260819_0212

Sep 18, 2026 18:43 · 1:41:10 · English · Whisper Turbo · 8 Sprekers
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0:01
S… Speaker 1 (260819_0212)
all right so if you speak a little bit on the building that should be fine so maybe we'll
0:05
S… Speaker 1 (260819_0212)
start with you and then you just probably introduce yourself and
0:09
S… Speaker 1 (260819_0212)
so maybe john
0:30
S… Speaker 1 (260819_0212)
In 2020 you should have, you should have seen it.
0:33
S… Speaker 2 (260819_0212)
Yes, so that's how I told you that.
0:35
S… Speaker 2 (260819_0212)
I know you're 4th.
0:36
S… Speaker 1 (260819_0212)
Yeah, do you want 4th?
0:38
S… Speaker 2 (260819_0212)
Sometimes why is that?
0:43
S… Speaker 1 (260819_0212)
What was it on the weekend?
0:45
S… Speaker 3 (260819_0212)
Sandwich.
0:46
S… Speaker 3 (260819_0212)
Ah, that's why.
0:47
S… Speaker 2 (260819_0212)
2019 then 2022.
0:49
S… Speaker 3 (260819_0212)
Yes, that's why.
0:50
S… Speaker 1 (260819_0212)
If you were in PFRH,
0:53
S… Speaker 4 (260819_0212)
you would like that.
0:53
S… Speaker 3 (260819_0212)
Okay, that makes sense.
0:56
S… Speaker 1 (260819_0212)
Alright, so I'm in PFRH.
0:59
S… Speaker 1 (260819_0212)
So,
1:00
S… Speaker 1 (260819_0212)
you can introduce yourself to me and where you
1:04
S… Speaker 1 (260819_0212)
were working when you've come here and what you do.
1:07
S… Speaker 2 (260819_0212)
So,
1:09
S… Speaker 2 (260819_0212)
for me,
1:10
S… Speaker 2 (260819_0212)
I'm a public doctor.
1:12
S… Speaker 2 (260819_0212)
I used to be a
1:16
S… Speaker 2 (260819_0212)
bono -ranger senior year and I came here in 2022.
1:21
S… Speaker 2 (260819_0212)
I'm the original CAAC coordinator and also
1:25
S… Speaker 2 (260819_0212)
the original maintenance of the campus.
1:27
S… Speaker 2 (260819_0212)
So that's what I do in the region.
1:29
S… Speaker 1 (260819_0212)
And just in terms of,
1:33
S… Speaker 1 (260819_0212)
you give me the broad teams,
1:35
S… Speaker 1 (260819_0212)
but when you say CAAC coordinator,
1:37
S… Speaker 1 (260819_0212)
what does that mean?
1:38
S… Speaker 2 (260819_0212)
So I coordinate a comprehensive Washington CAAC.
1:41
S… Speaker 2 (260819_0212)
activities in the region.
1:43
S… Speaker 5 (260819_0212)
So,
1:44
S… Speaker 2 (260819_0212)
basically, a region corporate salvage and care does,
1:47
S… Speaker 2 (260819_0212)
with a service provision,
1:49
S… Speaker 2 (260819_0212)
issues about that,
1:51
S… Speaker 2 (260819_0212)
getting funding,
1:53
S… Speaker 2 (260819_0212)
getting support,
1:54
S… Speaker 2 (260819_0212)
challenges,
1:55
S… Speaker 2 (260819_0212)
resolution,
1:56
S… Speaker 2 (260819_0212)
and all that,
1:57
S… Speaker 2 (260819_0212)
I coordinate it,
1:59
S… Speaker 2 (260819_0212)
and then, obviously,
2:01
S… Speaker 2 (260819_0212)
with my regional public health nurses,
2:04
S… Speaker 2 (260819_0212)
and then the direction of my directors,
2:07
S… Speaker 2 (260819_0212)
and its director,
2:08
S… Speaker 2 (260819_0212)
and the UDCC.
2:12
S… Speaker 6 (260819_0212)
Okay.
2:13
S… Speaker 2 (260819_0212)
So basically.
2:14
S… Speaker 2 (260819_0212)
Okay.
2:15
S… Speaker 1 (260819_0212)
Do you want to introduce yourself?
2:17
S… Speaker 7 (260819_0212)
Oh,
2:18
S… Speaker 7 (260819_0212)
yes.
2:19
S… Speaker 7 (260819_0212)
I'm a regional
2:23
S… Speaker 7 (260819_0212)
public health nurse.
2:24
S… Speaker 7 (260819_0212)
And as our
2:28
S… Speaker 7 (260819_0212)
sister has already said,
2:30
S… Speaker 7 (260819_0212)
we coordinate all the RCH activities of
2:34
S… Speaker 7 (260819_0212)
reproductive and child health activities in the region.
2:41
S… Speaker 1 (260819_0212)
Where were you before coming?
