Abstract
Ownership is an important construct of sustainability for community-based health programming, though it is often not clearly defined or measured. We implemented and evaluated a community-driven maternity waiting home (MWH) model in rural Zambia. We engaged stakeholders at all levels and provided intensive mentorship to an MWH governance committee comprised of community-selected members. We then examined how different stakeholders perceive community ownership of the MWH. We conducted 42 focus group discussions with community stakeholders (pregnant women, fathers, elders, and community health volunteers) and 161 in-depth interviews with MWH stakeholders (health facility staff, district health officials, and MWH governance committee and management unit members) at multiple time-points over 24 months. We conducted a content analysis and triangulated findings to understand community ownership of the MWH and observe changes in perceptions of ownership over time. Community members' perceptions of ownership were related to their ability to use the MWH and a responsibility toward its success. Community and MWH stakeholders described increasingly more specific responsibilities over time. Governance committee and management unit members perceived their ability to represent the community as a crucial component of their role. Multiple respondent types saw collaboration between the governance committee and the health facility staff as key to allowing the MWH to meet its goal of serving the community. The perceptions of community ownership evolved as the intervention became more established. Use of the MWH, and clear understanding of roles and responsibilities in management of the MWH, seemed to foster feelings of community ownership. To improve the sustainability of community-based maternal and child health programs, interventions should be accessible to target communities and clear roles should be established among stakeholders.
Highlights
Community Ownership of a Maternity Waiting Home Model in Zambia www.ghspjournal.org members have been engaged in the implementation of maternity waiting homes (MWHs),[4,5,6] which are residential dwellings located near heath facilities where women can stay to await childbirth by a skilled birth attendant and receive postnatal care services
We found that community members considered community ownership essential to the success of a potential MWH intervention.[8]
We have provided a description of in-depth interviews (IDIs) respondents (Table 1) and focus group discussions (FGDs) respondents (Table 2)
Summary
Community Ownership of a Maternity Waiting Home Model in Zambia www.ghspjournal.org members have been engaged in the implementation of maternity waiting homes (MWHs),[4,5,6] which are residential dwellings located near heath facilities where women can stay to await childbirth by a skilled birth attendant and receive postnatal care services. Women who can access a health facility with a high-quality MWH are more likely to deliver at a facility where a skilled birth attendant is present.[6] this type of intervention has shown promising results on reducing mortality among pregnant mothers in Africa.[7] in several studies of MWHs, women and community members were concerned about the sustainability of the intervention, regardless of its perceived success.[4,8,9]
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