"Ways and channels for voice regarding perceptions of maternal health care services within the communities of the Makamba and Kayanza provinces in the Republic of Burundi: an exploratory study"

Prosper Niyongabo*, Renate Douwes, Marjolein Dieleman, Frédéric Irambona, Jimmy Mategeko, Georges Nsengiyumva, Tjard de Cock Buning

*Corresponding author for this work

Research output: Contribution to JournalArticleAcademicpeer-review

Abstract

Background: Increased availability of maternal health services alone does not lead to better outcomes for maternal health.The services need to be utilized first.One way to increase service utilization is to plan responsive health care services by taking into account the community's views or expressed needs. Burundi has a high maternal mortality ratio, and despite improvements in health infrastructure, skilled staff and the abolition of user fees for pregnant women,utilization of maternal health services remains low. Possible reasons for this include a lack of responsive healthcare services. An exploratory study was conducted in 2013 in two provinces of Burundi (Makamba and Kayanza), with the aim to collect the experiences of women and men with the maternal health services,their views regarding those services, channels used to express these experiences, and the providers' reaction. Methods: Semi-structured interviews were used to collect data from men and women and key informants, including community health workers, health committee members, health providers, local authorities, religious leaders and managers of non-governmental organizations. Data analysis was facilitated by MAXQDA 11 software. Results: Negative experiences with maternal health services were reported and included poor staff behavior towards women and a lack of medicine. Health committees and suggestion boxes were introduced by the government to channel the community's views. However, they are not used by the community members, who prefer to use community health workers as intermediaries. Fear of expressing oneself linked to the post-war context of Burundi, social and gender norms, and religious norms limit the expression of community members' views, especially those of women. The limited appreciation of community health workers by the providers further hampers communication and acceptance of the community's views by health providers. Conclusion: In Burundi, the community voice to express views on maternal health services is encountering obstacles and needs to be strengthened,especially the women's voice. Community mobilization in the form of a mass immunization campaign day organized by women fora, and community empowerment using participatory approaches could contribute towards community voice strengthening.

Original languageEnglish
Article number46
Pages (from-to)1-14
Number of pages14
JournalBMC Health Services Research
Volume18
DOIs
Publication statusPublished - 29 Jan 2018

Funding

The study was funded by the Netherland organization for scientific cooperation “WOTRO” under the terms and agreements defined within the loan W 07.45.201.00 directed to the research-project on using social accountability to improve maternal health in Burundi and the Democratic Republic of Congo carried out by Vrije University of Amsterdam, The Royal Tropical Institute of Amsterdam, the National Institute for Public Health in Burundi (INSP) and the School of Public Health of Kinshasa.

FundersFunder number
National Institute for Public Health in Burundi
School of Public Health of Kinshasa
Instituto Nacional de Salud Pública

    Keywords

    • Community empowerment
    • Community mobilization
    • Maternal health
    • Participatory approaches
    • Social accountability
    • Voice

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