2:45
S… Speaker 7 (260819_0212)
I was in the Eastin region and I
2:50
S… Speaker 7 (260819_0212)
was a district public health nurse at Kohua Farm Place North
2:54
S… Speaker 7 (260819_0212)
and I've been the camp coordinator and even a service
2:58
S… Speaker 7 (260819_0212)
provider too.
3:04
S… Speaker 7 (260819_0212)
If you bring your wife,
3:06
S… Speaker 7 (260819_0212)
I can do it.
3:07
S… Speaker 7 (260819_0212)
Move the empathy.
3:08
S… Speaker 1 (260819_0212)
We haven't got in there.
3:11
S… Speaker 6 (260819_0212)
We'll do that.
3:14
S… Speaker 1 (260819_0212)
That's all.
3:18
S… Speaker 1 (260819_0212)
So,
3:21
S… Speaker 1 (260819_0212)
how long have you been in English now?
3:25
S… Speaker 2 (260819_0212)
That's three years.
3:29
S… Speaker 1 (260819_0212)
So I think two years is good for you to be able to.
3:31
S… Speaker 1 (260819_0212)
So let's start with some
3:36
S… Speaker 1 (260819_0212)
of the changes.
3:36
S… Speaker 1 (260819_0212)
I mean, a lot has happened.
3:38
S… Speaker 1 (260819_0212)
This is almost like more than five years now.
3:40
S… Speaker 1 (260819_0212)
A lot has happened in relation to GAC,
3:44
S… Speaker 1 (260819_0212)
service provision and all of that.
3:46
S… Speaker 1 (260819_0212)
What are some of the big changes you've
3:51
S… Speaker 1 (260819_0212)
seen in terms of the way we've organised and services?
3:55
S… Speaker 2 (260819_0212)
Okay, so I will start with even the coordination.
3:59
S… Speaker 2 (260819_0212)
So the coordinator
4:03
S… Speaker 2 (260819_0212)
for CAC,
4:04
S… Speaker 2 (260819_0212)
she left the region in 2020.
4:12
S… Speaker 2 (260819_0212)
And you know,
4:13
S… Speaker 2 (260819_0212)
it wasn't very formal.
4:15
S… Speaker 2 (260819_0212)
So I had to take up without any
4:19
S… Speaker 2 (260819_0212)
handover.
4:20
S… Speaker 2 (260819_0212)
So that
4:26
S… Speaker 2 (260819_0212)
was like a big blow.
4:29
S… Speaker 2 (260819_0212)
We had to pick up from wherever she left and then start
4:33
S… Speaker 2 (260819_0212)
looking out for who the providers are,
4:36
S… Speaker 2 (260819_0212)
getting them together,
4:37
S… Speaker 2 (260819_0212)
trying to put everyone together.
4:41
S… Speaker 2 (260819_0212)
is going on with the right so that was a big change because
4:45
S… Speaker 2 (260819_0212)
then you know formally this is a corporate institution where in
4:50
S… Speaker 2 (260819_0212)
case we are changing over leadership it should be done formally
4:54
S… Speaker 2 (260819_0212)
there should be a proper handover so that we know what you started with and
4:58
S… Speaker 2 (260819_0212)
then where you are
5:00
S… Speaker 2 (260819_0212)
Like you are living off with.
5:03
S… Speaker 2 (260819_0212)
But I wasn't so good.
5:05
S… Speaker 2 (260819_0212)
Notwithstanding,
5:05
S… Speaker 2 (260819_0212)
I was able to take up and then reorganize
5:10
S… Speaker 2 (260819_0212)
it and then get the system willing.
5:12
S… Speaker 1 (260819_0212)
But in terms of,
5:14
S… Speaker 1 (260819_0212)
so if you think about it in terms of system level,
5:17
S… Speaker 1 (260819_0212)
of course,
5:17
S… Speaker 1 (260819_0212)
and you can bring your experience from,
5:20
S… Speaker 1 (260819_0212)
it's a continuum,
5:21
S… Speaker 1 (260819_0212)
from Pumru and...
5:24
S… Speaker 1 (260819_0212)
If you think about it as a health system,
5:26
S… Speaker 1 (260819_0212)
what are some of the big changes you've seen in the last five
5:31
S… Speaker 1 (260819_0212)
years in the way that we've already had services?
5:36
S… Speaker 2 (260819_0212)
Okay, so in the past...
5:39
S… Speaker 1 (260819_0212)
Please feel free to come in.
5:40
S… Speaker 1 (260819_0212)
Oh,
5:41
S… Speaker 7 (260819_0212)
okay,
5:42
S… Speaker 7 (260819_0212)
that's right.
5:42
S… Speaker 7 (260819_0212)
I want it to be a position.
5:44
S… Speaker 7 (260819_0212)
I thought when you finish with it,
5:47
S… Speaker 1 (260819_0212)
you come.
5:47
S… Speaker 1 (260819_0212)
Oh, no, no, right.
5:48
S… Speaker 1 (260819_0212)
I think we will spend a lot of time.
5:51
S… Speaker 4 (260819_0212)
Oh, okay.
