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FACTORS INFLUENCING COMMUNITY PARTICIPATION IN
MATERNAL HEALTH CARE
Background of the study
In health, community participation is an essential element. A Local Agenda 21, of the 21st centrury,
of WHO strategy for health for all. The Cities Health plan is founded on the values of both of these
policies and community participation is hence essentially vital to attain health and maintainable
growth at the local level, WHO (1989). According to Bell, (1994), community participation needs
working outside consultation to allow people to develop an important part of the decision making
and action procedure. This is not limited to an answer to creativities or programs agreed by officials
and experts. It involves additional inputs by the people seeing the necessity and acting upon it as
activists, pressure groups or self-help groups. John (2013) conquers that community participation
attracts the vigor and passion that exists inside communities to describe what that community
intents to do and the way it wants to function. Smout, (2000), argues that individuals cannot be
enforced to get involved in projects which affect their own lives but should be given a chance when
necessary. Beneficiary community participation, away from attracting cost-effectiveness for project
execution and assets distribution to a broader coverage of weaker units of society, is a key strategy
of safeguarding that accountability and benefits trickle to the recipients also, (Barasa & Jelagat,
2013). Communal involvement might take place throughout one of the following events according
to Ahmed, wants evaluation – articulating sentiments about desirable progresses, ranking
objectives and negotiation, forecasting – expressing purposes, fixing objectives, condemning
policies, organizing – nurturing cognizance in a community around requirements, forming or
backing up organizational arrangements inside the community, teaching – involvement in official
management skills, executing – engaging in administrative events, operation, and management,
monitoring and evaluation – contributing in the assessment of work done, distinguishing progresses
that can be completed and redefining necessities, Ahmed, (2010)
Samuel, (2001), orates that there are many reasons that make community unwilling toward taking
apart in community participation; an biased sharing of efforts or benefits between fellows of the
community, an extremely peculiar society where there is minute or no sense of community, the
feeling that the government or agency ought to offer the amenities, agency treatment of community
members – when persons are treated like destitute they are further expected to behave as if they are.
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Community participation may add seriously to the success and competence of a programme; adds,
Kilpatrick S., (2009), the key issue in its achievement is the attitude of agency worker in the field.
When staff don’t treat persons with dignity or else are seen to favour certain persons or groups
inside a community, this can have a greatly unhelpful outcome on involvement. Rifkin, (2000),
argues that it is not easy for every member of a population to donate to a programme similarly
however, efforts can be made to recognize crucial members and persons that can be vigorously
involved. The shareholders could comprise of the affected people, native and agencies. The
significance of community participation in maternal health is unconcealed, says UNICEF, (2013)
‘involvement by individuals, communities and distinct groups in shaping their well-being should be
followed as a foundation for positive programs and services to uphold and improve their health’
Government agencies in Australia nationwide and at state level 4, have upheld a concern in
community participation since it has some perceived benefits. Rural health service development
community participation has remained to result in more reachable, significant, and suitable
services. Moreover, it is often implied that community participation will result in greater
community fulfilment with health services, and certainly improved health results, however, proof to
support this statement is inadequate, (Wyart, & Tallon-Baudry, 2009).
(Wyart, & Tallon-Baudry, 2009), argues that rural and distant Australian populations support
community participation and from time to time requests for it. There is an extended custom of
community offerings to all types of health services including hospitals, general practice services
and preventative health programs. Community participation, in assisting growth of these services
and agendas, is repeatedly premised on the theory that the health of the community, its energy, and
sustainability is endangered if health services and programs are inaccessible or unsuitable. In India,
according to (Ravindran & Sunil, 2012) says that rates of maternal deaths decreased from 212
deaths per 100,000 live births in 2007 to 178 deaths in 2012. The progress is mainly owed to vital
involvements by the government such as the (JSSK) Janani Shishu Suraksha Karyakaram system
which includes free maternity services for women and children, a countrywide acceleration of
emergency transfer systems and maternal death audits, and advances in the governance and
management of health services at all levels. nonetheless, adolescent and uneducated mothers and
those living in far to reach parts still have a much higher chance of dying in childbirth. Adolescent
girls outside Indian cities are particularly exposed as teenage marriage and pregnancies are very
high in rural and remote areas of the country. UNICEF India funds the Indian government at
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national and regional levels to increase the standards and coverage of great impact maternal health
services and to escalate community request for the services. Its emphasis is on efforts to bring to
attention the essentials of adolescent mothers who are more at danger of problems during
pregnancy and the delivery and post-delivery periods. Deprived females in remote areas are
limited to adequate health care. This is particularly real for areas with small numbers of skilled
health workers, such as sub-Saharan Africa and South Asia. Although, stages of antenatal care have
improved worldwide in the past decade, only 46% of women in low-income republics gain from
skilled care during childbirth. This means that many of births are not conducted by a skilled
midwife, a doctor or a trained nurse, Braun, (2006)
According to ( Iyaniwura & Yussuf, 2009) opines that quite a number of causes of maternal
mortality have been revealed by many studies in Gambia. They comprise of limited access to
emergency obstetric care, poor quality of referral care, hemorrhage and related conditions such as
hypertension and anemia, and widespread diseases such as malaria during pregnancy. Several
barriers to skilled birth attendance in The Gambia have also been revealed by recent survey,
reviewing that the most commonly recounted obstacles to skilled births were inadequate time to
travel (75%) besides, lack of transport (29%) . Further, likely obstacles include absence of trust in
government facilities, high cost of healthcare, domestic workload, and cultural practices that
include home delivery by traditional birth attendance. Further reviewed were known high maternal
age, domestic wealth, education, low parity and urban residence as factors that predict the use of
maternity services. Additionally, Crijns, (2012), argues that the risk factor of maternal death is the
probability that an adolescence woman will eventually die from a maternal cause, which is 1 in
3800 in industrialized countries, against 1 in 150 in unindustrialized states. Majority of
complications that account for 80% of all maternal mortality are: severe postpartum hemorrhage,
sepsis or infections, hypertension and dangerous abortion. High maternal mortality ratio (MMR)
endures in Kenya, despite serious commitment from the government to address the matter. Controls
by WHO, UNICEF, UNFPA, and the World Bank, founded on existing national data for Kenya,
demonstrate that maternal mortality declined slightly between 1990 and 2010, from 400 per
100,000 births to 360 (WHO 2012). Approximates by others are higher, such as an MMR of 560
per 100,000 between 1993-2010 calculated by Hill et al. (2007), and an maternal mortality ratio
between 1998-2008 at 488 per 100,000 births, by Kenyan Demographic and Health Surveys
(KNBS and ICF Macro, 2010).
