Abstract
The purpose of the current study was to explore the association between community health entrepreneurship and the sexual and reproductive health status of rural households in West-Uganda. We collected data using digital surveys in a cluster-randomized cross-sectional cohort study. The sample entailed 1211 household members from 25 randomly selected villages within two subcounties, of a rural West-Ugandan district. The association between five validated sexual and reproductive health outcome indicators and exposure to community health entrepreneurship was assessed using wealth-adjusted mixed-effects logistic regression models. We observed that households living in an area where community health entrepreneurs were active reported more often to use at least one modern contraceptive method [odds ratios (OR): 2.01, 95% CI: 1.30-3.10] had more knowledge of modern contraceptive methods (OR: 7.75, 95% CI: 2.81-21.34), knew more sexually transmitted infections (OR: 1.86, 95% CI: 1.14-3.05), and mentioned more symptoms of sexually transmitted infections (OR: 1.83, 95% CI: 1.18-2.85). The association between exposure to community health entrepreneurship and communities' comprehensive knowledge of HIV/AIDS was more ambiguous (OR: 1.27, 95% CI: 0.97-1.67). To conclude, households living in areas where community health entrepreneurs were active had higher odds on using modern contraceptives and had more knowledge of modern contraceptive methods, sexually transmitted infections and symptoms of sexually transmitted infections. This study provides the first evidence supporting the role of community health entrepreneurship in providing rural communities with sexual and reproductive health care.
| Original language | English |
|---|---|
| Pages (from-to) | 676-683 |
| Number of pages | 8 |
| Journal | Health Policy and Planning |
| Volume | 34 |
| Issue number | 9 |
| Early online date | 17 Sept 2019 |
| DOIs | |
| Publication status | Published - 1 Nov 2019 |
Bibliographical note
© The Author(s) 2019. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.Funding
Ethical approval. Ethical clearance was obtained from the Mildmay Uganda Research Ethics Committee and Uganda National Council for Science and Technology. In addition, all activities were agreed upon by the District Health Office. In accordance with Dutch and Ugandan law, no further ethical procedures were required. This work was supported by an anonymous donor through a trust fund from Erasmus University Rotterdam (22070000.040). Healthy Entrepreneurs offered material support to the principal investigator (R.A.J.B.). Both the anonymous donor and Healthy Entrepreneurs were not involved in the design, execution and analysis of this study, nor were they involved in conceiving, writing and editing this manuscript. The authors are immensely grateful for the cordiality of all engaged households. In addition, we would like to thank the team of enumerators for their dedication and guidance. Lastly, we would like to acknowledge the staff from Emesco Development Foundation and the warehouse for their support and hospitality. Conflicts of interest statement. None declared. 1Erasmus School of Health Policy & Management, Health Care Governance, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands, 2Department of Health Sciences, Faculty of Science, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands and 3Department of Social Work and Social Administration, Makerere University, PO Box 7062, Kampala, Uganda
| Funders | Funder number |
|---|---|
| Amsterdam Public Health Research Institute | |
| Emesco Development Foundation | |
| Erasmus Universiteit Rotterdam | 22070000.040 |
| Vrije Universiteit Amsterdam | 3Department |
| National Research Council of Science and Technology |
Keywords
- community health entrepreneurship
- Community health workers
- sexual and reproductive health
- social entrepreneurship
- social franchising