5:51
S… Speaker 7 (260819_0212)
Feel free to come in.
5:52
S… Speaker 1 (260819_0212)
You just say what you want to add based on what you've seen.
5:55
S… Speaker 7 (260819_0212)
Okay,
5:56
S… Speaker 7 (260819_0212)
that's right.
5:56
S… Speaker 2 (260819_0212)
So in the past,
5:58
S… Speaker 2 (260819_0212)
people used to hide and do the services.
6:00
S… Speaker 2 (260819_0212)
One...
6:02
S… Speaker 2 (260819_0212)
The services were not routinely part of the
6:06
S… Speaker 2 (260819_0212)
usual services provided goods,
6:10
S… Speaker 2 (260819_0212)
as in it wasn't institutionalized.
6:12
S… Speaker 2 (260819_0212)
So the providers that were trained could.
6:17
S… Speaker 2 (260819_0212)
take care of someone and not even report.
6:19
S… Speaker 2 (260819_0212)
And it wasn't really something that management were key
6:23
S… Speaker 2 (260819_0212)
on in the past.
6:24
S… Speaker 2 (260819_0212)
But then since then this is an organization where we
6:28
S… Speaker 2 (260819_0212)
engage the hospital leadership,
6:31
S… Speaker 2 (260819_0212)
the district leadership,
6:32
S… Speaker 2 (260819_0212)
now accountability has become a part of CAC where the
6:37
S… Speaker 2 (260819_0212)
data is being monitored,
6:39
S… Speaker 2 (260819_0212)
we are supervising.
6:41
S… Speaker 2 (260819_0212)
services are being supervised,
6:42
S… Speaker 2 (260819_0212)
the quality aspect is even being supervised,
6:45
S… Speaker 2 (260819_0212)
even at the facility level.
6:47
S… Speaker 2 (260819_0212)
So we can say that it has significantly changed,
6:51
S… Speaker 2 (260819_0212)
there has been significant progress from where CAC used
6:55
S… Speaker 2 (260819_0212)
to be and then where we are now.
6:58
S… Speaker 6 (260819_0212)
Okay,
7:00
S… Speaker 7 (260819_0212)
to add small to it,
7:03
S… Speaker 7 (260819_0212)
you know,
7:04
S… Speaker 7 (260819_0212)
previously as mentioned,
7:10
S… Speaker 7 (260819_0212)
But now it has been integrated to our
7:14
S… Speaker 7 (260819_0212)
routine.
7:17
S… Speaker 7 (260819_0212)
So everybody can just come in and talk to you and just
7:21
S… Speaker 7 (260819_0212)
accept the service as very valuable as you are.
7:24
S… Speaker 7 (260819_0212)
And you know,
7:26
S… Speaker 7 (260819_0212)
previously you have to work to the hospitals.
7:28
S… Speaker 7 (260819_0212)
Now,
7:28
S… Speaker 7 (260819_0212)
Chief's compounded,
7:29
S… Speaker 7 (260819_0212)
medallice,
7:30
S… Speaker 7 (260819_0212)
health center medallice,
7:33
S… Speaker 7 (260819_0212)
polyclinic medallice have been trained.
7:35
S… Speaker 7 (260819_0212)
And with the value clarification,
7:37
S… Speaker 7 (260819_0212)
you know,
7:38
S… Speaker 7 (260819_0212)
when you make people clarify their values,
7:41
S… Speaker 7 (260819_0212)
they see and accept that,
7:43
S… Speaker 7 (260819_0212)
oh!
7:44
S… Speaker 7 (260819_0212)
CAC is not a religious thing.
7:46
S… Speaker 7 (260819_0212)
Yeah.
7:46
S… Speaker 7 (260819_0212)
They seem to accept and know the main
7:51
S… Speaker 7 (260819_0212)
objective of CAC.
7:53
S… Speaker 7 (260819_0212)
And now,
7:54
S… Speaker 7 (260819_0212)
the service sector,
7:57
S… Speaker 7 (260819_0212)
I think,
7:58
S… Speaker 7 (260819_0212)
is quite higher than Dreamers.
8:01
S… Speaker 7 (260819_0212)
So, that's what I want to do.
8:04
S… Speaker 1 (260819_0212)
That's good.
8:04
S… Speaker 1 (260819_0212)
So,
8:05
S… Speaker 7 (260819_0212)
I wanted to talk a little bit about what we said earlier.
8:07
S… Speaker 1 (260819_0212)
So, you probably would know this more.
8:11
S… Speaker 1 (260819_0212)
The whole programme obviously was structured around about seven pillars.
8:14
S… Speaker 1 (260819_0212)
So we have leadership,
8:15
S… Speaker 1 (260819_0212)
we have the service delivery and all of that.
8:18
S… Speaker 1 (260819_0212)
So I just want us to work through these pillars and
8:22
S… Speaker 1 (260819_0212)
see what changes you have seen.
