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Community Health Director
I am the Community Health Director at Possible. I lead the Community Health strategy and oversees operations at two key levels of Possible’s hub-and-spoke healthcare model – clinics and community health workers. I will be leading our implementation team with the group pediatric care program!
Agraj! It was such a pleasure meeting you in KTM! Our team really enjoyed the prototyping and I look forward to seeing you again soon and working on this next phase with you! Thanks for all of your help and insight during this process!
Thank you so much for your thoughtful response. I have jotted down some of the answers to your questions below. We are currently running a Group ANC program that groups women from the same village cluster that are of the same gestational age. Their are similarities to the structure of our group ANC program and our group pediatric care in that the goal is to generate social support among mothers that are from the same area who may be facing similar challenges.
1) Is your group actively providing pediatric primary care in Nepal? Not yet. We have recently tested out a prototype of our Group pediatric care. As mentioned above, after brainstorming, feedback loops, and comments from the IDEO community, we realized that a big bottleneck in programmatic and HDC design was getting parent buy-in. We tested a prototype of our Group Care for Child Health that focused on answering questions around acceptability and desirability.
2) Is there primary care for children in rural Nepal? There is primary care for children in rural Nepal but the amount of time with a provider, quality of care delivered, and access to quality care is this region is limited. The group pediatric care aims to address these issues.
We have found that our group ANC program has been able to address these issues. The primary outcome is maternal mortality and morbidity and the secondary outcomes are 4 ANC visit completion and institutional delivery.
Firstly, we have found with our group ANC, carrying out group counseling allows pregnant mothers to interface with a clinician for a longer period of time then they would during individual visits. Secondly, our group ANC program was designed collaboratively with clinicians and public health professionals in Nepal and an OBGYN doctor from Bringhams Women's Hospital in Boston who has visited Achham district a number of times. They built in proper clinical care during these visits (ie lab tests, USG) that wouldn't otherwise be provided. During the redesign phase we have done a lot with building out proper referral care for women that are at risk of complications (ie - High BP, malpresentation, RH negative...etc). Lastly, the group ANC program is carried out at government health posts that are easier for women to access than a larger hospital where comprehensive care is available. This allows pregnant women, who live in extremely remote and mountainous areas, to access quality care closer to their homes. Additionally, the group sessions strengthen support among women, who are from the same area and facing similar challenges during pregnancy. Our sessions include a group participatory component that focuses on identifying contextual factors that create barriers to care and ways these women can work together to break down those barriers.
Our group pediatric care is designed to address the same issues. We want to bring women who are facing similar challenges as primary child care providers of children under two years, so that they have clinical support on how to best care for their child at these sessions, and social support that is generated at these sessions but extend beyond the health post. Additionally, these sessions will focus on identifying contextual factors that create barriers to care and support mothers to find ways to break down those barriers.
You mention that the groups will be run by experts. Who are they? The group pediatric care program is being developed by clinicians and public health professionals in Nepal and Duncan Maru, a pediatrician that also serves as the Chief Programs Officer for Possible.
I am not sure if I missed this in the description or somewhere in the thread below, but I am wondering how the official government lists, that determine who is eligible for a new floor, are managed. And if the caseworkers are employed by a local org, then why are the lists official government lists? Are the government lists that people sign up on only available at clinics or can people sign up to be on this list at other places (ie housing office, or district office)?