Restricted participation: Drivers, experiences and implications of disability stigma in Ethiopia

Background: Community-based inclusive development (CBID) acknowledges society's critical role in supporting the active participation of persons with disabilities. However, research on how this approach relates to the context-sensitive socially situated barriers of disability stigma is underexplored. Objectives: This study aimed to understand the drivers and experiences of disability stigma in Ethiopia, from the perspective of persons with disabilities engaged in CBID programmes, and to establish how disability stigma acts as a barrier to participation. Methods: An inductive methodological approach guided the research design. Mixed methods were used including a narrative review of disabilities studies literature, 16 semi-structured interviews with persons with disabilities, and a quantitative survey of 970 persons with disabilities across three communities in Ethiopia. Results: Informed by theories of epistemic justice, this study identified specific indicators of meaningful participation and examined how these relate to experiences of disability stigma. The study found that the participation of adults with disabilities in society is restricted across different areas of life. Misconceptions about the causes of disability and social perceptions regarding the capacities of persons with disabilities are found to exacerbate stigma and act as a barrier to participation. Conclusion: Targeted efforts to challenge internalised norms and harmful beliefs within CBID approaches are required to address disadvantages arising from embedded disability stigma. Contribution: This study makes conceptual, empirical and practical contributions that advance insights into the relationship between disability stigma and participation in Ethiopia and the dimensions of epistemic justice relevant to understanding the nature and drivers of disability stigma.

Mediating antiretroviral treatment for HIV during COVID-19: lessons from implementation in Gomba District, Uganda

Initial and subsequent waves of COVID-19 in Uganda disrupted the delivery of HIV care. In rural areas, village health teams and organisations on the ground had to develop strategies to ensure that people living with HIV could continue their treatment. It was necessary to take evolving circumstances into account, including dealing with movement restrictions, constrained access to food and stigma due to anonymity being lost as a result of a shift from health facility-based services to community-level support. Uganda has a long history of community-driven response to HIV, although health systems and response programming have become more centralised through government and donors to address political commitments to HIV treatment and other targets. The delivery system for antiretroviral therapy was vulnerable to the impacts of COVID-19 restrictions and related circumstances. To understand the continuum of challenges, and to inform ongoing and future support of treatment for people living with HIV, interviews were conducted with HIV organisation implementers, health workers, village health team members and people living with HIV. It was found that stigma was a central challenge, which led to nuanced adaptations for delivering antiretroviral treatment. There is a need to strengthen support to households of people living with HIV through improving community capacity to manage crises through improving household food gardens and savings, as well as capacity to organise and interact with support systems such as the village health teams. In communities, there is a need to evoke dialogue on stigma and to support community leadership on pressing issues that affect communities as a whole and their vulnerable groups. There are opportunities to reawaken the grassroots civic response systems that were evident in Uganda's early response to HIV yet were lacking in the COVID-19 context.

A description of community-based participatory research of hypertension awareness, prevention and treatment in a district of Matabeleland South Province, Zimbabwe

Background: Hypertension is an important worldwide public health challenge because of its high prevalence and concomitant risks of cardiovascular and kidney diseases. The risk factors for hypertension are well known, and screening, diagnosis and treatment of hypertension have been well researched. However, this knowledge has not been translated into community practice as there remains a huge knowledge gap between the academics, health workers and the communities. There is need for community participation in developing and implementation of health interventions among marginalised communities.Aim: The aim of this project was to improve the community's knowledge about hypertension by positively influencing beliefs and behaviours, leading to improved community hypertension outcomes.Setting: The study was undertaken in Ward 14, a rural area situated south-west of Gwanda District, Matebeleland South Province in Zimbabwe.Methods: We conducted a health services research utilising qualitative methods by using a community-based participatory approach using a cooperative inquiry group.Results: There was improvement in knowledge about awareness and primary prevention of hypertension. Community hypertension care was established through competence training of village health workers (VHWs) and more persons living with hypertension were enrolled into care. Pill pickup rate and treatment compliance improved and the community's confidence in VHWs was restored. Community hypertension screening, treatment registers and health facility referrals were established.Conclusion: The community was empowered; the VHW was established as a key link between the community and the formal health delivery. This was a sustainable form of improving community hypertension health outcomes