8:24
S… Speaker 1 (260819_0212)
So I think you've already talked about the fact right now all
8:28
S… Speaker 1 (260819_0212)
the regions at least have the Kaka Omega,
8:31
S… Speaker 1 (260819_0212)
which is part of that.
8:32
S… Speaker 1 (260819_0212)
But in terms of,
8:34
S… Speaker 1 (260819_0212)
you've been in Burma and I'm here,
8:35
S… Speaker 1 (260819_0212)
in terms of the leadership front.
8:40
S… Speaker 1 (260819_0212)
What would you say are some of the bigger changes you've seen?
8:43
S… Speaker 1 (260819_0212)
Both attitudes now,
8:46
S… Speaker 1 (260819_0212)
but also think about the response,
8:50
S… Speaker 1 (260819_0212)
leadership response to target issues.
8:53
S… Speaker 1 (260819_0212)
What would you say are the changes you have seen?
8:57
S… Speaker 5 (260819_0212)
Okay,
8:58
S… Speaker 2 (260819_0212)
so I would say for leadership,
9:00
S… Speaker 2 (260819_0212)
there's been a significant progress for
9:04
S… Speaker 2 (260819_0212)
some districts.
9:07
S… Speaker 2 (260819_0212)
the leaders have also received their V -CAT orientation because
9:12
S… Speaker 2 (260819_0212)
in the past it was being antagonized by some
9:16
S… Speaker 2 (260819_0212)
of our leaders because then they had their own personal values
9:21
S… Speaker 2 (260819_0212)
and their religious beliefs so if I'm a med student,
9:25
S… Speaker 2 (260819_0212)
I'm a Catholic and I don't believe in CAT services I wouldn't want to
9:30
S… Speaker 2 (260819_0212)
support the activity but then since the institutionalization
9:34
S… Speaker 2 (260819_0212)
of CAT in 2021
9:37
S… Speaker 2 (260819_0212)
and VCAT,
9:38
S… Speaker 2 (260819_0212)
that has gone wrong.
9:40
S… Speaker 2 (260819_0212)
I think now,
9:41
S… Speaker 2 (260819_0212)
irrespective of the person's religious background,
9:43
S… Speaker 2 (260819_0212)
they will still allow them to do their services.
9:46
S… Speaker 2 (260819_0212)
So that has been very significant,
9:49
S… Speaker 2 (260819_0212)
where we don't have any different director saying,
9:53
S… Speaker 2 (260819_0212)
no, we can't do CAC in this facility.
9:55
S… Speaker 3 (260819_0212)
Yes,
9:55
S… Speaker 2 (260819_0212)
we've not had such challenges now,
9:58
S… Speaker 2 (260819_0212)
but in the past,
9:59
S… Speaker 2 (260819_0212)
it was being reported.
10:00
S… Speaker 2 (260819_0212)
where most people say no,
10:01
S… Speaker 2 (260819_0212)
I won't allow you to do the carcass.
10:04
S… Speaker 2 (260819_0212)
We've not heard it's been legalized.
10:06
S… Speaker 2 (260819_0212)
And they were using the legal aspect to counter,
10:10
S… Speaker 2 (260819_0212)
because then they knew that that's what behavior they could use
10:14
S… Speaker 2 (260819_0212)
to counter their activity.
10:16
S… Speaker 2 (260819_0212)
And for now,
10:17
S… Speaker 2 (260819_0212)
they all come soon.
10:20
S… Speaker 2 (260819_0212)
appreciate the services we are providing with
10:24
S… Speaker 2 (260819_0212)
the CAC and then the fact that it's for the
10:28
S… Speaker 2 (260819_0212)
betterment of women is all for safe womanhood
10:32
S… Speaker 2 (260819_0212)
and we are trying to reduce unsafe abortion
10:37
S… Speaker 2 (260819_0212)
and they've come to appreciate all those things.
10:40
S… Speaker 2 (260819_0212)
When they go,
10:41
S… Speaker 2 (260819_0212)
if you don't do their services,
10:42
S… Speaker 2 (260819_0212)
they will still come back in a very complicated situation.
10:45
S… Speaker 2 (260819_0212)
So for now,
10:47
S… Speaker 2 (260819_0212)
I would say that that leadership aspect has
10:51
S… Speaker 2 (260819_0212)
been significant.
10:52
S… Speaker 2 (260819_0212)
We've gotten them supporting their guard activities.
10:59
S… Speaker 1 (260819_0212)
So what has driven that change,
11:01
S… Speaker 1 (260819_0212)
you would say?
11:02
S… Speaker 1 (260819_0212)
Is it just the orientation?
11:04
S… Speaker 1 (260819_0212)
There are some sanctions that probably...
11:08
S… Speaker 2 (260819_0212)
No, no, so the VCAT orientation.
11:09
S… Speaker 2 (260819_0212)
We've done a series of VCAT orientation,
11:12
S… Speaker 2 (260819_0212)
value clarification,
11:13
S… Speaker 2 (260819_0212)
and that has really impacted on this program.
