Presentation at the Global Maternal Newborn Health Conference, October 21, 2015
Background: The USAID-funded Health Communication Partnership strengthened community capacity (CC) in 22 districts in Zambia to improve social norms and advance health outcomes. The program encouraged households and communities to take positive health action by: (1) strengthening community systems; (2) mobilizing leaders and youth; and (3) stimulating dialogue on positive maternal and child health practice. We hypothesized that strengthened CC would yield improved health behaviours. The study aimed to: (1) develop and validate community-generated capacity indicators; and (2) measure change in community capacity related to health outcomes.
Methodology: Phase I, of the three-phased study, elicited community-generated capacity indicators. Community stakeholders identified most significant changes in their communities through stories on how change transpired. Sixteen focus groups with men and women and 14 semi-structured key informant interviews were held in four rural and urban study sites. Factors affecting change informed their selection of CC domains and indicators. In Phase II, community-identified CC indicators were tested. In Phase III validated indicators were incorporated into the program’s population-based end-line evaluation.
Results: Capacity domains evaluated included: community participation, leadership, social cohesion, collective efficacy, individual efficacy, conflict resolution, and resource mobilization. Five of six CC domains demonstrated significant improvements in intervention areas compared to non-intervention areas. Individual efficacy showed change, but not significantly. Programming had direct CC effects; and enhanced CC was associated with communities taking action for health. Importantly, increases in CC mediated by community action and controlling for confounders, had a significant effect on women’s contraceptive use, children’s bed-net use, and HIV testing.
Conclusion: Strengthening CC through community mobilization interventions can be a means to an end – improved health behaviors – and a measurable end in itself. This provides further evidence for empowering community mobilization interventions as a valuable program component to support ending preventable maternal and child deaths.