Building Community Capacity for Maternal Health Promotion: An Important Complement to Investments in Health Systems Strengthening
EngenderHealth’s Fistula Care Plus project recently published the results of two studies in Guinea, one examining factors associated with institutional delivery and another investigating the effect of an intervention to build the capacity of community-level volunteers to promote maternal health care-seeking.
Community empowerment and participation has long been recognized as a fundamental component of good health programming and as a critical strategy for improving access to and use of health services. However, as Susan B. Rifkin notes in a 2014 review of the literature, evidence directly linking community participation to improved health outcomes remains weak.
For maternal health, the evidence gap is particularly acute. A 2014 World Health Organization (WHO) report reviewed a community mobilization approach that involves training and supporting women’s groups to carry out an ongoing process of problem exploration, priority-setting and action planning. The report concluded that, while such participatory approaches appeared to have a strong effect on neonatal mortality, there was no evidence of effects on maternal mortality or on other critical maternal health indicators, such as institutional delivery, delivery with a skilled attendant, or receiving the recommended number of antenatal care visits.
While important questions remain about what types of interventions are effective in improving maternal health, our recent research in Guinea found that women’s use of maternal health services was associated with the existence of strong support systems for maternal health within communities. Our study focused on villages where community volunteers had been trained to raise awareness about obstetric risks, including fistula, to monitor pregnancies, and to promote women’s routine use of maternal heath services. We assessed the extent to which community members were aware of and relied on community-level cadres as a main source of maternal health information and advice.
We also found that women living in communities with a high score on our community capacity index were much more likely to use maternal health services than those living in communities with weak support systems. In fact, women living in villages with a high score on our community capacity index were more than twice as likely to attend at least four antenatal care visits during their pregnancies, to deliver in a health facility, and to seek care for perceived obstetric complications.
Building the capacity of community cadres and volunteers to promote maternal heath and monitor maternal health care-seeking is challenging, and it does not occur overnight. However, our findings suggest that such capacity-building investments are worth it since community-level cadres can be important catalysts for changes in maternal health care-seeking when they have the training, support, and recongiztion they need to serve as a resource in their communities. Such investments are an important complement to ongoing efforts to improve the availability, accessibility, and quality of the continuum of maternal health services.