11:17
S… Speaker 2 (260819_0212)
I think when they started the program in the region,
11:21
S… Speaker 2 (260819_0212)
the VCAT orientation was done by first the regional health laboratory
11:25
S… Speaker 2 (260819_0212)
team, and then they scaled it up to the district health management team.
11:29
S… Speaker 2 (260819_0212)
then before we even started the training so I think
11:33
S… Speaker 2 (260819_0212)
you know in the past they had those who were trained by IPAS
11:37
S… Speaker 2 (260819_0212)
they faced a lot of challenges but then those who were trained with
11:41
S… Speaker 2 (260819_0212)
the institutionalized they are not facing those challenges those
11:46
S… Speaker 2 (260819_0212)
providers faced so it's been very instrumental
11:50
S… Speaker 2 (260819_0212)
the VCAT has been very instrumental and then also the
11:56
S… Speaker 2 (260819_0212)
the legal engagements you know we started this legal engagement
12:00
S… Speaker 2 (260819_0212)
so engagement with the legal forces so
12:05
S… Speaker 2 (260819_0212)
in the past they used to threaten our service providers the police
12:09
S… Speaker 2 (260819_0212)
yes the police and the message were like we don't want issues
12:13
S… Speaker 2 (260819_0212)
But when they also came to understand the amendment of the abortion
12:18
S… Speaker 2 (260819_0212)
law, and they came to appreciate that,
12:20
S… Speaker 2 (260819_0212)
oh, it's not even illegal.
12:22
S… Speaker 2 (260819_0212)
Now they are backing the providers.
12:24
S… Speaker 2 (260819_0212)
So when even such issues come up,
12:27
S… Speaker 2 (260819_0212)
sometimes they even resolve it before telling us.
12:29
S… Speaker 2 (260819_0212)
So I think that the VCAT orientation has helped the legal enforcement
12:34
S… Speaker 2 (260819_0212)
engagement and all those things.
12:36
S… Speaker 7 (260819_0212)
So you want to do something?
12:38
S… Speaker 6 (260819_0212)
Yes.
12:42
S… Speaker 7 (260819_0212)
One challenge that our leaders were
12:46
S… Speaker 7 (260819_0212)
facing was the charges.
12:50
S… Speaker 7 (260819_0212)
So we were not having a formal charging of the
12:54
S… Speaker 7 (260819_0212)
CAC activities.
12:55
S… Speaker 7 (260819_0212)
So the midwife will just sit away and charge whatever they
13:00
S… Speaker 7 (260819_0212)
want. And they will not bring their money to the director or
13:04
S… Speaker 7 (260819_0212)
to the appropriate accounting system.
13:07
S… Speaker 7 (260819_0212)
So it was a big challenge for the program
13:11
S… Speaker 7 (260819_0212)
because they were doing it.
13:13
S… Speaker 7 (260819_0212)
And you know...
13:15
S… Speaker 7 (260819_0212)
As human as we are,
13:16
S… Speaker 7 (260819_0212)
we love money.
13:17
S… Speaker 7 (260819_0212)
And you know,
13:18
S… Speaker 7 (260819_0212)
CAC services,
13:19
S… Speaker 7 (260819_0212)
we don't have extreme line charges that is just being there
13:23
S… Speaker 7 (260819_0212)
for the whole.
13:24
S… Speaker 7 (260819_0212)
When someone comes for medical,
13:25
S… Speaker 7 (260819_0212)
I was for charges.
13:26
S… Speaker 7 (260819_0212)
When someone comes for an IVA charges.
13:28
S… Speaker 7 (260819_0212)
So that was a leadership challenge that we were having
13:32
S… Speaker 7 (260819_0212)
when, even as a service provider,
13:35
S… Speaker 7 (260819_0212)
I was having difficulties.
13:38
S… Speaker 1 (260819_0212)
I think we'll get to,
13:40
S… Speaker 1 (260819_0212)
there's a whole lot of conversation on that challenge
13:44
S… Speaker 1 (260819_0212)
because it's something that has come up with all the assessment and in fact they really
13:48
S… Speaker 1 (260819_0212)
want to understand what the thinking is now.
13:52
S… Speaker 1 (260819_0212)
For example,
13:56
S… Speaker 1 (260819_0212)
Is it possible to have a uniform charging system if you are not providing the commodities?
14:00
S… Speaker 2 (260819_0212)
So yeah,
14:02
S… Speaker 2 (260819_0212)
I don't know whether we are to answer.
14:03
S… Speaker 6 (260819_0212)
No, no,
14:04
S… Speaker 1 (260819_0212)
for now, I think we'll get there because there's a service delivery component
14:08
S… Speaker 1 (260819_0212)
which probably is tied into that.
14:10
S… Speaker 1 (260819_0212)
So you've talked about the services.
14:10
S… Speaker 2 (260819_0212)
So now we've talked about it,
14:11
S… Speaker 1 (260819_0212)
yeah. So what are the changes you've made to service?
14:15
S… Speaker 1 (260819_0212)
Service delivery,
14:16
S… Speaker 2 (260819_0212)
yes.