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

Community based health insurance scheme: Preferences of rural dwellers of the federal capital territory Abuja, Nigeria

In 2010, community based health insurance scheme (CBHIS) was launched in the Federal Capital Territory (FCT) of Nigeria. Little is known about the preferences and perception of the rural dwellers of the FCT about the scheme. This study aimed to determine the preferences of healthcare consumers towards CBHIS in FCT. A descriptive cross sectional study of 287 household heads was done. Systematic random sampling was used. Information was collected using a semi-structured, interviewer administered questionnaire. Data was analysed with SPSS version 21. Male respondents were 175 (61%), 242 (84.3%) were aware of the existence of CBHIS, 126 (82%) also enrolled their dependents. Annual payment of health insurance premium was preferred by 91 (59.9%) of enrolled respondents, 92 (60.1%) enrolled in the scheme because they perceived it to be a cheap way to access healthcare. No proper understanding was the reason why 33 (28.4%) of those aware of the scheme did not enroll themselves or their dependents. Only 124 (55.1%) were satisfied with the overall services provided to them by their health care provider (HCP). More community enlightenment on CBHIS is required. There is a need to factor in the preferences of the community members into the FCTCBHIS to determine what community members are willing to pay for their healthcare premium and how making contributions will be convenient for them

Community perceptions of the socio-economic structural context influencing HIV and TB risk, prevention and treatment in a high prevalence area in the era of antiretroviral therapy

Following calls for targeted HIV prevention interventions in so-called "hotspots", we explored subjective perceptions of community members in places considered to be high HIV and tuberculosis (TB) transmission areas and those with low prevalence. Although more people now have access to antiretroviral therapy (ART), some areas are still experiencing high HIV transmission rates, presenting a barrier to the elimination of HIV. A rapid qualitative assessment approach was used to access a sample of 230 people who contributed narratives of their experiences and perceptions of transmission, treatment and prevention of HIV and TB in their communities. Theoretical propositions case study strategy was used to inform and guide the thematic analysis of the data with Research Department of Epidemiology & Public Health, University College London, London, UK. Our results support the concept of linking perceived control to health through the identification of structural factors that increase communities' sense of agency. People in these communities did not feel they had the efficacy to effect change in their milieu. The few socio-economic opportunities promote social mobility in search of better prospects which may have a negative impact on community cohesn and prevention strategies. Communities were more concerned with improving their immediate social and economic situations and prioritised this above the prevention messages. Therefore approaches that focus on changing the structural and environmental barriers to prevention may increase people's perceived control. Multifaceted strategies that address the identified constructs of perceived control may influence the social change necessary to make structural interventions successful

Strategies to increase immunization coverage of tetanus vaccine among women in Sub Saharan Africa: a systematic review

World Health Organization (WHO) estimated in 2013 that 49,000 deaths all over the world were caused by neonatal tetanus. Only as recently as the year 2000, neonatal tetanus was a public health problem in 59 countries, but since then it has been eliminated in 36 of the countries concerned. The objective of this piece of work, therefore, was to investigate which strategies intended to increase demand for vaccination are effective in increasing anti-tetanus vaccination coverage of women in Sub Saharan Africa. We searched the following electronic databases from January 1989 to July 2016: Medline, EMBASE (Excerpta Medica Database), The Cochrane Library, Google Scholar, CINAHL (Cumulative Index to Nursing and Allied Health Literature), WHOLIS (World Health Organization Library Database), LILACS (Latin American and Caribbean Literature on Health Sciences) and contacted experts in the field. There were no restrictions to language or publication status. All study designs that could provide the information we sought were eligible, provided the studies were conducted in sub-Saharan Africa. Critical appraisal of all identified citations was done independently by two authors to establish the possible relevance of the articles for inclusion in the review. Our search strategy yielded 191 records and after assessment for eligibility, 6 papers met the criteria for inclusion. In Ivory Coast, after reorganization, health workers said they were satisfied with the work environment and the care provided in 91% and 96% of cases, respectively. In Kenya, the main factors contributing to having sufficiently immunized part of the population against tetanus are lower birth order, higher household wealth index, women's employment, making joint health-related decisions with a partner, and higher number of antenatal care visits. Particularly in Ethiopia, compared with other member countries, the size of the unimmunized population, reporting quality, fragileness of the health system, , resource limitation, and others deserve further concerted attention. In Nigeria, the prevalence of missed opportunities was 66%. The factors responsible for missed opportunities were; poor history taking, lack of knowledge of the current immunization schedule, dependence on physician referral for immunization and inefficient immunization records keeping system. In Nigeria, socio-logistic variables found to be important in Expanded Programme on Immunization implementations included scheduling, health staff attitude, intersectoral collaboration, and health education. Lack of community participation was also found to be a crucial constraining factor. There are many challenges to increase immunization coverage of tetanus vaccine for women. So far very few interventions addressing these challenges have been evaluated scientifically. Community mobilization interventions to change or impact beliefs and attitudes of women are absolutely needed. Additionally, improving accessibility, affordability, availability and accommodation of vaccination service venues will make them more attractive