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On the other hand, Kenya adopted the Health21, initiative by WHO (2012), even though, delivery
of service delivery is still inadequate. In 2014 the first lady initiated Beyong Zero Campaign
tolerance mobile clinics to cap the many case of child mortality and death related due to maternal
complications. Today even in Kitui county the mobile clinics are lying idle without health worker,
nor equipment to run the mobile clinics. World Aids Day of 2013, in Kenya, unveiled a Strategic
Framework initiative for the engagement of First Lady in HIV control and promotion of maternal,
newborn and child health, in the ‘Beyond Zero campaign. The framework focuses on five key
areas: Fast-tracking HIV programmes, - Persuading investment in high impact actions to support
maternal and child health and HIV control – encouraging male involvement as partners and game
changers - Linking communities to speak about barriers in seeking HIV, maternal and child health
services and providing guidance, accountability and acknowledgement to accelerate the attainment
of HIV, maternal and child health targets, Izugbara, (2016). As evidence shows from various
countries in this background, mortality rate is still an issue whose time has come to deal with, from
the point of community participation. Izugbara, (2016) suggests that whereas funders provide
required finance, it is vital for countries, communities and supporters team up to ensure that
programmes are gainful and in line with national main concerns. This is why the study wished to
focus on investigating the influence of community participation on maternal health project in Kutui
County.
It was reported by World Health organization’s (2001) that in Sub-Saharan African many women
deliver in their rural homes and out of every 10 children born, 6% die of birth complications or the
mother dies in regards to child birth. Most of the children who make it develop other health related
complication surmountable by lack of understanding. Children or mothers die lack the basic
maternal health care that are provided by the health care institutions in many of the counties.
In Kenya, the national maternal health programs comprise: family planning, antenatal care, skilled
birth, HIV testing and counseling, , emergency obstetric care, care after birth and being in line with
national policies, Izugbara, (2016). In Kenya maternal health in public hospitals is required to be
free of charge, and any child under the age of 5 is supposed to get free treatment. Despite the
government providing free maternal health, child mortality and related death have been prevalent in
many counties especially in Kitui county. The devolution of health care from the central
government to county government seems to have brought in its share of challenges too in maternal
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health care.
Maternal health Improvement is one of the eight Millennium Development Goals (MDGs) adopted
by the international community in 2000. Under MDG5, countries dedicated to reducing maternal
mortality by three quarters between 1990 and 2015. However, between 1990 and 2010, the global
maternal mortality ratio (i.e. the number of maternal deaths per 100 000 live births) declined by
only3.1% per year. This is far from the annual decline of 5.5% required to achieve MDG5, WHO,
(2014). The United Nations Population Fund (UNFPA) estimated that 289,000 women died of
pregnancy or childbirth related causes in 2015.These causes range from severe bleeding to
obstructed labour, all of which have highly effective interventions. As women have gained access
to family planning and skilled birth attendance with backup emergency obstetric care, the global
maternal mortality ratio has fallen from 380 maternal deaths per 100,000 live births in 1990 to 210
deals per 100,000 live births in 2015. This has resulted in many countries halving their maternal
death rate, Izugbara, (2016). The community’s perception of going to hospital is hampered by the
view that hospitals are not meant for them since the traditional healers or mid-wives can do better,
is an absurd phenomena at best since it lacks scientific prove and it feels like an assumption or an
excuse to hide an underlying issues. Elimelech, (2014) observed however that in many Sub-Saharan
Africa funded projects, local community members have failed to be involved in making critical
decisions that directly affects their projects. This is raising concerns as to whether it is possible
reasons as to why many projects have failed after the sponsor withdraw their support.
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