Developing guidelines to promote community participation and local accountability for pregnant women’s access to basic antenatal care in Mpumalanga Province South Africa

Abstract

The study sought to collect empirical evidence on local perceptions, needs, views on and experiences of antenatal care services, community participation and local accountability for health in Bushbuckridge sub-District, Mpumalanga Province with a view of promoting basic antenatal care. The sub-District is located in Ehlanzeni District which one of the districts in the country with the highest institutional maternal mortality rate. The aim of the study was to develop guidelines to enhance community participation and local accountability for health by exploring ways to involve the community in basic antenatal care to increase antenatal uptake. This would contribute to reduction of maternal mortality and morbidity in the area. It was an exploratory qualitative study to explore and describe the perceptions, experiences and needs in promoting community participation and local accountability for pregnant women to access basic antenatal care in the area. The study was conducted in two phases where purposive sampling was used to select the participants. In phase 1 data was collected through focus group discussions and face-to-face indepth individual interviews. The participants were pregnant women, community leaders, members of governance structures and midwives. Data was analysed, category scheme developed and coded resulting into eleven themes. The findings showed perceived barriers which prevented pregnant women to attend antenatal care services. The barriers were related to health systems, socio-demographic factors, cultural beliefs and myths, and pregnant women's unmet financial, physical, psychosocial needs. The governance structures were perceived to be functional and informally accountable to the community. The identified perceived needs were: community involvement and participation in promoting antenatal care attendance; training of the identified stakeholders to be involved in health promotion activities to strengthen their knowledge and skills; collaboration of the facility staff and the community in identifying local health problems affecting their community and seeking health care solutions. The eleven identified themes were integrated with Comprehensive Community and Home-based Health Care CCHBHC model in the context of the relevant literature. The process resulted into a modified conceptual framework of the CCHBHC model which served as the basis for, and provided guidance towards formulation and development of the preliminary guidelines by the researcher. The objective for phase 2 was to develop guidelines that could promote community participation and local accountability for pregnant women’s access to basic antenatal care. The set of preliminary guidelines were further developed and refined into the final guidelines by involving experts using the Delphi technique which completed the process of guideline development. Implementing the developed guidelines could contribute in promoting community participation and local accountability for pregnant women’s access to basic antenatal care in Bushbuckridge sub-District. A set of recommendations was developed for the Department of Health, policy makers, nursing education and practice and the community as role players in the study.