Level of Awareness and Community Participation
Wyart, & Tallon-Baudry, (2009) defines awareness as the capacity to recognize and
distinguish, to feel, or to be of occasions. Additionally, state or value of being mindful of
something. Awareness offers raw material from which animals grow qualia or subjective
ideas about their experience. Community participation in health programmes rationale has
incorporated answering and responding better to communities’ requirements, designing
programmes that account for relative effects on well-being of society, such effects of local
knowledge or traditional practices, growing public responsibility for health, and for it being
aneeded in itself. Working with communities is believed to be key in cultivating health fairness,
healthcare service delivery and uptake, this has remained suggested in international meetings
and charters, (Wilcox, 2017). World Health Organization Study Group of 1991, well defined
community participation in health as: “a process whereby people, both individually and in
groups, exercise their right to play an active and direct role in the development of appropriate
health services, in ensuring the conditions for sustained better health and in supporting the
empowerment of community to help development. [Community involvement in health] actively
promotes people’s involvement and encourages them to take an interest in, to contribute to and
take some responsibility for the provision of services to promote health” WHO’s (1991) report.
According to Quiggin, et al., (2010), adds that approaches to involvement can be agreed in
relations of two broad categories; the first is effective, where involvement is a distinct,
temporary intervention and might include for example, “[using] community resources (land,
labour and money) to offset the costs of providing services”). However, the method has been
condemned for treating involvement as supplement on or input to healthcare programmes and
for disregarding the fundamental perspective and procedures contributing to communities’
health differences.
Dialogue that develops over time among the community on maternal health awareness
heightens the level of awareness in the community. It pays attention to absence of resources and
social unfairness as reasons of poor health and perceives community participation as a means to
allocate control more equally within and amid societies, healthcare specialists, and the state,
while also developing individuals’ and groups’ own abilities to contribute in the process of
change – cultivating their own health directly, or through community development activities. In
other words, this ‘community development’ or ‘empowerment’ method realizes contribution as
a longer-term method in which communities are vigorously involved in determining on and
applying plans to change the socio-political, economic, and psychological conditions that shape
their health, (Rabkin 2010),
Looking at participation as a vibrant practice rather than a separate involvement, suggests that
as well as looking at outcomes, assessment must also account for fundamental complications
such as the different forms. Participation can take in diverse settings, and the sustainability of
participation over time – for example, is the impression of participation acknowledged inside
the community, or is it temporarily accepted while donors provide money for interventions?
(Quiggin, 2010). According to Samuel, (2001) mobilizing communities inspires developments
and wellbeing of the communities by empowering its members– including powerful
“doorkeepers” – to pinpoint, address and advocate for right to accessing quality health care. He
adds that mobilizing communities, addressees awareness needs of maternal health among those
communities by discussing issues together on a mutual understanding that the issue at hand are
theirs and can only be addressed by themselves. Mobilization is quality helped by all
stakeholders coming together and made aware of maternal health issues through facilitation by
government agencies, NGOs and development conscious grouped like world bank, WHO
among others. Randomized control judgements demonstrate the usefulness of the women’s
groups approach learning how to adjust this to different local contexts. The groups develop
their own plans, organize their own resources and self-evaluate their work, especially health of
mothers or the would be mothers. (Pavlou, P.A. and El Sawy, O.A., 2011).
