Indigenous Peoples’ access to Health Services
According to Ngomane et al., indigenous women made the following comments about their treatment in the hospital: ɜɜ “ The kneeling position is not allowed in hospital and nurses give you instructions and won’t listen to you”. ɜɜ “If you air your views or your opinion, they laugh at you and ridicule you”. ɜɜ “They make you feel small and useless“. ɜɜ “The nurses give you instructions and will not listen to you”. he women also indicated that their rationale for going to clinics and hospitals is often motivated T by fear of complications or maternal death and complications that could cause them to lose their infants: ɜɜ “I came to the clinic to put my name on their books, in case I have a difficult delivery”. ɜɜ “My sister was saved by the hospital as the baby was delivered by an operation”. I t is important that there is dialogue between the community and the health sector. The similarities and differences between the two must be identified in order to reach consensus on issues pertaining to improved antenatal attendance. This will create a feeling of empowerment and awareness in the community, which will assist members of the community to utilize their resources and antenatal care services optimally.
Innovation in delivery of health services When studies of Chadian pastoralists and their livestock revealed that the vaccination status was higher in the animals than in children59,60 authorities decided to conduct joint campaigns bringing together veterinarians and public health workers. These campaigns not only demonstrated the feasibility of working across sectors, but were also 15 per cent cheaper than separate campaigns. For such efforts to succeed however there is need for community participation at all stages and multi-stakeholder engagement. Other innovations which are being used by countries are maternity shelters in remote areas. These shelters are in the hospital compound and encourage pregnant women to come and stay there towards the end of their pregnancies. For example, one such shelter is found in Garissa in the North-Eastern part of Kenya. In this area, the maternal mortality rates in 2003 were estimated between 1,000-1,300 per 100,000 live births against a national figure of 410 per 100,000 live births.61
59
Zinsstag J., Schelling E., Daoud S. et al. (2002) “Serum retinol of Chadian nomadic pastoralist women in relation to their livestocks’ milk retinol and beta-carotene content”, International Journal for Vitamin and Nutrition Research 72, 221-228.
60
Schelling E., Diguimbaye C., Daoud S. et al. (2003) “Brucellosis and Q-fever seroprevalences of nomadic pastoralists and their livestock in Chad”. Preventive Veterinary Medicine 61, 279-293.
61
Central Bureau of Statistics (CBS) [Kenya], Ministry of Health (MOH) [Kenya], and ORC Macro. 2004. Kenya Demographic and Health Survey 2003. Calverton, Maryland: CBS, MOH, and ORC Macro.
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