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. 2020 Feb 5;15(2):e0228137.
doi: 10.1371/journal.pone.0228137. eCollection 2020.

Effectiveness of participatory community solutions strategy on improving household and provider health care behaviors and practices: A mixed-method evaluation

Gizachew Tadele Tiruneh  1 , Nebreed Fesseha Zemichael  1 , Wuleta Aklilu Betemariam  1 , Ali Mehryar Karim  2
Affiliations

Effectiveness of participatory community solutions strategy on improving household and provider health care behaviors and practices: A mixed-method evaluation

Gizachew Tadele Tiruneh et al. PLoS One. .

Abstract

Introduction: We implemented a participatory quality improvement strategy in eight primary health care units of Ethiopia to improve use and quality of maternal and newborn health services.

Methods: We evaluated the effects of this strategy using mixed-methods research. We used before-and-after (March 2016 and November 2017) cross-sectional surveys of women who had children 0-11 months to compare changes in maternal and newborn health care indicators in the 39 communities that received the intervention and the 148 communities that did not. We used propensity scores to match the intervention with the comparison communities at baseline and difference-in-difference analyses to estimate intervention effects. The qualitative method included 51 in-depth interviews of community volunteers, health extension workers, health center directors and staff, and project specialists.

Results: The difference-in-difference analyses indicated that 7.9 percentage points (95% confidence interval [CI]: 1.8-13.9%) increase in receiving skilled delivery care between baseline and follow-up surveys in the intervention area that is attributable to the strategy. The intervention effect on postnatal care in 48 hours of the mother was 15.3% (95% CI: 7.4-23.2). However, there was no evidence that the strategy affected the seven other maternal and newborn health care indicators considered. Interview participants said that the participatory design and implementation strategy helped them to realize gaps, identify real problems, and design appropriate solutions, and created a sense of ownership and shared responsibility for implementing interventions.

Conclusions: Community participation in planning and monitoring maternal and newborn health service delivery improves use of some high-impact maternal and newborn health services. The study supports the notion that participatory community strategies should be considered to foster community-responsive health systems.

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Conflict of interest statement

The authors declare that they have no competing interests. The authors have been working for JSI Research & Training Institute, Inc., a commercial company. We declared that this commercial affiliation does not alter our adherence to PLOS ONE policies on sharing data and materials. The senior author of this manuscript has been working for JSI Research and Training Institute Inc. during the design, field work, and report-up of this manuscript. However, he recently left JSI and joined Gates Foundation. We would like to declare that we do not have any conflict of interest with the Foundation-paid staff in preparing this manuscript.

Figures

Fig 1
Fig 1. Participatory community QI cycle.
Fig 2
Fig 2. Partograph use and administration of prophylactic uterotonics.
See this image and copyright information in PMC

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