Peer empowers marginalized women elmusharaf ifgh presentation 2 feb 2012 http://www.globalhealth.ie/index.php?i=247&PHPSESSID=4bccbb3b0e91c794cfe9c82ae33c7a1c IFGH 2012: participatory ethnographic evaluation research (peer) empowers marginalized women to engage in community directed reproductive health interventions Irish Forum for Global Health | Conference Abstracts Authors: Elmusharaf K.1’2, O’Donovan D.2
 Author Affiliations:1Reproductive & Child Health Research Unit ‘RCRU’, University of Medical Sciences &Technology, 2 National University of Ireland Galway
 Option 2 -Lessons from the field; project and programme evaluations; and syntheses or analyses Presented as – Oral Presentation Issues: This abstract demonstrates how Participatory Ethnographic Evaluation Research (PPER) can build the capacity, empower and engage local women in conflict affected hard-to-reach communities to participate in Community Directed Reproductive Health Interventions (CDRHI). Description: Fourteen marginalized women with no formal education were trained in PEER which included developing skills to design research instruments, conduct interviews, collect narratives and stories, and analyse the data. Twelve months later, 10 out of the 14 women were able to lead work on health communication with employees of local NGOs and local theatrical band members. They shared their information and data about the important issues related to women health in their community, developed action messages, created culturally appropriate health education materials, and delivered it to their community in form of pictograms, songs, and drama. Lessons learned: The women believe that PEER enhanced their credibility - when they returned to their social circles people were more accepting to what they said because they were perceived to know more than others. They are more confident about their ability to influence change. Participation in research design, data collection and data analysis was a particularly powerful tool to enhance their empowerment in post conflict settings. The approach adopted illustrates the developing of the capacity, mobilizing the community and increasing the level of readiness to participate in CDRHI. Next steps: By using PEER we not only gain an in depth understanding of the social, economic, and cultural contexts in which people live, but we also empower and engage marginalized women in hard to reach communities. Moreover, it gives a sense of ownership, ensures sustainability, and assists in planning, implementation, monitoring and evaluation of Community Directed Reproductive Health Interventions.

1. Participatory Ethnographic Evaluation
Research (PEER)
empowers marginalized women to engage in
Community Directed
Reproductive Health Interventions

2. Dr. Khalifa Elmusharaf, MBBS, PgDip, FRSPH (UK)
PhD Researcher in health system & Policy
National University of Ireland Galway (NUIG)
Head of Reproductive & Child Health Research Unit 'RCRU’
University of Medical Sciences & Technology (Sudan)

4. South Sudan

5. Maternal health indicators (SHHS, 2006)
MMR in South Sudan 2054 per 100,000 live births
10 % delivered by Skilled Birth Attendants
23% get ANC by any qualified personnel
Accessibility to Emergency Obstetric Care is low as indicated by
Caesarean Section rate of 2%

6. The women in South Sudan face alarmingly low
maternal health status to the extent that UNICEF
survey found that:
Girls in southern Sudan are more
likely to die in pregnancy and
childbirth than to finish primary school
(UNFPA 2006).

7. Most of the efforts of Health System including
International and National NGOs have been done to
reduce supply side barriers
USAID, 2007: “Most of the attention is focused at the
facility level -- waiting for clients to come into the
facility, and the facilities appear to be underutilized.”
However, very low utilization of accessible
maternal health care facilities in South Sudan is one of
the major obstacles to improve maternal survival,
....which is much influence by DEMAND side barriers.

