SCS Guinea: Citizen Involvement in Health Governance
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SCS Guinea: Citizen Involvement in Health Governance Funding provided by: United States Agency for International Development Cooperative Agreement No. AID-675-LA-17-00001 Baseline Assessment: Submitted: January 19, 2018 Washington, DC Submitted to: Ruben Johnson Agreement Officer Representative USAID/Guinea [email protected] This report was prepared with funds provided by the U.S. Agency for International Development under Cooperative Agreement AID-675-LA-17-00001. The opinions expressed herein are those of the author(s) and do not necessarily reflect the views of the U.S. Agency for International Development. CONTENTS ACRONYMS .................................................................................................................................. ii I. EXECUTIVE SUMMARY .................................................................................................... 1 II. BACKGROUND .................................................................................................................... 3 2.1 Citizens’ Involvement in Health Governance Activity .......................................................... 3 2.2 Guinea Background ............................................................................................................... 4 III. ASSESSMENT PURPOSE AND QUESTIONS .............................................................. 12 IV. BASELINE ASSESSMENT METHODOLOGY.............................................................. 13 4.1 Nationwide Household Opinion Survey ............................................................................. 13 4.2 Focus Group Discussions (FGDs) ...................................................................................... 16 4.3 Key Informant Interviews (KIIs) ........................................................................................ 17 4.4 Stakeholder Roundtables .................................................................................................... 17 4.5 Study Limitations ................................................................................................................ 18 V. FINDINGS AND CONCLUSIONS ..................................................................................... 19 5.1 Health Governance .............................................................................................................. 19 5.1.1 Findings........................................................................................................................ 19 5.1.2 Conclusions .................................................................................................................. 26 5.2 Citizen Perceptions of, Use of and Satisfaction with Healthcare Services ......................... 27 5.2.1 Findings........................................................................................................................ 27 5.2.2 Conclusions .................................................................................................................. 36 5.3 Citizen Knowledge of and Involvement in the Health System ...................................... 37 5.3.1 Findings........................................................................................................................ 37 5.3.2 Conclusions .................................................................................................................. 42 5.4 Civil Society Engagement on Health Reform ...................................................................... 43 5.4.1 Findings........................................................................................................................ 43 5.4.2 Conclusions .................................................................................................................. 45 5.5 Media Engagement on Health Reform ................................................................................ 46 5.5.1 Findings........................................................................................................................ 46 5.5.2 Conclusions .................................................................................................................. 50 VI. CONSIDERATIONS FOR PROGRAM IMPLEMENTATION....................................... 51 Annex A: Household Survey Questionnaire .............................................................................. 57 Annex B: Margin of Error Table ............................................................................................... 65 Annex C: Focus Group Discussion Protocol ............................................................................. 66 Annex D: Roundtable Protocol ................................................................................................. 69 Annex E: Bibliography ............................................................................................................. 70 i ACRONYMS AGIL Alliance pour la Promotion de la Gouvernance et des Initiatives Locales AGUIFPEG Guinean Women Association for Governance ANAFIC National Agency for the Financing of Local Communes CCSS Health Sector Coordination Committee CDCS Country Development Cooperation Strategy CENAFOD Centre Africain De Formation Pour Le Developpement CIHG Citizens’ Involvement in Health Governance CNOSCG Le Conseil National des Organisations de la Société Civile Guinéenne COSAH Comités de santé et d’hygiène CSM Civil Service Ministry CSO Civil Society Organization DHS Demographic and Health Survey ECOWAS Economic Community of West African States ENAPGUI L’Enquête Nationale sur la Perception des Guinéens EU European Union EVD Ebola Virus Disease FEGUIPAH Federation of Persons with Disabilities (PWD) Associations FGDs Focus Group Discussions FHI 360 Family Health International 360 GoG Government of Guinea GPS Global Positioning System GNF Guinean Franc HC3 Health Communication Capacity Collaboration Project HFG Health Finance and Government Project KIIs Key Informant Interviews MATD Ministry of Territorial Administration and Decentralization MEL Monitor, Evaluation, and Learning MICS Multiple Indicator Cluster Survey MOE Margin of Error MOH Ministry of Health NA National Assembly NGO Non-governmental Organization NLDF National Local Development Fund P2P Proportional-to-Population POSSAV Platform for the Promotion of Health and Vaccinations PDES Programme de Developpement Economique et Sociale PNACC Programme National d'Appui aux Communes de Convergence PNDS Plan National Developpement Sanitaire POSSAV Plate-forme des Organisations de Société Civile pour le Soutien à la Santé et La Vaccination PRODEJ Programme Décennal pour le Développement de la Justice PWD Person with Disabilities ii RAJ-Gui Guinean Youth Associations Network REFMAP Réseau des Femmes Ministres et Parlementaires SFCG Search for Common Ground SI Social Impact TL Team Leader UNDP United Nation’s Development Program UNICEF United Nations International Children’s Emergency Fund USAID United States Agency for International Development USD United States Dollars iii I. EXECUTIVE SUMMARY The Citizens’ Involvement in Health Governance (CIHG) Activity, funded by the United States Agency for International Development (USAID), aims to improve citizen understanding of and participation in Guinea’s health system reforms. The program was started July 28, 2017 and is led by Family Health International (FHI 360), in partnership with Search for Common Ground (SFCG) and Social Impact (SI). Since the 2014 outbreak of Ebola Virus Disease (EVD), the Government of Guinea (GoG) has made strides to improve health governance and prevent a future epidemic, as evidenced by the 2015-2017 Post-Ebola Socio-Economic Recovery and Resiliency Strategy, efforts to decentralize health services, and reviews of current health legislation. Even with these positive steps, civil society, the media and government must collaborate more effectively and more extensively to advance health reform substantively and improve health services for Guineans. CIHG is therefore partnering with civil society, the media and government actors in all of Guinea’s eight administrative regions, providing technical assistance and targeted grant support, so that they can improve health governance, heath services and thus health outcomes for Guineans. The purpose of this baseline assessment was to gather evidence to inform activity implementation and allow CIHG to be responsive to the needs of Guineans. The baseline also provides a snapshot of citizen, media, civil society, and government perceptions of health governance and their capacities. This baseline will also provide a benchmark against which to measure the effects and outcomes of CIHG’s interventions. The baseline assessment gathered quantitative and qualitative data related to a number of questions: 1. What is the current status of Guinea’s health governance and what is needed to improve it? 2. To what extent are citizens satisfied with and to what extent do they use health services? 3. What is the level of citizen knowledge of health governance and recent reforms? 4. From where do citizens receive information about health governance? 5. How are citizens, the media and civil society currently involved in health governance? 6. What factors influence participation in health governance? 7. What capacities do civil society and the media possess and what must they strengthen to more effectively contribute to improved health governance? 8. Where should CIHG target its program implementation? Data were disaggregated and analyzed by age,