Targeting marginalised groups
Many people are unable to access mainstream SRH services or programmes for reasons of poverty, language, disability and geographical inaccessibility; or are denied access because of stigma, discrimination or restrictive laws and policies. Overcoming inequalities in access requires that the SRH needs of marginalised people are identified, and interventions are targeted towards meeting their needs in a culturally considerate manner.
Mobile health facilities which bring services directly to people are one method of addressing physical barriers to access for the most isolated and often the poorest populations. The International Planned Parenthood Federation has used mobile health units, sometimes in the form of canoes and planes, to reach isolated populations across countries in Latin America and the Caribbean, and provide them with education, supplies and services. The initiative resulted in a reduction of total births and increase in births attended by a trained professional (see IPPF).
Mobile health units have also been used to deliver free condoms, STI testing and treatment, and prenatal care to sex workers in Brazil. The clinics are based in red-light districts so that workers do not have to lose earnings as a result of time spent travelling to clinics. In India, an NGO called SANGRAM (Sampada Grameen Mahila Sanstha) uses a peer based model to reach out to sex workers. Peer educators, who are themselves sex-workers, undertake a variety of activities including raising awareness about HIV and AIDS, distributing condoms, and assisting people in accessing medical care.
Identifying groups that have unmet needs for SRH services can be difficult because there are often a number of simultaneous factors that prevent access. Also, targeting services towards specific groups can be difficult because people may not identify themselves as belonging to these groups. For instance MSM who do not consider themselves as being gay or bisexual are unlikely to respond to HIV/STI services designed for these communities. With this in mind, Profamilia, an NGO in Columbia, launched an initiative to increase access to quality services and information for MSM. It provided sexual health services in environments sensitive to all sexualities, and used a variety of media to promote messages including vouchers at clinics, advertisements in magazines, and websites (see IPPF).
