Community Participation in Maternal and Child Health/Family Planning Programmes at the Subdistrict Level

Abstract

Community Participation has been identified as a key factor in the improvement of health care delivery in Ghana. The Wa District Health Administration set up a number of community health structures with the intention to get communities more involved/participating in health programmes in order to improve coverage and utilization. Despite these community, health structures and other efforts aimed at improving coverage / utilization in health services, there has not be any significant improvement. Nevertheless, the Wa District Health Management Team (DHMT) strongly felt that the unsatisfactory coverage/utilization in health programmes might be due to low or narrow community participation. This study assessed the extent of community participation in health programmes using MCH/FP programmes as a proxy. The study also sought to identify factors which influence community participation. The study was descriptive in design using only qualitative approach. Both primary and secondary data were collected through the use of focus group discussions, in-depth individual/key informant interviews, annual reports, minutes books and log book. Altogether 106 people selected from 38 communities in four subdistricts were involved in the study. The “Pentagram Model” developed by Susan B. Rifkin and associates in 1988 was used to assess the extent of community participation. This model uses five factors or indicators namely Needs Assessment, Resource Mobilization, Organization, Management, and Leadership to assess the extent of Community participation. One of the significant findings was that in all the four subdistricts studied the extent of community participation was found to be either restricted (small) or lying between restricted and mean (fair). The most strained areas were Needs Assessment and Management. Since the extent of community participation was either small (restricted) lied between small and mean it could partly or fully account for the low coverage/utilization of MCH/FP services as well as other health services. However since only subjective and qualitative indicators were used no correlation could be established between small or poor community participation and low coverage/utilization. Another significant finding was that the health professionals had inadequate knowledge on community participation. They had not been trained on the extent to which they should involve the communities in health programmes. The study identified some positive features which could improve community participation. They included the existence of community health structures (e.g. subdistrict health management teams [SDHMTs] village health volunteers, e tc ), and absence of community conflicts in most communities. The study also revealed a few negatively reinforcing factors of community participation. These included: unwillingness of the communities to contribute financially towards health programmes and development, poor quality of leadership especially the SDHMT members in some communities, absence of team work at the community level, and the influence of soothsayers and fetish priests in some of the communities. A standardized framework on the extend and/or level to which the public or communities should participate in health programmes/projects should be developed especially in areas of planning, implementation, monitoring evaluation, and financial mobilization. The Upper West Regional Health Management Team and Wa District Health Management Team should come out with an incentive package for the community structures. The communities should also support the community health structures financially or otherwise especially the traditional birth attendants (TBAs). It is also recommended that health professionals should educate the communities on the need to contribute financially or otherwise to support health programmes. The pentagram model has been found to be very useful. It should be used periodically to assess the extent of community participation in health programmes/projects.