14:16
S… Speaker 2 (260819_0212)
So I'll talk about the health facilities.
14:20
S… Speaker 2 (260819_0212)
Right.
14:21
S… Speaker 2 (260819_0212)
So, in the past,
14:23
S… Speaker 2 (260819_0212)
we had few health facilities providing CAC.
14:25
S… Speaker 2 (260819_0212)
And there were even the hospitals,
14:28
S… Speaker 5 (260819_0212)
the bigger hospitals.
14:29
S… Speaker 2 (260819_0212)
But like,
14:29
S… Speaker 2 (260819_0212)
as I mean, I have the government said,
14:31
S… Speaker 2 (260819_0212)
now chiefs and the health centers are all provided.
14:33
S… Speaker 2 (260819_0212)
Currently,
14:35
S… Speaker 2 (260819_0212)
we have about 42 of our health facilities providing CAC.
14:41
S… Speaker 2 (260819_0212)
If we are the chips,
14:42
S… Speaker 2 (260819_0212)
we have about...
14:43
S… Speaker 2 (260819_0212)
Let me get the right data for you.
14:46
S… Speaker 1 (260819_0212)
I mean,
14:46
S… Speaker 1 (260819_0212)
I'm going to follow up with some of these data and then you can give me some reports.
14:50
S… Speaker 1 (260819_0212)
But maybe I just want to focus on the chips.
14:52
S… Speaker 1 (260819_0212)
So you can do that for now.
14:53
S… Speaker 1 (260819_0212)
And just keep on.
14:55
S… Speaker 2 (260819_0212)
So, yes.
14:55
S… Speaker 2 (260819_0212)
So, it's been very significant.
15:00
S… Speaker 2 (260819_0212)
the facilities.
15:01
S… Speaker 2 (260819_0212)
So each district,
15:02
S… Speaker 2 (260819_0212)
we are looking at the area,
15:06
S… Speaker 2 (260819_0212)
the communities where services are needed and
15:10
S… Speaker 2 (260819_0212)
then we are training people there.
15:12
S… Speaker 2 (260819_0212)
So I would say for service delivery one,
15:15
S… Speaker 2 (260819_0212)
we have trained a lot of providers now
15:20
S… Speaker 2 (260819_0212)
at every level and the mapping
15:24
S… Speaker 2 (260819_0212)
of the facilities also.
15:25
S… Speaker 2 (260819_0212)
It's not centralizing the bigger facilities.
15:28
S… Speaker 2 (260819_0212)
You don't have to be referred for CAC services.
15:31
S… Speaker 2 (260819_0212)
Wherever you are,
15:32
S… Speaker 2 (260819_0212)
we are using the CHIPS concept.
15:33
S… Speaker 2 (260819_0212)
So it's the doorstep,
15:36
S… Speaker 2 (260819_0212)
so that your CHIPS compound,
15:38
S… Speaker 2 (260819_0212)
you go to Jatozongo in Atebubu.
15:41
S… Speaker 2 (260819_0212)
Jatozongo,
15:42
S… Speaker 2 (260819_0212)
from Jatozongo to Atebubu,
15:44
S… Speaker 2 (260819_0212)
municipal hospital in Slava,
15:45
S… Speaker 2 (260819_0212)
30 minutes right.
15:46
S… Speaker 2 (260819_0212)
But then Jatozongo provides CAC.
15:48
S… Speaker 2 (260819_0212)
They may provide CAC for you.
15:50
S… Speaker 1 (260819_0212)
You don't have to go there.
15:51
S… Speaker 2 (260819_0212)
Yes, so those are some of the...
15:54
S… Speaker 2 (260819_0212)
changes we have seen and then with that service
15:58
S… Speaker 2 (260819_0212)
delivery also we always make sure that where there's vacancy immediately
16:02
S… Speaker 2 (260819_0212)
let's say staff attrition staff leaves immediately
16:07
S… Speaker 2 (260819_0212)
we mark and then we train somebody to refill and for instance last
16:11
S… Speaker 2 (260819_0212)
year we had one of our providers she
16:16
S… Speaker 2 (260819_0212)
left for school
16:18
S… Speaker 2 (260819_0212)
This year,
16:19
S… Speaker 2 (260819_0212)
in the training we did,
16:20
S… Speaker 2 (260819_0212)
we found someone to train their delivery if their has been trained.
16:23
S… Speaker 2 (260819_0212)
So,
16:24
S… Speaker 2 (260819_0212)
for service delivery,
16:26
S… Speaker 2 (260819_0212)
they are looking at making sure that the chips come and
16:30
S… Speaker 2 (260819_0212)
all the various levels have people to provide
16:34
S… Speaker 2 (260819_0212)
their services and then they can really get their services.
16:42
S… Speaker 1 (260819_0212)
Between when you say you do training to replace what
16:46
S… Speaker 1 (260819_0212)
what then what is the what is there?