Due to awareness levels by mobilization of community concerned on the matters of maternal
health, can bring about policy awareness hence policy examination and support initiatives can
influence those in positions of power to bring about changes that make an actual change to
people’s health and welfare. Many communities have no or low knowledge of awareness
regarding maternal health of ANC in the countries of Sub Saharan Africa. This has created
misconception in the way mothers hand ANC bringing about mortality rate high World Health
Organization and UNICEF (2010). Capacity building of the community approach focuses on
understanding the problems that hinder different groups of people, government organizations
from recognizing their growth and development, while enhancing the abilities that allow them
to achieve measurable and sustainable outcomes, (Moore, G. 2002). (Shirlow, & Murtagh,
2004), suggests that community capacity building often relates to strengthening the skills,
competencies and abilities of people and communities in developing societies so that, they can
overcome the reasons of their rejection and suffering. Moore, G. (2002). States Community
capacity building at the societal level should support the establishment of a more "collaborative
public administration that learns equally from its actions and from feedback it receives from the
population at large." Community capacity building must be used to develop public
administrators that are receptive and answerable. Among possible factors that are expected to
promote communal involvement in improvement on the community driven approach include;
material (benefits), growth interest, growth need, past development experience, giving back to
society, project meets needs and peer pressure, (Maraga, 2010)
According (O’Meara, Chesters, & Han, 2004), who says that communities must be educated to
identify and answer to obstetric emergencies, and the quality of health care offered to women
must be improved. Moreover, communication must be improved between official and non-
official health care systems, between communities and health care facilities, and between
women and providers. Most partners in maternal health are uniquely placed to work with their
communities to raise awareness about maternal health issues. They are aware of the traditional
practices and misconceptions that prevent women from seeking care and have often
experienced first-hand the dangers of giving birth at home and failing to seek antenatal and
post-natal care for their children. This provides them with the credibility needed to address
barriers to access to care and to educate community members about safe motherhood practices,
family planning, and the importance of giving birth in a health facility assisted by skilled
medical personnel.
Research has demonstrated the usefulness of specific involvements to increase maternal health.
Among the methods that have been adopted by many governments and organizations are: 1)
access to good quality family planning (including medical and surgical abortion); 2) skilled care
during childbirth; 3) access to emergency obstetrical care (EmOC) at the local hospital when
complications arise; and 4) increasing knowledge and awareness of pregnancy and childbirth
and skills to respond to danger signs (Marsh, 2002; Ahluwalia, 2003). In addition, it is
important to increase awareness of the rights and needs of women, and this should be a part of
any intervention. Society should improve quality of care, linkages and social support for
women, men, families and communities (WHO, 2003).
Many governments and organizations have been working to identify the most effective and
cost- efficient methodologies for reducing maternal deaths. Although advanced technology
undoubtedly plays an important role in saving mothers’ lives, the lessons of the past decade
demonstrate this is not the only way to prevent maternal deaths. Even though many developing
countries lack advanced obstetrical and neonatal technology, training can improve outcomes.
For example, maternal and child problems can be reduced with health education as the
following examples demonstrate. Diarrhea can be reduced if the mother boils drinking water
and washes her hands before preparing and serving food. Tetanus can be prevented by
vaccinating the mother and using sterile tools to cut the umbilical cord. Malnutrition could be
reduced if parents understood how to incorporate nutritious foods already available in their
villages (Williams, 1994). According to (Stuebe, & Schwarz, (2010), says that while safe
motherhood programs take a broad-based approach incorporating health, social and economic
factors, which many aren’t aware of yet many policy makers think about the problems strictly
in terms of available resources; "Problems can be solved once we have enough money to get
adequate medical services." Some use this argument as a justification not to do anything until
the resources are available based on the link between low Gross National Product (GNP)
and high maternal mortality. The level of awareness on perinatal mortality is still low in the
sub-saharan Africa. A large proportion of perinatal mortality is due to complications of
childbirth (Troedsson, 2002). Perinatal and maternal mortality are closely linked and it has
been estimated that there are ten perinatal deaths for every maternal death (Andersson, 2000).
However, only recently has perinatal mortality has received global attention. The socio-
economic and developmental impact on maternal mortality is most dramatically demonstrated
by the fact that most of maternal deaths occur in developing countries which is equivalent to
more than 99% of maternal deaths which occur in developing countries. Maternal Mortality
represents the highest difference in health statistics between developing and developed
countries (WHO, 2006). The MMR is 20 in developed regions, compared to 440 in developing
regions. The gap is even larger between the most and least developed countries. For example, in
2000, the MMR was 11 in the United States but was 523 in Haiti (compared to a low of 1 in
Sweden; 1,132 in the Central African Republic; and a high of 1,900 in Afghanistan (WHO,
2004). Access to appropriate medical care and treatment is the crucial to reducing maternal,
perinatal deaths and morbidity when complications arise. Many factors such as health seeking
behavior and utilization of appropriate care are dependent on individual and community
recognition of illness and warning signals. Outcome of a study conducted in India showed that
54% of the maternal mortality cases were not referred to a hospital because family members
were not aware of the severity of the symptoms (Kumar, 1995). Social stigma associated with
seeking care and the lack of awareness about illnesses that need attention have been recognized
as major problems (Dixon-Mueller, 1991). Complications can arise suddenly and cause
immediate harm if there is no appropriate medical care and treatment. Therefore, understanding
early warning signs and actions to take when complications occur are crucial steps to lowering
mother and the unborn child morbidity and mortality.
