Unlocking community capabilities for improving maternal and newborn health: participatory action research to improve birth preparedness, health facility access, and newborn care in rural Uganda

Abstract

BackgroundCommunity capacities and resources must be harnessed to complement supply side initiatives addressing high maternal and neonatal mortality rates in Uganda. This paper reflects on gains, challenges and lessons learnt from working with communities to improve maternal and newborn health in rural Uganda.MethodsA participatory action research project was supported from 2012 to 2015 in three eastern districts. This project involved working with households, saving groups, sub county and district leaders, transporters and village health teams in diagnosing causes of maternal and neonatal mortality and morbidity, developing action plans to address these issues, taking action and learning from action in a cyclical manner. This paper draws from project experience and documentation, as well as thematic analysis of 20 interviews with community and district stakeholders and 12 focus group discussions with women who had recently delivered and men whose wives had recently delivered.ResultsWomen and men reported increased awareness about birth preparedness, improved newborn care practices and more male involvement in maternal and newborn health. However, additional direct communication strategies were required to reach more men beyond the minority who attended community dialogues and home visits. Saving groups and other saving modalities were strengthened, with money saved used to meet transport costs, purchase other items needed for birth and other routine household needs.However saving groups required significant support to improve income generation, management and trust among members. Linkages between savings groups and transport providers improved women’s access to health facilities at reduced cost. Although village health teams were a key resource for providing information, their efforts were constrained by low levels of education, inadequate financial compensation and transportation challenges. Ensuring that the village health teams and savings groups functioned required regular supervision, review meetings and payment for supervisors to visit.ConclusionsThis participatory program, which focused on building the capacity of community stakeholders, was able to improve local awareness of maternal and newborn health practices and instigate local action to improve access to healthcare. Collaborative problem solving among diverse stakeholders, continuous support and a participatory approach that allowed flexibility were essential project characteristics that enabled overcoming of challenges faced.

<p>Out-of-pocket expenditure for home and facility-based delivery among rural women in Zambia: a mixed-methods, cross-sectional study</p>

“…To address the high cost of baby clothes and baby blankets and mitigate it as a barrier, future programs could strategize on how to make these clothes and blankets more physically and financially accessible such as by promoting social enterprises to bring down their cost and extend the availability of lower priced clothing/blankets to rural areas. Furthermore, village savings groups and birth preparedness interventions40,45,46,47,48 could assist women in rallying the sufficient resources to more easily purchase these items. 2) Delivery Supplies Though minimal in comparison to total expenditure, the shifted burden for acquiring delivery supplies nonetheless remains a substantial perceived burden to accessing facility-based delivery. The Zambian Ministry of Health should consider health systems strategies to ensure health facilities have adequate financial resources to provide supplies of disinfectant, cord clamps, a razor blade to cut the cord, plastic sheets, and buckets to receive the placenta to every laboring woman free of charge. 3) Transport Lastly, our study suggests that the availability of transport and physical obstacles may be a more important barrier to health facility delivery than the cost of transport itself, though this is difficult to untangle.…”

Leaving no one behind: using action research to promote male involvement in maternal and child health in Iringa region, Tanzania

“…It is one of the few to have used action research approach to promote male involvement inMCH. While action research has been used extensively in the health sector in Tanzania [30][31][32] and in other low-income and middle-income countries, [33][34][35][36] there has been little evidence of its appropriateness in promoting male involvement in MCH. We have demonstrated how stakeholders, including men, were able to design culturally acceptable strategies to increase male involvement in MCH.…”

Effectiveness of upgraded maternity waiting homes and local leader training in improving institutional births among women in the Jimma zone, Ethiopia: study protocol for a cluster-randomized controlled trial

“…Negative perceptions associated with MWH use among communities can discourage women from staying at MWHs [42]. Local religious and community leaders can function as change agents who, if engaged, can positively influence beliefs and practices and mobilize support for women [43, 44].…”