members are involved in these forums

• SCSG/SCAT actively involved in planning & organizing

satellite clinics.

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Addressing financial barriers

• Exemption policy for the very poor– Health benefit card

– Pricing policy for able to pay customers

• NSDP piloted incentive scheme in four NGOs

• Fund diversification strategies adapted– Involving business for serving extremely poor people

– 83 clinics of 13 NGOs generated Tk. 3,55,632 as community fund & using RDF profit for serving poor

– Pharmaceutical companies are started to provide free medicine.

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Percentage of Clients Who Are Poor

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

Months

Percentage

NGO Service Delivery Program (NSDP) Slide # 12

Some Changes

• All concerned are highly sensitized and oriented to meet needs of the poor

• NSDP incorporated the needs and expectations of the community in the work plan

• Providers’ satisfaction enhanced because they are involved in planning process

• Interpersonal communication strengthened

• Service utilization increased by the poor

• Pro-poor BCC strategy adapted.

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Conclusion

• NGOs learned the application of participatory

techniques to integrate into their management.

• SCSG/SCAT to be more active in promoting linkages

with community groups and play advocacy role

• NGOs need to focus on providers attitude towards poor

in making service poor friendly

• Continuous community feedback and consultation may

help developing new strategic direction.

Thank You