The Health Behavioural Model suggest that health searching behaviour is a function of three
sets of personal features - predisposing characteristics for example age, household size,
education, number of previous pregnancies, - supporting characteristics, that is income,
relationship with health workers, etc. and - need characteristics, that is perceived health status,
and benefits expected from the treatment. Awareness through facilitation and mobilization by
health workers, NGOs, and government agencies on maternal health for instance other diseases
and illnesses decreases the risk of maternal deaths. One example is HIV/AIDS control and
treatment; others include malaria, venereal diseases, and other infectious diseases. Insufficient
food and lack of micronutrients can lead to nutritional deficiencies and poor health. Other
society and community level factors include increasing awareness and support of maternal and
new born health with the involvement of a extensive variety of groups and persons
comprising of community and leaders from different religions, groups of women, youth
groups, other local associations and health experts. Another issue is the identification and
coordination of resources to implement safe motherhood strategies such as referral, emergency
transport, distribution and healthcare support for providers and cost- sharing. Also, the
community must play a role in monitoring and evaluating the effect of these interventions.
Legislative and policy actions are essential to create sustainable and comprehensive programs
in the whole country Danger sign awareness is a key foundation for all these levels of
mobilization (WHO, 1999).
REFERENCES
Agha S. and Carton T.W., (2011), Determinants of institutional delivery in rural Jhang,
Pakistan.Int J Equity Health, 2011. 10: p. 31. doi: 10.1186/1475-9276-10-31.
pmid:21801437
Ahmed, M.,et al., (2010), Participatory Management of low-cost water supply &
Sanitation.
ITN-Bangladesh
Ayeni, O. (1985), The Baseline Survey: Health Status and the Utilization of Health
Facilities.Ibadan University College Hospital. Fertility Research Unit. 134-141.
Barasa, F &Jelagat, T (2013) "Community Participation in Project Planning,
Management and Implementation: Building the Foundation for Sustainable
Development" International Journal of Current Research , 5 (02) : 398-401 7.
Berhane Y., et al., Women's health in a rural setting in societal transition in Ethiopia.
SocSci Med, 2001. 53(11): p. 1525–39. pmid:11710427
Borghi J, et al.,.(2003) Costs of near miss obstetric complications for women and their
families in Benin and Ghana.Health Policy and Planning; 18:383–90
Braun KL, (2006), Building Native Hawaiian capacity in cancer research and
programming. A legacy of ‘Imi Hale.Cancer. 2006 Oct 15;107(8 Suppl):2082-90
Cham M., Sundby J., and Vangen S., (2005)Maternal mortality in the rural Gambia, a
qualitative study on access to emergency obstetric care. Reprod Health, 2005.
2(1): p.
3. pmid:15871743 View ArticlePubMed/NCBI Google Scholar
Cheng, D., et al., (2011). "Alcohol consumption during pregnancy: Prevalence and
provider assessment". Obstetrics and
Gynecology. 117 (2,Pt. 2): 212–
217. doi:10.1097/aog.0b013e3182078569.
Crijns, H.J., &others., (2012). Prescriptive contraceptive use among isotretinoin users in
the Netherlands in comparison with non-users: A drug
utilization study. Pharmacoepidemiology and Drug Safety. cited in Santrock,
John W. (14th ed.). Life-Span Development.McGraw Hill, 2013.
