“Ways and channels for voice regarding perceptions of maternal health care services within the communities of the Makamba and Kayanza provinces in the Republic of Burundi: an exploratory study”

Abstract

BackgroundIncreased availability of maternal health services alone does not lead to better outcomes for maternal health.The services need to be utilized first.One way to increase service utilization is to plan responsive health care services by taking into account the community’s views or expressed needs.Burundi has a high maternal mortality ratio, and despite improvements in health infrastructure, skilled staff and the abolition of user fees for pregnant women,utilization of maternal health services remains low. Possible reasons for this include a lack of responsive healthcare services.An exploratory study was conducted in 2013 in two provinces of Burundi (Makamba and Kayanza), with the aim to collect the experiences of women and men with the maternal health services,their views regarding those services, channels used to express these experiences, and the providers’ reaction.MethodsSemi-structured interviews were used to collect data from men and women and key informants, including community health workers, health committee members, health providers, local authorities, religious leaders and managers of non-governmental organizations. Data analysis was facilitated by MAXQDA 11 software.ResultsNegative experiences with maternal health services were reported and included poor staff behavior towards women and a lack of medicine. Health committees and suggestion boxes were introduced by the government to channel the community’s views. However, they are not used by the community members, who prefer to use community health workers as intermediaries. Fear of expressing oneself linked to the post-war context of Burundi, social and gender norms, and religious norms limit the expression of community members’ views, especially those of women. The limited appreciation of community health workers by the providers further hampers communication and acceptance of the community’s views by health providers.ConclusionIn Burundi, the community voice to express views on maternal health services is encountering obstacles and needs to be strengthened,especially the women’s voice. Community mobilization in the form of a mass immunization campaign day organized by women fora, and community empowerment using participatory approaches could contribute towards community voice strengthening.Electronic supplementary materialThe online version of this article (10.1186/s12913-017-2822-y) contains supplementary material, which is available to authorized users.

Community Perceptions of Person-Centered Maternity Care in Migori County, Kenya

“…Though there is a dearth of quantitative research on community perceptions on the quality of maternal care, it has been explored by a few qualitative studies. Similar with other studies, we find that community members have poor perceptions of quality of maternal care ( 27 , 28 ). A possible reason for these poor perceptions is the perceived lack of emotional support women receive from healthcare providers ( 29 ).…”

“…One interpretation of this finding relates to the idea of hierarchical social relations (28). Given that literacy is closely related to one's family social status, it could be that community members with a lower literacy level have poorer perceptions of supportive care because they witness the social stigma their female relatives experience within the healthcare system (28,30).…”

Citizens Committees and Local Elites: Elite Capture, Captured Elites, and Absent Elites in Health Facility Committees

“…There are, however, doubts as to whether this system is effective. Indeed, the scant research in Burundi has noted that HFC members are rarely supported and aware of their tasks and roles and that there is an apparent disconnect between the HF staff, the catchment area population, and their committees (Falisse et al 2012;Niyongabo et al 2018).…”

“…They also need to have the genuine possibility to influence the HF, which stems not only from their knowledge but also depends on "systematic asymmetries of power inherent in unequal societies" (Osmani 2008, p. 38). Pointing to the negligible influence of committee members at their HF (Falisse et al 2012;Niyongabo et al 2018), the research on HFC in Burundi suggests a power gap: HFC members have limited influence over HF staff members. By throwing their weight behind the committee, local elites may potentially help narrow such a gap.…”

Factors Associated With Contraceptive Use Among Antenatal Care Clients With 3 or More Children at a Central Hospital in Burundi: A Cross-Sectional Study

“…1,20 Information sources also play a role in contraception uptake. [22][23][24] In our study, medical personnel were the most frequently reported source of information about contraception, over neighbours, radio or television, and the Church. In rural Malawi, it has been shown that the media can play a significant role in improving maternal health outcomes when it is community-led and locally driven.…”