Exploring community participation in project design: application of the community conversation approach to improve maternal and newborn health in Zambia

Abstract

BackgroundThe United Nations Development Programme (UNDP) has adopted an approach entitled Community Conversation (CC) to improve community engagement in addressing health challenges. CCs are based on Paulo Freire’s transformative communication approach, in which communities pose problems and critically examine their everyday life experiences through discussion. We adopted this approach to engage communities in maternal and newborn health discussions in three rural districts of Zambia, with the aim of developing community-generated interventions.MethodsSixty (60) CCs were held in three target districts, covering a total of 20 health facilities. Communities were purposively selected in each district to capture a range of rural and peri-urban areas at varying distances from health facilities. Conversations were held four times in each community between May and September 2014. All conversations were digitally recorded and later transcribed. NVivo version 10 was used for data analysis.Results and DiscussionThe major barriers to accessing maternal health services included geography, limited infrastructure, lack of knowledge, shortage of human resources and essential commodities, and insufficient involvement of male partners. From the demand side, a lack of information and misconceptions, and, from the supply side, inadequately trained health workers with poor attitudes, negatively affected access to maternal health services in target districts either directly or indirectly. At least 17 of 20 communities suggested solutions to these challenges, including targeted community sensitisation on the importance of safe motherhood, family planning and prevention of teenage pregnancy. Community members and key stakeholders committed time and resources to address these challenges with minimal external support.ConclusionWe successfully applied the CC approach to explore maternal health challenges in three rural districts of Zambia. CCs functioned as an advocacy platform to facilitate direct engagement with key decision makers within the community and to align priorities while incorporating community views. There was a general lack of knowledge about safe motherhood and family planning in all three districts. However, other problems were unique to health facilities, demonstrating the need for tailored interventions.

Access to maternal-child health and HIV services for women in North-Central Nigeria: A qualitative exploration of the male partner perspective

“…In sub-Saharan Africa, the barriers to access and uptake of maternal-child health services include geographical and financial inaccessibility, poorly equipped facilities, unaffordable user fees, and clients’ perceptions or experiences of healthcare worker incompetence and/or unprofessional attitudes [ 15 – 20 ]. Socio-cultural factors relating to the traditional, expected roles of women in African societies also underlie many of these barriers [ 4 , 17 , 21 – 23 ]. In some of these settings, women are unable to independently make health-related decisions for themselves [ 9 , 24 ], due to patriarchal norms [ 3 , 25 , 26 ].…”

Facilitating community participation in family planning and contraceptive services provision and uptake: community and health provider perspectives

“…In this regard, the participants reported that dialogue between the community and health providers would help identify obstacles affecting the use of FP/C services, and allow for the joint development of locally relevant implementable solutions. Other studies have used community dialogues in identifying and implementing context-relevant interventions to improve maternal and child health outcomes [26]. Furthermore, community dialogues can facilitate participation in health services by providing a platform for the health system to engage community actors such as parents and religious leaders who are vital in generating wider community support FP/C services [27].…”

Facilitating community participation in family planning and contraceptives service provision and uptake: community and health provider perspectives

“…In this regard, the participants reported that dialogue between the community and health providers would help identify obstacles affecting the use of FP/C services, and allow for the joint development of locally relevant implementable solutions. Other studies have used community dialogues in identifying and implementing context relevant interventions to improve maternal and child health outcomes [26]. Furthermore, community dialogues have been shown to play an important role in facilitating participation in health services as they provide a platform for the health system to engage community actors such as parents and religious leaders who are vital in generating wider community support FP/C services [27].…”