Gordis, D. (1993), Mother Care Nigeria, Maternal Healthcare Project Quantitative
Research.Working Paper 178.. Jegede, A.S. (1999), African Cultural and Health
in Nigeria. Ibadan: Stirling Horden Publishers. 48-69.
Hansford, F., O. Anjorim, and K. Pittore,(2014), Gender inequality and maternal and
child nutrition in Northern Nigeria. 2014. [Ref list]
Hoestermann C.F., et al.,(1996) Maternal mortality in the main referral hospital in The
Gambia, west Africa.Trop Med Int Health, 1996. 1(5): p. 710–7. pmid:8911458
Izugbara, C. et al,(2016). "Women, poverty and adverse maternal outcomes in Nairobi,
Kenya". BMC Women's Health. 10 (33). doi:10.1186/1472-6874-10-33.
Kenya National Bureau of Statistics (KNBS) and ICF Macro. (2010.) Kenya
Demographic and Health Survey 2008-09. Calverton, Maryland: KNBS and ICF
Macro.
Kerber KJ, de Graft-Johnson JE, Bhutta ZA, Okong P, Starrs A, Lawn JE. (2007),
Continuum of Care for Maternal, Newborn, and Child Health: From Slogan
to Service Delivery. Lanca
Kilpatrick S., et al., (2009), Boundary crossers, communities, and health: Exploring the
role of rural health professionals. Health and Place. 2009;15:284-90.
King R., et al., (2015), Barriers and facilitators to accessing skilled birth attendants in
Afar region, Ethiopia.Midwifery, 2015. 31(5): p. 540–6. doi:
10.1016/j.midw.2015.02.004. pmid:25745841.
Leone T, James KS, &Padmadas SS.(2012) The Burden of Maternal Health Care
Expenditure in India: Multilevel Analysis of National Data , Maternal and Child
Health Journal.
Lerberg P.M., et al., (2014) Barriers to skilled birth attendance: a survey among mothers
in rural Gambia. Afr J Reprod Health, 2014. 18(1): p. 35–43. pmid:24796167
Maraga, J et al., (2010) "Factors Determining Community Participation In Afforestation
Projects In River Nyando Basin, Kenya" , African Journal of Environmental
Science and Technology, 4(12): 853-859. Available from:
http://www.academicjournals.org/AJEST
(Accessed 20 October 2011)
Moore, G. (2002). ‘Community Capacity Building: Facts and fiction’ community
builder.nsw, website accessed
17/01/17www.communitybuilders.nsw.gov.au/builder/what/facts.html
Namasivayam A., et al.,(2012), The role of gender inequities in women’s access to
reproductive health care: a population-level study of Namibia, Kenya, Nepal,
and India. Int J Womens Health, 2012. 4: p. 351–364. doi:
10.2147/IJWH.S32569. pmid:22927766
O’Meara, P., Chesters, J. & Han, G. (2004). ‘Outside-Looking In: evaluating a
community capacity building project’, Rural Society, 14(2), 126-141
Odhiambo F.O., et al. 2013. “An analysis of pregnancy related data in the KEMRI/CDC
Health Demographic Surveillance System in western Kenya.” PLoS ONE, 8(7):
e68733.
Ogunjimi L., et al., (2012) Curbing maternal and child mortality: The Nigerian
experience.
International Journal of Nursing and Midwifery; 4(3), 33-39.
Onyango M.A., Owoko S., and Oguttu M., Factors that influence male involvement in
sexual and reproductive health in western Kenya: a qualitative study. Afr J
Reprod Health, 2010. 14(4 Spec no.): p. 32–42. pmid:21812196
O'Sullivan, Arthur;Sheffrin, Steven M. (2003). Economics: Principles in Action. Upper
Saddle River, New Jersey 07458: Pearson Prentice Hall. p. 16. ISBN 0-13-
063085-3.
Piper, B.J., et al., (2011), Abnormalities in parentally rated executive function in
metamphetamine/polysubstance exposed children. Pharmacology, Biochemistry,
and Behavior, 98, 432-439. cited in Santrock, John W. (14th ed.). Life-Span
Development.McGraw Hill, 2013.
