Participatory approaches involving community and healthcare providers in family planning/contraceptive information and service provision: a scoping review.

As efforts to address unmet need for family planning and contraception (FP/C) accelerate, voluntary use, informed choice and quality must remain at the fore. Active involvement of affected populations has been recognized as one of the key principles in ensuring human rights in the provision of FP/C and in improving quality of care. However, community participation continues to be inadequately addressed in large-scale FP/C programmes. Community and healthcare providers’ unequal relationship can be a barrier to successful participation. This scoping review identifies participatory approaches involving both community and healthcare providers for FP/C services and analyzes relevant evidence. The detailed analysis of 25 articles provided information on 28 specific programmes and identified three types of approaches for community and healthcare provider participation in FP/C programmes. The three approaches were: (i) establishment of new groups either health committees to link the health service providers and users or implementation teams to conduct specific activities to improve or extend available health services, (ii) identification of and collaboration with existing community structures to optimise use of health services and (iii) operationalization of tools to facilitate community and healthcare provider collaboration for quality improvement. Integration of community and healthcare provider participation in FP/C provision were conducted through FP/C-only programmes, FP/C-focused programmes and/or as part of a health service package. The rationales behind the interventions varied and may be multiple. Examples include researcher-, NGO- or health service-initiated programmes with clear objectives of improving FP/C service provision or increasing demand for services; facilitating the involvement of community members or service users and, in some cases, may combine socio-economic development and increasing self-reliance or control over sexual and reproductive health. Although a number of studies reported increase in FP/C knowledge and uptake, the lack of robust monitoring and evaluation mechanisms and quantitative and comparable data resulted in difficulties in generating clear recommendations. It is imperative that programmes are systematically designed, evaluated and reported

Predictors and pregnancy outcomes associated with a newborn birth weight of 4000 g or more in Lusaka, Zambia

To identify predictors and outcomes associated with a birth weight of 4000 g or more in Lusaka, Zambia

Clinical Performance of Digital Cervicography and Cytology for Cervical Cancer Screening in HIV-Infected Women in Lusaka, Zambia

While there is a growing literature on the clinical performance of VIA in HIV-infected women, to our knowledge none have studied VIA enhanced by digital cervicography. We estimated clinical performance of cervicography and cytology to detect cervical intraepithelial neoplasia grade 2 or worse. Sensitivity and specificity of cervicography were 84% (95% confidence interval [CI]: 72%–91%) and 58% (95%CI: 52%–64%). At the high-grade squamous intraepithelial lesion or worse cutoff for cytology, sensitivity and specificity were 61% (95%CI: 48%–72%) and 58% (95%CI: 52%–64%). In our study, cervicography appears to be as good as cytology in HIV-infected women

Teamwork in Qualitative Research

Multicountry teamwork in qualitative research is receiving increased recognition in an attempt to address global health problems. We report our experience of teamwork implementing a multicountry study (Zambia, South Africa, and Kenya), employing qualitative research to gain insight into met needs of contraception. Using this study example, we demonstrate the innovative development of a multicountry, south–south relationship (i.e., collaboration and sharing of knowledge between developing countries located in the Global South) within the health-care research setting. In addition, strategies employed for a collaborative research process and approaches used for data collection and analysis are described. We also describe the parallel but interlinked processes of developing a collaborative relationship, rigorous data collection, and the process of teamwork in data analysis. We discuss how we collaboratively developed and tested codes and themes and the use of a shared codebook in a team. The end result was country-specific data analyses reports using a single shared codebook, allowing for analyses that were appropriate to the region yet comparable across countries. The success of this project can be attributed to the methodological rigor, facilitated by intense communications, and support processes in this south–south collaboration

Community and health systems barriers and enablers to family planning and contraceptive services provision and use in Kabwe District, Zambia

