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.
