Facilitators and Barriers to Engaging Communities in Maternal and Newborn Health Programs
Several community-based interventions have achieved impressive results, driving increases in the utilization of maternal and newborn health services, improvements in the quality of care and even reductions in maternal mortality. Involving community members throughout the process of designing, implementing and evaluating maternal and newborn health interventions is critical to the success and sustainability of programs.
A recent review published in BMC Pregnancy and Childbirth examined factors that contribute to effective community participation in maternal and newborn health programs. The authors presented several facilitators and barriers from sixteen studies across the globe to understand how maternal and newborn health initiatives can successfully engage communities. Several of their findings are included in the table below.
|
Facilitators |
Barriers | |
| Enabling/ supportive environment | Supportive policies, interest from community, more cohesive social networks | Gender inequality, lack of supportive maternal health policies, discrimination against marginalized groups, conflict, insecurity, violence against women, uncooperative politicians |
| Community capacity | Strong community leadership, participation of women, youth and marginalized groups, multi-organizational partnerships, awareness and support of community health workers (CHWs), community use of data and resources for decision-making and problem-solving | Lack of prioritization of maternal health among community leaders, limited community capacity to work together, trust issues, disorganization |
| Health system | Adequate numbers of trained health workers, availability of accurate data, leadership at district and facility levels | Human resource constraints, weak health system supervision, lack of equipment and technologies, low quality data, limited capacity for data management, poor health worker attitudes, ineffective referral systems |
| Community and health system interaction | CHWs help link communities with formal health services, regular meetings and joint assessments, participation of non-governmental organizations as facilitators | Lack of access to health facilities, financial constraints, poor communication |
| Intercultural sensitivity/ competence | Acknowledgement and respect for existing local beliefs and practices, use of culturally appropriate materials in local languages, focus on changing cultural norms, emphasis on gender rights | Reluctance to travel far for newborn care, challenges reaching marginalized groups and people with low literacy levels |
| General program conditions | Participatory methodology, packages of complementary interventions, long-term funding, trained program facilitators | Low coverage for complex interventions, overworked volunteers, limitations of proxy indicators for monitoring and evaluation |
In their review of the literature on this topic, the authors identified several areas that warrant additional research, attention or clarification including:
- Stakeholder perspectives on maternal and newborn health quality improvement initiatives
- Connection between implementation factors and specific health outcomes
- Reasoning behind choosing a certain approach
- Process of community participation and motivation
- Roles of program implementers throughout the learning process
- Increased use of qualitative data
- Clear operational definitions of “community”
Community-based interventions to improve maternal and newborn health are only successful and sustainable over time when the communities themselves are engaged and are equipped with the resources they need to be successful. A deeper understanding of how to involve communities effectively and respectfully is key to making a lasting, positive impact for mothers and newborns.
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Check out a related post from the Maternal Health Task Force (MHTF) blog, “Community-Based Maternal Health Care: Meeting Women Where They Are.”
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