8. Research challenges

9. Research challenges
Trust
– A lack of mutual trust between the
Illiteracy researcher (outsider) and the
respondents remains the main
competition TRUST
challenge to obtain reliable information.
–This research was done during the
period of referendum and separation
Complexity
Overcome the lack of trust and
sensitive issues

10. Research challenges
Trust Power differences between researcher
and participant:
Illiteracy • The researcher alone contributes the
competition ILLITERACY
thinking that goes into the project,
and
• The subjects contribute the contents
to be studied.
Complexity
Increase community readiness

11. Research challenges
Trust
– Competing with NGOs that
Illiteracy provide services and Food
COMPETITION
competition – Lack of motivation to participate
in any research (low response rate)
Complexity
Engage communities

12. Research challenges
Trust
Illiteracy – Complexity of social institutions
competition COMPLEXITY
and cultures in which behaviour is
contextualized.
Complexity
Listen to hard to reach population

13. PEER

14. PEER Participatory Ethnographic Evaluation & Research
Research & Empowerment

15. PEER
PEER is an
innovative, rapid, particip
atory and qualitative
research method
involving ordinary
members of the
community to generate
in-depth and contextual
data
(Price and Hawkins 2002).

16. PEER
14 women recruited by village
leaders

17. PEER
14 marginalized women with no formal
1. Design research instruments
education attended a Four-day PEER
2. Conduct interviews
training workshop to develop their skills
3. Collect narratives and stories
to: Analyse the data
4.

18. PEER training workshop
Concept of peer research
1 Discussed important issues
of maternal health in their
community.

19. PEER training workshop
2
Identified key themes and
questions for the
qualitative research

20. PEER training workshop
Final themes and sub themes
1. Family & Determinants of Family Size,
2. Experiences of Pregnancy,
3. Experiences of Birth,
2
(20 sub themes and Images)

21. PEER training workshop
3 Developed images to remind
them with the questions.

22. PEER training workshop
3

23. PEER
PEER
Researcher

24. They returned to their
villages to carry out in-
depth interviews in the
third person format with
three of their friends
three times
over three weeks

25. PEER
Women asked to describe
experiences of “women like
them” or of other women
in the village, not to tell
stories about themselves.

26. De-briefing with PEER researchers
Researcher visited them to collect their findings in
a series of debriefing sessions

27. Researcher visited the women
in their villages,
‘in hard-to-reach communities’

28. Researcher was making detailed
notes of the narrative data that
women had collected.

29. PEER Analysis workshop
Upon completion of
three discussions, the
women came
together for analysis
workshop
IdentifyAct out Dramasfindings
Developimportant
the profile stories

30. PEER
A dialogue between
researcher and the
women has been
generated

31. 12 months later

32. CDRHI Community Directed Reproductive Health Interventions
10 out of the 14 PEER researchers were
able to lead work on health
communication with employees of local
NGOs and local theatrical band members

33. 1. They shared their information and data about
the important women health issues in their
community.

34. PEER
researchers
2. They developed action messages.

35. PEER researchers and
Local NGOs Employees
3. They created culturally appropriate health
education materials.

36. Theatrical band members
4. They delivered it to their community in form of
pictograms, songs, and drama.

37. We should reduce heavy work from pregnant

38. Do not hit pregnant women
solve your problems without violence.

39. http://www.youtube.com/watch?v=sHLfGAP0N6k

40. Lessons learned

41. Lessons learned
The women believe that PEER
enhanced their credibility
When they returned to their
social circles people were more
accepting to what they said
because they were perceived to
know more than others.
They are more confident about
their ability to influence change.

42. Lessons learned
Participation in research design, data
collection and data analysis was a
particularly powerful tool to enhance
their empowerment
The approach adopted illustrates the
developing of the capacity, mobilizing
the community and increasing the
level of readiness to participate in
CDRHI.

43. Conclusion

44. PEER
Capacity

45. PEER
Capacity
Build ownership

46. Capacity
Build ownership
Empowerment

47. PEER
Capacity
Build ownership
Empowerment
in-depth contextual data

48. PEER
Capacity
Build ownership
Empowerment
in-depth contextual data
Understanding Local Context

49. PEER
Capacity
Build ownership
Empowerment
in-depth contextual data
Understanding Local Context
Strengthening Society