Ellen Brazier, Renee Fiorentino, Mamadou Saidou Barry and Moustapha Diallo. The value of building health promotion capacities within communities: evidence from a maternal health intervention in Guinea Health Policy Plan. (2014) doi: 10.1093/heapol/czu089
Abstract / Summary:
This article presents results from a study that explored the association between community capacity for maternal health promotion and womenâ€™s use of preventive and curative maternal health services. Implemented in the Republic of Guinea, the intervention aimed to build the capacity of community-level committees to heighten awareness about maternal health risks and to promote use of professional maternal health services throughout pregnancy and childbirth. Data were collected through a population-based survey. A total of 2335 women of reproductive age were interviewed, including 878 with a live birth or stillbirth since the launch of the intervention. An index of community capacity was created to explore the effect of living in a community with strong community-level resources and support for maternal health. Other composite variables were created to measure the content of womenâ€™s antenatal counselling and their individual exposure to maternal health promotion activities at the community level. Multivariate logistic regression was used to explore the effect of community capacity and individual exposure variables on womenâ€™s use of antenatal care (ANC) (=4 visits), institutional delivery, and care for complications. Our results show that women living in communities with a high score on the Community Capacity Index were more than twice as likely as women in communities with low score to attend at least four ANC visits, to deliver in a health facility, and to seek care for perceived complications. Building the capacity of community-level cadres to promote maternity care-seeking by women in their villages is an important complement to facility-level interventions to increase the availability, quality and utilization of essential health services.
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- Although recent evaluations of community mobilization efforts have shown promising results for neonatal health outcomes, the impact on maternal health care-seeking appears to be mixed, highlighting the need to strengthen the measurement of intermediate outcomes of community capacity-building efforts in order to better understand intervention factors that positively influence womenâ€™s care-seeking during pregnancy and childbirth.
- An intervention in two regions of Guinea, which focused on building the capacity of community committees to monitor and promote maternal health care-seeking, showed that use of antenatal care, delivery care and care for perceived complications was significantly higher in villages with higher levels of community capacity for maternal health promotion.
- Building the capacity of community-level cadres to monitor maternal health and to promote maternity care-seeking is an important complement to facility-level interventions aimed at improving the availability, quality and utilization of obstetric care.
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