16:48
S… Speaker 1 (260819_0212)
Do you have like some temporary measures that you then put in?
16:52
S… Speaker 1 (260819_0212)
If you have a midwife who provides a certain and then all of a sudden leaves for
16:56
S… Speaker 2 (260819_0212)
school, what happens?
16:57
S… Speaker 2 (260819_0212)
Yes, so usually when the midwife makes whoever replaces,
17:01
S… Speaker 2 (260819_0212)
if the person doesn't know caca,
17:04
S… Speaker 2 (260819_0212)
then what we do is that that person will be a referral.
17:07
S… Speaker 2 (260819_0212)
So when cases come.
17:09
S… Speaker 2 (260819_0212)
then the person will refer.
17:11
S… Speaker 2 (260819_0212)
For instance,
17:12
S… Speaker 2 (260819_0212)
we have Jema Nantizongo.
17:16
S… Speaker 2 (260819_0212)
We had one bride who was very influential.
17:20
S… Speaker 2 (260819_0212)
She is one of our regional resource team.
17:22
S… Speaker 2 (260819_0212)
And then she left for school.
17:24
S… Speaker 2 (260819_0212)
Immediately, the main driver was brought there.
17:26
S… Speaker 2 (260819_0212)
She was not providing the car services.
17:28
S… Speaker 2 (260819_0212)
So I told her,
17:30
S… Speaker 2 (260819_0212)
you will refer to the municipal,
17:31
S… Speaker 2 (260819_0212)
the district hospital for now.
17:34
S… Speaker 2 (260819_0212)
But when you got the opportunity to train with it,
17:37
S… Speaker 2 (260819_0212)
it was within three months.
17:38
S… Speaker 2 (260819_0212)
She's been trained.
17:39
S… Speaker 2 (260819_0212)
So then,
17:40
S… Speaker 2 (260819_0212)
although the main driver there might not be providing the services,
17:44
S… Speaker 2 (260819_0212)
she will still refer.
17:45
S… Speaker 2 (260819_0212)
She wouldn't let the people go.
17:47
S… Speaker 2 (260819_0212)
So that's what we do.
17:48
S… Speaker 3 (260819_0212)
Okay.
17:49
S… Speaker 6 (260819_0212)
Yeah,
17:50
S… Speaker 7 (260819_0212)
so the change is easy access.
17:57
S… Speaker 1 (260819_0212)
How easy is the access?
18:00
S… Speaker 2 (260819_0212)
Yes,
18:01
S… Speaker 7 (260819_0212)
it's easy because now,
18:03
S… Speaker 7 (260819_0212)
chips compound are providing it.
18:06
S… Speaker 7 (260819_0212)
So if I'm pregnant and I don't want to keep the pregnancy,
18:11
S… Speaker 7 (260819_0212)
the nearest chips compound is provided.
18:13
S… Speaker 7 (260819_0212)
As compared to you having
18:18
S… Speaker 7 (260819_0212)
a lot of issues with traveling far away to the...
18:23
S… Speaker 7 (260819_0212)
Hospital or whatever.
18:25
S… Speaker 6 (260819_0212)
Yes.
18:27
S… Speaker 7 (260819_0212)
So that is the access.
18:28
S… Speaker 7 (260819_0212)
So the accessibility has come.
18:30
S… Speaker 6 (260819_0212)
Yes.
18:32
S… Speaker 1 (260819_0212)
I just want,
18:33
S… Speaker 1 (260819_0212)
in terms of the chips,
18:34
S… Speaker 1 (260819_0212)
what are they permitted to?
18:38
S… Speaker 7 (260819_0212)
So it's the early pregnancy.
18:40
S… Speaker 7 (260819_0212)
So after nine weeks.
18:42
S… Speaker 7 (260819_0212)
So if you are nine weeks pregnant,
18:45
S… Speaker 7 (260819_0212)
you are good to go.
18:46
S… Speaker 7 (260819_0212)
So it's the assessment that they have to just access the
18:51
S… Speaker 7 (260819_0212)
gestational aid.
18:52
S… Speaker 7 (260819_0212)
And for the gestational aid now,
18:56
S… Speaker 7 (260819_0212)
you don't need to go for a scan.
18:59
S… Speaker 7 (260819_0212)
For that,
19:00
S… Speaker 7 (260819_0212)
a whole lot of scan costs and others,
19:03
S… Speaker 7 (260819_0212)
we can do common physical examination to identify the
19:08
S… Speaker 7 (260819_0212)
gestational risks that we have.
19:10
S… Speaker 7 (260819_0212)
So, I think the accessibility is a key here.
19:13
S… Speaker 7 (260819_0212)
And even the cost -effective,
19:15
S… Speaker 7 (260819_0212)
because no scan,
19:16
S… Speaker 7 (260819_0212)
we can test through physical examination and provide the care.
19:20
S… Speaker 1 (260819_0212)
Which of the methods?
19:21
S… Speaker 2 (260819_0212)
No, the tattoo comes in with the method,
19:23
S… Speaker 2 (260819_0212)
so that everyone has service delivery in the past.