Abstract Background Unmet need for contraception results in several health challenges such as unintended pregnancies, unwanted births and unsafe abortions. Most interventions have been unable to successfully address this unmet need due to various community and health system level factors. Identifying these inhibiting and enabling factors prior to implementation of interventions forms the basis for planning efforts to increase met needs. This qualitative study was part of the formative phase of a larger research project that aimed to develop an intervention to increase met needs for contraception through community and health system participation. The specific study component reported here explores barriers and enablers to family planning and contraceptive services provision and utilisation at community and health systems levels. Methods Twelve focus group discussions were conducted with community members (n = 114) and two with healthcare providers (n = 19). Ten in-depth interviews were held with key stakeholders. The study was conducted in Kabwe district, Zambia. Interviews/discussions were translated and transcribed verbatim. Data were coded and organised using NVivo 10 (QSR international), and were analysed using thematic analysis. Results Health systems barriers include long distances to healthcare facilities, stock-outs of preferred methods, lack of policies facilitating contraceptive provision in schools, and undesirable provider attitudes. Community level barriers comprise women’s experience with contraceptive side effects, myths, rumours and misconceptions, societal stigma, and negative traditional and religious beliefs. On the other hand, health systems enablers consist of political will from government to expand contraceptive services access, integration of contraceptive services, provision of couples counselling, and availability of personnel to offer basic methods mix. Functional community health system structures, community desire to delay pregnancy, and knowledge of contraceptive services are enablers at a community level. Conclusions These study findings highlight key community and health systems factors that should be considered by policy, program planners and implementers in the design and implementation of family planning and contraceptive services programmes, to ensure sustained uptake and increased met needs for contraceptive methods and services

Additional file 2: of Community and health systems barriers and enablers to family planning and contraceptive services provision and use in Kabwe District, Zambia

Appendix D, FGD guide_healthcare providers. (DOCX 45 kb

Community and provider perspectives on addressing unmet need for contraception: Key Findings from a formative phase research in Kenya, South Africa and Zambia (2015-2016)

Unmet need for contraception remains a challenge especially in low and middle-income countries. Community participation or the ―active involvement of affected populations in all stages of decision-making and implementation of policies, programs, and services‖ is a precondition for attaining the highest standard of health. Participation as a key component of rights and quality of care frameworks could increase met needs. However, it has been inadequately addressed in contraceptive programs. A qualitative, exploratory methodology that included focus group discussions and in-depth interviews with community members, healthcare providers, and other stakeholders were conducted to identify domains or key thematic areas of action through which stakeholders could be engaged. The study conducted in Kenya, South Africa, and Zambia explored knowledge and use of contraceptives, barriers and enablers to access, quality of care, and participatory practices. Thematic analysis was used, facilitated by NVivo (version 10 QSR International) with a single master codebook. Comparing the thematic areas that emerged from the county data, four domains were selected: quality of care, informed decision-making, acceptability, and accountability. These domains informed the theory of change of a participatory programme aiming to meet unmet needs. Identifying possible generalizable domains establishes measurable and comparable intermediate outcomes for participatory programs despite diverse African contexts. Les besoins non satisfaits en matière de contraception restent un problème, en particulier dans les pays à revenu faible et intermédiaire. La participation communautaire ou la "participation active des populations touchées à toutes les étapes de la prise de décision et de la mise en oeuvre des politiques, des programmes et des services" est une condition préalable pour atteindre le niveau de santé optimal. La participation en tant qu'élément clé des cadres relatifs aux droits et à la qualité des soins peuvent augmenter les besoins satisfaits. Toutefois ceci n‘a été suffisamment aborde dans des programmes contraceptifs. Une méthodologie exploratoire qualitative comprenant des discussions de groupe et des entretiens approfondis avec des membres de la communauté, des prestataires de soins de santé et d‘autres parties prenantes a été menée pour identifier des domaines ou des domaines thématiques clés d‘action à travers lesquels les parties prenantes pouvaient être engagés. L‘étude menée au Kenya, en Afrique du Sud et en Zambie a exploré la connaissance et l‘utilisation des contraceptifs, les obstacles et les facilitateurs d‘accès, la qualité des soins et les pratiques participatives. Une analyse thématique a été utilisée, facilitée par NVivo ( version 10 QSR International) avec un seul livre de codes maître. En se basant sur les données des comtés, quatre domaines ont été sélectionnés: qualité des soins, prise de décision en connaissance de cause, acceptabilité et responsabilité. Ces domaines ont éclairé la théorie du changement d'un programme participatif visant à répondre à des besoins non satisfaits. Identifier les domaines généralisables possibles établit des résultats intermédiaires mesurables et comparables pour les programmes participatifs malgré la diversité des contexts africains.Keywords: Community participation, unmet need, family planningAfr J Reprod Health 2019; 23[3]: 106-11

Additional file 3: of Community and health systems barriers and enablers to family planning and contraceptive services provision and use in Kabwe District, Zambia

Appendix D, FGD guide_males. (DOCX 43 kb

Additional file 4: of Community and health systems barriers and enablers to family planning and contraceptive services provision and use in Kabwe District, Zambia

Appendix D, In-depth interview guide_key stakeholders. (DOCX 51 kb

Additional file 1: of Community and health systems barriers and enablers to family planning and contraceptive services provision and use in Kabwe District, Zambia

Appendix D, FGD guide_females. (DOCX 44 kb