Mobilizing community action to improve maternal health in a rural district in Tanzania: lessons learned from two years of community group activities

ABSTRACT

Background: Community participation can provide increased understanding and more effective implementation of strategies that seek to improve outcomes for women and newborns. There is limited knowledge on how participatory processes take place and how this affects the results of an intervention.

Objective: This paper presents the results of two years of implementing (2013–2015) community groups for maternal health care in Magu District, Tanzania.

Method: A total of 102 community groups were established, and 77 completed the four phases of the participatory learning and action cycle. The four phases included identification of problems during pregnancy and childbirth (phase 1), deciding on solutions and planning strategies (phase 2), implementation of strategies (phase 3) and evaluation of impact (phase 4). Community group meetings were facilitated by 15 trained facilitators and groups met monthly in their respective villages. Data was collected as an ongoing process from facilitator and meeting reports, through interviews with facilitators and local leaders and from focus group discussions with community group participants.

Results: The majority of groups prioritized problems related to the availability of and accessibility to health services. The most commonly actioned solution was the provision of health education to the community. Almost all groups (95%) experienced a positive impact on the community as results of their actions, including increased maternal health knowledge and positive behaviour changes among health care workers. Facilitators were positive about the community groups, stating that they were grateful for the gained knowledge on maternal health, and positively regarded the involvement of men in community groups, which are traditionally women-only.

Conclusion: The process of establishing and undertaking community groups in itself appeared to have a positive perceived impact on the community. However, sustained behaviour change, power dynamics and financial incentives need to be carefully considered during implementation and sustaining the community groups.

KEYWORDS:

• Community participation
• community group intervention
• participatory learning and action cycle
• reproductive health
• maternal health

Responsible Editor

Peter Byass, Umeå University, Sweden

Responsible Editor

Peter Byass, Umeå University, Sweden

Acknowledgments

We would like to thank the students of the University of Utrecht, University of Maastricht and VU University of Amsterdam: Ayla Emmink, Benjamin Wendt, Veerle van Loevezijn and Hanneke Bakker. Special appreciation also goes to Naomi Maselle, Athanas Lugata, Clementina R. Kyench, Jamal Barras, Sanna Koet and all community group facilitators and community group member who participated in the project.

Author contributions

Conceptualization, ASM, LSZ; Methodology, ASM, SvP; Data collection, SvP, ASM; Analysis, ASM, SvP; Investigation, ASM, SvP; Resources, African Woman Foundation; Data Curation, ASM, SvP, LSZ; Writing-Original Draft Preparation, ASM; Writing-Review & Editing, SvP, ASM, WdB, LSZ; Validation, ASM, LSZ, WdB, SvP; Visualization, ASM; Supervision, LSZ, ASM; Project Administration, ASM, SvP; Funding Acquisition, African Woman Foundation.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethics and consent

Ethical approval was obtained from the National Institute of Medical Research in Tanzania (MR/53/100/103-349-399) and the VU University of Amsterdam in the Netherlands (2013/135). A research permit was granted by the Tanzanian Commission for Science and Technology (No.2015-255-ER-2013-32). Local authorities provided written permission for data collection. Verbal group consent was obtained within the community groups when group meeting notes were taken by the facilitator, whereby anonymity was guaranteed. Interview and FGD participants provided written informed consent prior to data collection. Data was only accessible to the local research team.

Paper context

Community participation, and the Action Cycle in specific, has proven to be a successful tool to understand communities and to implement strategies to improve maternal health. Little knowledge exists on the relation between the implementation process and the results of the intervention. In this paper, results of the implementation of the Action Cycle are presented together with a reflection on the implementation process itself and contextual factors and how this affected the results.

Additional information

Funding

This research was supported by funds raised through the African Woman Foundation. The Woman Centered Care Project was supported financially through Triple Jump Funds. During the time of writing of this manuscript ASM was supported by the Research Council of Norway through the Global Health and Vaccination Programme (GLOBVAC) for her PhD, project number 244674; Norges Forskningsråd (NO).