Addressing contraceptive needs within a human rights framework through community dialogue between community members and healthcare providers.
ESC Congress Library. Smit J. May 10, 2018; 208148; ESC215
Prof. Jennifer Smit
Prof. Jennifer Smit
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Objectives Unequal or conflictual interactions between the community and healthcare providers (HCPs) act as a barrier to uptake of family planning/contraception (FP/C). The UPTAKE Project, under the umbrella of the World Health Organization, aimed to develop an approach to increase community and HCP participation in the provision of FP/C services. The study, conducted in South Africa, Zambia and Kenya in 2015-2016, used a Theory of Change (ToC) methodology to test whether a community dialogue approach could be successfully employed to increase community participation. Here, findings from the South African site are presented. Design and Methods Community members, HCPs, and key stakeholders (n=28) attended the community dialogue in eThekwini, KwaZulu-Natal, South Africa. Guides were developed to facilitate a step-by-step process for delivery and evaluation of the dialogue. After the dialogue, 3 focus group discussions were held to obtain feedback on the feasibility and acceptability of this approach. The 3 focus groups comprised HCPs-only, community-only and a mixed group (HCP and community members).  Six evaluators assessed the feasibility of the dialogue through observation of the process using a standardized feasibility check-list. Results There was robust discussion with good participation between HCPs and community members: 'There were no attacks between community and health care providers. We had a successful discussion and negotiated without judging...' (community-only group). Community members felt empowered by the process: 'This makes us feel honoured even though we are unemployed. We can now share this information with others'; and providers felt motivated to institute change: 'I felt so comfortable….They put forward their points as facts. We can take these points back to our clinic and try implement them. We are working in the clinic and we don't fully understand what some of the problems are.'  Some participants identified the need for community dialogues to run during school holidays or weekends to accommodate inclusion of youth. Key factors contributed to the success of this community dialogue: a skilled facilitator, good representation of participants, establishing ground rules, good timekeeping, and using the ToC to facilitate goal identification and dialogue. Conclusions There was good participation in the community dialogue process regardless of participant age, sex and whether a community member or HCP; feedback received after the dialogue was very positive. This suggests that community dialogue is a feasible and enabling platform and should be considered by policy makers and programme developers as an intervention to address unmet FP/C needs.
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