19:27
S… Speaker 2 (260819_0212)
we were more concerned about the MVA.
19:29
S… Speaker 2 (260819_0212)
So even if the gestational week was just two,
19:33
S… Speaker 2 (260819_0212)
three weeks,
19:34
S… Speaker 2 (260819_0212)
we were doing the MVA.
19:35
S… Speaker 2 (260819_0212)
But for now,
19:37
S… Speaker 2 (260819_0212)
most of our providers have been trained on them for the medical abortion.
19:41
S… Speaker 2 (260819_0212)
And so we are able to know who
19:45
S… Speaker 2 (260819_0212)
will need what.
19:47
S… Speaker 2 (260819_0212)
So yes, if the gestation doesn't really call for MVA,
19:50
S… Speaker 2 (260819_0212)
we don't go in for MVA.
19:52
S… Speaker 2 (260819_0212)
We can use the MVA.
19:53
S… Speaker 2 (260819_0212)
And then the MVA is also convenient.
19:55
S… Speaker 2 (260819_0212)
We can start at their first meeting.
19:57
S… Speaker 2 (260819_0212)
The client will go and then complete.
20:00
S… Speaker 2 (260819_0212)
It's very convenient for the client to access
20:04
S… Speaker 2 (260819_0212)
any method they want.
20:06
S… Speaker 2 (260819_0212)
So it's self -choice.
20:08
S… Speaker 2 (260819_0212)
We will counsel them and then they will decide which one they will go
20:12
S… Speaker 1 (260819_0212)
for. Yeah, that's what I wanted clarity on that,
20:14
S… Speaker 1 (260819_0212)
whether in terms of,
20:16
S… Speaker 1 (260819_0212)
of course, if you assume everything is okay with gestational age,
20:20
S… Speaker 1 (260819_0212)
whether the choice is actually like a client.
20:32
S… Speaker 7 (260819_0212)
So, for the Medicare abortion,
20:35
S… Speaker 7 (260819_0212)
if I had the question right,
20:36
S… Speaker 7 (260819_0212)
can you ask the question?
20:38
S… Speaker 1 (260819_0212)
So the question is really who makes the final
20:42
S… Speaker 1 (260819_0212)
decision about,
20:43
S… Speaker 1 (260819_0212)
let's say,
20:45
S… Speaker 1 (260819_0212)
I want to do MA or I want to do MA.
20:47
S… Speaker 7 (260819_0212)
It's an informed choice.
20:49
S… Speaker 7 (260819_0212)
And it's based on the capacity of
20:53
S… Speaker 7 (260819_0212)
the staff to.
20:54
S… Speaker 7 (260819_0212)
Because we didn't train everybody to do MVA and the
20:58
S… Speaker 7 (260819_0212)
medical abortions train for it.
21:00
S… Speaker 7 (260819_0212)
Some were trained for medical abortions,
21:02
S… Speaker 7 (260819_0212)
some were also trained for the MVA.
21:04
S… Speaker 7 (260819_0212)
Okay,
21:05
S… Speaker 7 (260819_0212)
so if I was trained for MVA and an informed choice,
21:09
S… Speaker 7 (260819_0212)
if you say, oh,
21:09
S… Speaker 7 (260819_0212)
I want the MVA.
21:11
S… Speaker 7 (260819_0212)
and i cannot provide i will equally prefer so it's an informed
21:15
S… Speaker 7 (260819_0212)
choice but if i haven't trained in both i can provide too yes
21:22
S… Speaker 1 (260819_0212)
Okay, I think we can talk about the health workforce because,
21:25
S… Speaker 1 (260819_0212)
I mean,
21:26
S… Speaker 1 (260819_0212)
in a previous,
21:29
S… Speaker 1 (260819_0212)
this has been a very difficult area.
21:32
S… Speaker 1 (260819_0212)
I mean,
21:34
S… Speaker 1 (260819_0212)
we get a sense that there are a lot more people who are willing to provide now,
21:38
S… Speaker 1 (260819_0212)
but it seems to also be very high.
21:41
S… Speaker 1 (260819_0212)
attrition rate and what's the situation
21:45
S… Speaker 1 (260819_0212)
with your region in
21:49
S… Speaker 1 (260819_0212)
terms of like health workforce development and people still doing this yes
21:55
S… Speaker 2 (260819_0212)
so um for staff attrition like you mentioned is i
21:59
S… Speaker 2 (260819_0212)
think it's a national challenge now everyone going out for greener pastures
22:03
S… Speaker 2 (260819_0212)
and notwithstanding
22:08
S… Speaker 2 (260819_0212)
The frequency has not been very high with respect
22:13
S… Speaker 2 (260819_0212)
to the CAC providers we have trained.
22:15
S… Speaker 2 (260819_0212)
The number of
22:19
S… Speaker 2 (260819_0212)
service providers that were trained from 2021 to now,
22:22
S… Speaker 2 (260819_0212)
although some athletes,

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