Consideraciones legales

Varimpere and Naro had CETS previously operating but failed to sustain the programs. These communities discussed factors that facilitated the start up of CETS originally and reasons why they were not able to sustain the service. Both Varimpere

and Naro expressed intent to restart the service, but no significant strides had been made to do so at the time of interviews and focus group discussions.

Participants in Varimpere identified the nurse as a key facilitator in the start up as she was able to communicate the idea of CETS and gain the community’s support for the service.

“Since she is educated, she can say something and throw more light on the issue and then people will understand her better than someone else” (F, FG, Varimpere).

This sense of trust in CHNs was discussed as a facilitator to starting CETS frequently among Varimpere community members. Participants said the CHN was successful at engaging the community in meetings and a lot of people were eager to join. She was also important in keeping the service running:

“the nurse was the secretary and the treasurer. For us, even if we call for a meeting sometimes we have to wait hours upon hours for people to come, but the nurse did very well to mobilize us initially and get people to come together to meet” (M, FG, Varimpere).

However, sustaining the enthusiasm was a challenge:

“Everybody is always eager to join something that is new. But as time goes on, people have a lukewarm attitude. Sometimes you call for a meeting and no one comes” (F, FG, Varimpere).

The participants of Varimpere attributed the programs’ failure mostly to the CHN leaving their CHPS zone:

“The nurse was important in settling trust issues, and she’s not here now so we’re having some problems bringing everyone together” (M, FG, Varimpere).

A new CHN had been stationed in the community at the time of interview and was just settling in. In this community there was an apparent reliance on the CHN with regards to

community relations. Participants reported that they had been less able to self-organize and cooperate without the presence of the nurse. This speaks to the challenge with sustainability of CETS even if it restarts.

The people of Naro also spoke about the absence of their CHN, saying she is away often for training or other reasons. They emphasized the importance of a good relationship with the CHN, and said her absence sometimes strains the relationship. All interviews and discussions highlighted the importance of the nurse’s role in their ability or inability to start or sustain CETS, so it is understandable that a strained relationship may act as a barrier. This speaks to the importance of the nurses’ ability to mobilize the communities they serve, something that is an expected deliverable by CHPS officials.

Additionally, lack of trust and the idea that funds would be misused was reported to be a significant threat to the initiation and sustainment of CETS in Naro.

“People believed that when they contribute people would misuse the money…mismanagement and the issue of trusting who can actually keep the money” (F, FG, Naro).

Reportedly, few people were contributing when the program was started, and the number decreased over time. Community members still have this concern which has been a challenge in re-starting the program, something the community members told me they intend to do. Another reason for the failure of CETS in Naro is that some members don’t see the need for the program.

One male shared that for himself personally, CETS was a good thing because he saw the need for the service and contributed money he used to spend on alcohol to the fund instead. It helped him to see the need to drink less and contribute to a fund that would

help himself and his family, since he had been in a positon where a family member would have benefited from the service in the past.

People in Varimpere and Naro expressed a desire to start CETS again. Women in Varimpere had already taken steps to do so, however, they reported that lack of cooperation and support from men has prevented the successful reinstatement of the service:

“We the women alone cannot sustain this thing, and if CETS is going to work, we need the help of the men and men need to be on board. But then one of the issues is that women don’t feel like talking or bringing their ideas on board because the men. Sometimes there are issues where you have a meeting and a woman will come out and give her opinion and you will get back to your house and your husband will beat you” (F, IDI, Varimpere).

In the communities where CETS has failed there seems to be more conflict among residents, particularly between men and women.