In the first week of September, National Programme Coordinators (NPCs) of the UFBR and ASK Programme visited the Netherlands. Together with staff from Dutch Alliance Members they shared and learned their strategies on how to approach SRHR issues based on their experiences in their own country. Their visit included a fieldtrip to the Public Health Service of Amsterdam (GGD) and COC, a Dutch organisation for LGBT men and women. We had a short chat with Ghana's and India's NPCs.
“The visit to the Public Health Service’s STI Outpatient Clinic was quite inspiring and provided an insight into the Public Health Service of the Netherlands. This system has the merit of integrating many disciplines and research components under one roof.
I was very excited by the HIV prevention PreP research programme and the “Tailored Approach” on Web-based media communication. It was nice to see that the clinics are managed by ‘nurses’ multi-tasking in client examination, history taking, counselling and treatment advice. The clinic also has a very good atmosphere that allows the clients to feel comfortable and less threatened. It was also interesting to see the community outreach programme for the sex workers and their linkages with Public Health Service. I was also impressed by the web and telephone based appointment system, but I wonder what happens to patients that want to access the service immediately.”
“The health system in India is highly dominated by the doctors’ lobby. Hence nurses are not allowed or encouraged to examine clients or provide medical advice: they are seen as the doctor’s helpers. Client counselling is mostly non-existent, or if it is available, it is done by a counsellor in another room. The striking point in the GGD for me was that all the services are provided in one room by the nurse. In India, clients are asked to visit many rooms or departments (and if it’s a big hospital, this entails going to different buildings in the campus) for registration, examination, counselling, screening or tests, results, medicines, and so on. This results in patients dropping or not wanting to come back to the government facility. Illiterate clients are the ones who suffer most.
I was part of one Municipal Corporation health team to establish client-friendly Sexual Health Services in a new ‘Vatsayan’ clinic (named after the sage who wrote the Kamasutra) created by the government. The major challenge was to help illiterate clients to reach the clinic. The hospital designed colour coding for each department so that all illiterate or semi-literate clients could follow the directions. Since the clients had to consult doctors, counsellors lab and pharmacy staff, they have to spend a lot of time to access services. The GGD system could represent one of the solutions to reducing time spent on receiving treatment.
In the current UFBR programme, most of Simavi’s partners are lobbying the district and state administration to have more functional adolescent reproductive and Sexual Health (ARSH) clinics. These centres also face a similar kind of situation, with a lack of privacy for example. No clients attend the clinic due to a lack of integration with outreach programmes and similar activities.”
“It was a very interesting and revealing trip. The presentations at COC on sexual diversity were very educational and left me with many reflections about the situation in Ghana.
Both the Netherlands and Ghana pay attention to young people SRHR and continue to make efforts towards improvements. They both recognize the power of E&M Health platforms and new media in empowering young people to make healthy decisions about their sexuality.”
“In terms of provision of information and education on SRHR for young people, the Netherlands has an elaborate and interactive E-health platform that young people can access independently to learn all manner of SRHR information. These platforms are firmly anchored by an education system that provides SRHR information to young people through schools. Whilst in Ghana, the SRHR E-health platforms are limited in many ways, including the necessary level of interaction to address young people’s concerns.
In addition, these platforms are only accessible to a privileged few who have skills in ICT. Many young people, particularly those who live in rural parts of Ghana, have no Internet access and are therefore unable to use such platforms. In these circumstances peer education by trained Peer Educators is more effective and preferable. As for our national education system, it provides limited space for teaching bits and pieces of sexuality education in an uncoordinated manner – and even this doesn’t take place in many schools.
The Netherlands has a very progressive and liberal policy and social environment for SRHR, including LGBTIQ, that supports sexual and gender diversity and rights for all; whilst in Ghana sexual diversity and rights are still big issues that are yet to gain tolerance and acceptance from the general Ghanaian society.
Finally, in the Netherlands, high quality SRHR services are provided free to all clients at the Public Health Clinic, ensuring a high level of confidentiality in a non-judgemental way; whilst in Ghana we still have many issues over the quality of SRHR services and establishing an environment that is enabling enough for young people to access SRHR services. Many service providers are still judgemental, especially towards young women.”
Jose Thomas, the NPC of the UFBR Programme in India. and Kenneth Danuo, the NPC of the ASK Programme in Ghana.
about the differences of the Indian and Ghanaian health system compared to the Netherlands
“I think the most important thing I’ve learned is the regulation of client inflow in to the clinic. This is vital for hospitals in India: a client screening system has to be established to regulate the inflow of clients and identify the right client. The second part is integrating the outreach within the clinic and creating an information sharing mechanism.
Further significant challenges we have to face relate to the doctors’ lobby’s influence on the Indian health system and the mentality of a society that views nurses as only capable of nursing care for indoor patients and providing injections.”
“We use a combination of strategies such as developing interactive and youth-focused electronic platforms through new media. We use these platforms to provide empowering information and messages to increase the capacity of young people to access services which are youth friendly, confidential and non-judgemental in a health facility with an environment that provides all these qualities.”