L'intégration communautaire dans les journées nationales de vaccination au poliovirus : cas de Dschang

Introduction : L'épidémie de poliomyélite déclenchée en fin 2013 à l'Ouest Cameroun avait conduit à plusieurs Journées Nationales de Vaccination de Riposte (JNVr). Le district de Dschang avec ses 22 aires de santé est l'un des plus vastes de l'Ouest Cameroun. Durant les campagnes de vaccination de riposte au poliovirus, les chefs des aires utilisent différentes approches pour d'optimiser la couverture vaccinale. L'objectif principal de l'étude était d'analyser la participation communautaire dans les activités de vaccination supplémentaire, lors de la riposte contre l'épidémie de poliomyélite au Cameroun.Matériel et méthode : Une étude transversale descriptive à été menée en août 2014 dans les aires de santé de Baleveng ; Mbeng ; Fialah-Foreke ; Ndoh-Djutitsa et Fondonera, du district de santé de Dschang. Le statut vaccinal de 136 enfants de 0 à 59 mois a été étudié et 60 parents interviewés dans les ménages. La méthode des enquêtes "Lot Quality Assurance Sampling (LQAS)" a été utilisée. Le marquage de l'auriculaire gauche de l'enfant avec l'encre noire par les vaccinateurs indiquait l'état vaccinal de l'enfant. Résultats : Il ressort que, seules les aires de Mbeng et Fometa avaient des couvertures vaccinales satisfaisantes(respectivement 100% et 95%), alors que Baleveng (80%) ; Fondonera (88,8%) ; Ndoh-Djutitsa (81%) et Fialah-Foréké (88,9%) avaient des couvertures intermédiaires. Les canaux de communication les plus accessible étaient, les mobilisateurs et centres de santé ; les médias et les crieurs. Les canaux les plus sollicités par les parents étaient : les mobilisateurs (20%) ; les affiches (16,7%) et le téléphone (15%). Les aires de santé de Mbeng et Ndoh enregistrent les taux les plus élevés de parents informés (respectivement 9/10 et 8/10). Discussion : Un vaccinateur pour 185 enfants, suite à l'injection des fonds communautaires, permet d'obtenir des couvertures vaccinales > 90%. Des parents informés bien avant le passage des vaccinateurs pourrait conduire à des couvertures vaccinales satisfaisantes. Nous recommandons plus de ressources communautaires et mobilisation sociale dans la mise œuvre des activités vaccinales supplémentaires de riposte à la poliomyélite

Community-Based Surveillance on Polio Eradication in the Horn of Africa

Community-based surveillance complements the existing surveillance systems in the mission to control and eradicate polioviruses. It is a cost effective method and has a number of benefits. It was introduced in Ethiopia in 2003 and in the South Sudan CORE Group Polio Project areas in 2010. As well as the results obtained from this initiative; the report looks at the challenges; lessons learned and suggests some ways to strengthen the programme

Problematique du systeme de reference-contre-reference des urgences obstetricales et l'implication des communautes dans le district de Bamako

