Abstract
BackgroundAlthough community participation has been identified as being important for improved and sustained health outcomes, designing and successfully implementing it in large scale public health programmes, including family planning and contraceptive (FP/C) service provision, remains challenging. Zambian participants in a multi-country project (the UPTAKE project) took part in the development of an intervention involving community and healthcare provider participation in FP/C services provision and uptake. This study reports key thematic areas identified by the study participants as critical to facilitating community participation in this intervention.MethodsThis was an exploratory qualitative research study, conducted in Kabwe District, Central Province, in 2017. Twelve focus group discussions were conducted with community members (n = 114), two with healthcare providers (n = 19), and ten in-depth interviews with key community and health sector stakeholders. Data were analyzed using a thematic analysis approach.ResultsFour thematic categories were identified by the participants as critical to facilitating community participation in FP/C services. Firstly, accountability in the recruitment of community participants and incorporation of community feedback in FP/C.programming. Secondly, engagement of existing community resources and structures in FP/C services provision. Thirdly, building trust in FP/C methods/services through credible community-based distributors and promotion of appropriate FP/C methods/services. Fourthly, promoting strategies that address structural failures, such as the feminisation of FP/C services and the lack FP/C services that are responsive to adolescent needs.ConclusionsUnderstanding and considering community members’ and healthcare providers’ views regarding contextualized and locally relevant participatory approaches, facilitators and challenges to participation, could improve the design, implementation and success of participatory public health programmes, including FP/C.
Highlights
Community participation has been identified as being important for improved and sustained health outcomes, designing and successfully implementing it in large scale public health programmes, including family planning and contraceptive (FP/C) service provision, remains challenging
We explore Zambian study participants’ perceptions of community participation and identify factors that can facilitate its application in FP/C service provision
The results show that four thematic categories are critical in facilitating community participation in FP/Cs services provision
Summary
Community participation has been identified as being important for improved and sustained health outcomes, designing and successfully implementing it in large scale public health programmes, including family planning and contraceptive (FP/C) service provision, remains challenging. Planning and contraceptive (FP/C) programmes recommend community participation as a key strategy for improved service provision [5]. This is partly because uptake of FP/C methods and services is shaped by several socially embedded community factors such as religious values, political climate and dominating moral understandings [6]. Key policies such as the Family Planning 2020 (FP 2020), note that community participation is vital in expanding access to information, services and supplies to women and girls in remote communities [7]. The World Health Organization’s (WHO) Guideline on ensuring human rights in the provision of contraceptive information and services [9], as well as the Global strategy for women’s, children’s and adolescents’ health [10], emphasize the role of community participation in increasing met needs and improving utilisation of FP/C services
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