Developing a successful participatory approach (methodology) through which health system and community engage to increase met needs for family planning/contraception
ESC Congress Library. Smit J. May 10, 2018; 208173; ESC272
Prof. Jennifer Smit
Prof. Jennifer Smit
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Abstract
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Objectives: Community participation is a key component in frameworks for improving quality of health services.  Community participation in achieving health improvements remains ill-defined, making it difficult to measure the impact on desired programme outcomes. The UPTAKE Project aimed to increase met needs for family planning/contraception through a participatory approach involving both community and healthcare providers. Within the context of the project, participation is defined as the active involvement of individuals, communities or community-based organizations in the functioning of community health services and systems. To ensure that the collaboration between community and healthcare provider takes place, a systematic Approach was developed. Design and Methods: The study was conducted in South Africa, Zambia and Kenya in 2015-2016. The Approach was developed during the formative phase of the study through an iterative process and was informed by evidence from existing literature review (a scoping review was conducted to identify community and health care participatory approaches). The Approach was refined through integration of community, health care and other stakeholders' input through qualitative research activities such as focus group discussions, in-depth interviews, as well as mapping of existing structures, services and policies. Feasibility testing and pre-testing of the Approach was conducted, involving a community dialogue engaging both community members and health providers using a step-by-step guide based on a Theory of Change structure. Results: Five key issues were identified that needed to be addressed by the Approach: programme initiation, participant identification and recruitment, enabling dialogue and collaboration between community and health system, and ensuring sustainability and scale-up.Overall findings from the qualitative research and community dialogues across the countries showed that engagement between the community members and heath care providers enable needs to be addressed and discussed. During the feasibility testing of the Approach and pre-testing of the intervention in county/district meetings, representatives of the community and the health system recognised the value of such an approach and of the methodology in which it was developed. Participants agreed that it was feasible to implement such an approach and expressed their willingness to commit to take part in such a programme. This support was from a variety of stakeholders. Conclusions: A community participation Approach to address unmet family planning needs, if developed systematically, and is culturally sensitive is operationally feasible. It is imperative that all five components of the Approach are addressed. Failure to do so has resulted in participatory programmes failing in the past.
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