But : Cette etude a pour but d'evaluer les difficultes du systeme de reference contre-reference dans le district sanitaire de la Commune V de Bamako. Patients et Methodes: C'est une etude transversale descriptive du 05 septembre au 05 novembre 2011dans le district sanitaire de la Commune V de Bamako. Ont ete incluses les patientes referees ou evacuees pour des soins obstetricaux pendant la periode d'etude. N'ont pas ete inclues les patientes venant d'autres aires et structures de sante ou venues d'elles-memes. La saisie des donnees a ete effectuee sur Excel 8.0 puis analysees sur les logiciels Epi info3.5.3 et STATA. Resu(tats : Durant la periode d'etude nous avons enregistre 1824 cas d'accouchements parmi lesquelles 180 repondaient aux criteres d'inclusion. Au cours de notre etude 92;2% des references etaient adequates ; 78;3 % etaient justifiees et 72;2 % etaient opportunes. Par ailleurs seul le centre de reference de la commune V avait paye sa quote-part pendant la periode de l'etude. Conc(us ion : Notre etude a montre que l'insuffisance des moyens logistiques et la non implication des communautes handicapent le fonctionnement du systeme de reference dans la commune V du District de Bamako

Impact of inaccessible spaces on community participation of people with mobility limitations in Zambia

Background: The study investigated the perspective of people with mobility limitations (PWML) in Zambia, firstly of their accessibility to public buildings and spaces, and secondly of how their capacity to participate in a preferred lifestyle has been affected. Objectives: Firstly to provide insight into the participation experiences of PWML in the social, cultural, economic, political and civic life areas and the relationship of these with disability in Zambia. Secondly to establish how the Zambian disability context shape the experiences of participation by PWML. Method: A qualitative design was used to gather data from 75 PWML in five of the nine provinces of Zambia. Focus group discussions and personal interviews were used to examine the accessibility of the built environment and how this impacted on the whole family's participation experiences. The nominal group technique was utilised to rank inaccessible buildings and facilities which posed barriers to opportunities in life areas and how this interfered with the whole family's lifestyle. Results: Inaccessibility of education institutions; workplaces and spaces have contributed to reduced participation with negative implications for personal, family, social and economic aspects of the lives of participants. Government buildings, service buildings, and transportation were universally identified as most important but least accessible. Conclusion: Zambians with mobility limitations have been disadvantaged in accessing services and facilities provided to the public; depriving them and their dependants of full and equitable life participation because of reduced economic capacity. This study will assist in informing government of the need to improve environmental access to enable equal rights for all citizens

Attitude to the Formation of Community Health Committee in an Oil Bearing Community in South-South Nigeria

BACKGROUND.Community participation in the running of health services has been identified as key to unlocking the potentials of primary health care in achieving health for all members of the community. This and the desire to entrench democratic practices in Nigeria explain why the revised national policy on health recommended the constitution of community health committees (CHC) in all wards and local governments in the country. This study assessed the attitude of health workers; and members of an oil-bearing community towards this recommendation.METHOD.The study was carried out in Ogbogu; a small semi-urban; oil-bearing community in Rivers State; using a pre-intervention/ post-intervention study design. The attitude of members of the community/ and the health workers in the community's health center were assessed before; and six months after the constitution of a CHC; using focus group discussions; key-informant interviews; and field observations as study tools.RESULTS.The health workers knew the importance of the CHC; but refused the offer of assistance in the constitution of the committee; until they got clearance from their superior. But the idea was warmly received by members of the community. However; six months after the formal inauguration of the committee; the committee was only able to hold 2; out of their 6 scheduled meeting; with only 6; out of the 14 members of the committee; attending all the meetings. Most of the issues discussed during the meetings centered on the accountability of the money realized by the health center. Some members of the committee were frustrated by the committee's inability to effect its decisions; while the health workers felt the community members of the committee were unnecessarily interested in financial matters.CONCLUSIONS The attitude to the CHC was poor. Giving the committee the full powers to effectively utilize the human and material resources of the health center in achieving the health aspirations of the community is thereby recommended

Community participation in malaria control in olorunda local government area, osun state, southwestern Nigeria

