Abstracts Category : Other

Developingguidelines to promote community participation and localaccountability for pregnant womens access to basic antenatal carein Mpumalanga Province South Africa

by EvangelineXihlamariso Mthethwa

The study sought to collect empirical evidence onlocal perceptions, needs, views on and experiences of antenatalcare services, community participation and local accountabilityfor health in Bushbuckridge sub-District, Mpumalanga Province witha view of promoting basic antenatal care. The sub-District islocated in Ehlanzeni District which one of the districts in thecountry with the highest institutional maternal mortality rate.The aim of the study was to develop guidelines to enhance communityparticipation and local accountability for health by exploringways to involve the community in basic antenatal care to increaseantenatal uptake. This would contribute to reduction of maternalmortality and morbidity in the area. It was an exploratoryqualitative study to explore and describe the perceptions,experiences and needs in promoting community participation andlocal accountability for pregnant women to access basic antenatalcare in the area. The study was conducted in two phases wherepurposive sampling was used to select the participants. In phase 1data was collected through focus group discussions and face-to-faceindepth individual interviews. The participants were pregnantwomen, community leaders, members of governance structures andmidwives. Data was analysed, category scheme developed and codedresulting into eleven themes. The findings showed perceivedbarriers which prevented pregnant women to attend antenatal careservices. The barriers were related to health systems,socio-demographic factors, cultural beliefs and myths, andpregnant women's unmet financial, physical, psychosocial needs.The governance structures were perceived to be functional andinformally accountable to the community. The identified perceivedneeds were: community involvement and participation in promotingantenatal care attendance; training of the identified stakeholdersto be involved in health promotion activities to strengthen theirknowledge and skills; collaboration of the facility staff and thecommunity in identifying local health problems affecting theircommunity and seeking health care solutions. The elevenidentified themes were integrated with Comprehensive Community andHome-based Health Care CCHBHC model in the context of the relevantliterature. The process resulted into a modified conceptualframework of the CCHBHC model which served as the basis for, andprovided guidance towards formulation and development of thepreliminary guidelines by the researcher. The objective for phase 2was to develop guidelines that could promote communityparticipation and local accountability for pregnant womens accessto basic antenatal care. The set of preliminary guidelines werefurther developed and refined into the final guidelines byinvolving experts using the Delphi technique which completed theprocess of guideline development. Implementing the developedguidelines could contribute in promoting community participationand local accountability for pregnant womens access to basicantenatalAdvisors/Committee Members: Peu, Mmapheko Doriccah (advisor), De Waal, Maretha (coadvisor), Yazbek, Mariatha (coadvisor).