Malaria is a major health burden in developing countries and needs multiple strategies for its control. Community participation as one of the strategies for malaria control promotes self-awareness and confidence; causes the people to examine the problems and to think positively about the solutions. The study was aimed at assessing the level of community participation in malaria control in Olorunda local government area of Osogbo; Osun state; Nigeria. The study employed a cross-sectional descriptive design. Multi-staged sampling technique was used to choose 550 respondents. An interviewer-administered semi-structured questionnaire was used to elicit information from the respondents. Most of the respondents (65.0) fell between the age ranges 20-39 years; with a mean age of 32.85 + 12 years. Almost all (98.4) respondents had knowledge of malaria with most of them (88.0) correctly aware that mosquito bite could lead to malaria fever. Respondents stated that stagnant pool (92.6) and refuse dump (89.0) could predispose to malaria. About two-thirds (60.6) of the respondents participated in the control of the breeding sites of mosquitoes on specific days for environmental sanitation. The association between community participation in health talk and community participation in malaria control was statistically significant (p

Communication pour la sante en vue du changement de comportement: role des autorites de base; administratives et confessionnelles; dans la promotion de la sante de la communaute

La presente etude vise a montrer le role des autorites de base dans l'amelioration de l'etat de sante de la population. Elle a pour objectifs specifiques de relever les principales strategies de Communication pour la Sante utilisees au Rwanda pour la periode 2003-2008 pour resoudre les principaux problemes de sante et de montrer le role joue par les autorites de base dans le processus de resolution de ces problemes. Un echantillon de 1690 individus issus de dix Districts couverts par les programmes de sante finances par le Global Fund pour le programme VIH et SIDA-Tuberculose et Paludisme a fait l'objet de l'etude. Par ailleurs; des interviews approfondies ont ete menees aupres des partenaires et institutions du Ministere de la Sante responsables du developpement des programmes de prevention de ces problemes de sante. Les principaux resultats de l'etude se presentent comme suit :les programmes de prevention pour les principaux problemes de sante ont ete developpes et sont operationnels sur le terrain. La majorite des repondants (84) ont recu l'information sur la sante a travers la mobilisation sociale par le canal des autorites de base alors que la reception des messages sur la sante a travers les Agents de sante communautaire et les prestataires des services de sante ne represente successivement que 27 et 20 des repondants. Nous recommandons aux autorites de base de continuer a s'impliquer activement dans la transmission des messages relatifs a la sante dans l'interet de leurs populations respectives

MaiMwana Women's Groups: a Community Mobilisation Intervention to Improve Mother and Child Health and Reduce Mortality in Rural Malawi

This article presents a detailed description of a community mobilization intervention involving women's groups in Mchinji District; Malawi. The intervention was implemented between 2005 and 2010. The intervention aims to build the capacities of communities to take control of the mother and child health issues that affect them. To achieve this it comprises trained local female facilitators establishing groups and using a manual; participatory rural appraisal tools and picture cards to guide them through a community action cycle to identify and implement solutions to mother and child health problems. Significant resource inputs include salaries for facilitators and supervisors; and training; equipment and materials to support their work with groups. It is hypothesized that the groups will catalyse community collective action to address mother and child health issues and improve the health and reduce the mortality of mothers and children. Their impact; implementation and cost-effectiveness have been rigorously evaluated through a randomized controlled trial design. The results of these evaluations will be reported in 2011

Factors Influencing Individual and Community Participation in the Control of Tetse Flies and Human African Trypanosomiasis in Urambo District; Tanzania

This study was carried out to assess the knowledge and level of individual and community participation in the control of Human African trypanosomiasis in Urambo District; western Tanzania. Semi structured questionnaires were used to collect information from individuals at house hold level. Retrospective data of HAT was sought from the medicalofficers in-charge of health facilities. The results indicate that; 191 (90.5 ; n = 211) individuals knew tsetse flies and 187(88.6; n=211) knew HAT. All nine key informants reported that; the communities were aware of HAT while seven key informants reported that; the communities were aware of health risks associated with tsetse bites in human. There was poor knowledge about the role played by animals in the transmission of HAT (26.7; n=187). Majority of those who knew HAT (n = 187) were willing to contribute labour (70.1) and money (64.2) to tsetse and HAT control whereas amongst those who knew tsetse flies; 66.5 and 60.7 were willing to contribute labour and money; respectively. Amongst those who knew any HAT control technique (n = 108); 78.7 and 82.4were willing to contribute money and labour respectively. A total of 454 cases of HAT were reported in the area from 1999 to 2006. It is concluded that; the factors influencing individual and community participation include the knowledge of tsetse; HAT and control measures