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Table 1 Characteristics of studies and description of interventions

From: Factors affecting effective community participation in maternal and newborn health programme planning, implementation and quality of care interventions

No Study Setting CPa Time frame Approach Level General description of intervention or aim of the study
1 Purdin S, et al. (2009). Reducing maternal mortality among Afghan refugees in Pakistan Pakistan: Hangu district of Khyber Pakhtunkhwa Province (rural refugee settlements) P&I 1980–2007` Community outreach and stakeholder committee Outreach Provision of reproductive health services for Afghan refugees through establishment of Basic Health Units and Basic Emergency Obstetric Care facilities. Camp-based health committees included community representatives who attended bi-monthly meetings with health staff to discuss project activities and provide feedback to providers on services provided. The Basic Health Unit staff trained Community Health Workers and committee members including men on safe motherhood and reproductive health topics to educate others in the refugee community.
2 Ahluwalia I, et al. (2003). An evaluation of a community-based approach to safe motherhood in northwestern Tanzania (See also Ahluwalia, 2003) Tanzania: Kwimba
Missungwi districts (rural)
P&I 1998–2000 Community mobilizing Outreach, Consult, Involve As part of a Community Based Reproductive Health Project (CBRHP) strengthening of community level services was done through a special activity called the Community Capacity Building and Empowerment Project. The project aimed for local problem solving through 1) training, technical assistance, and support for (village health workers) VHWs who provided educational house visits on topics such as recognition of danger signs and birth preparedness; [2] developing community-based plans for transportation to health facilities and [3] increasing participation by community members in planning and decision-making through community meetings, aiming to identify and solve local health problems.
3 Ahluwalia I, et al. (2010). Sustainability of community-capacity to promote safer motherhood in northwestern Tanzania: what remains? (See also Ahluwalia, 2010) Tanzania: Kwimba
Missungwi districts (rural)
P&I 2006 Community mobilizing Outreach, Consult, Involve This study reports on a follow-up study of Ahluwalia (2003) with the aim to examine the remains of the CBRHP as described above. Activities continued from 2001 to 2006 without project support. A post project assessment was conducted with focus on the CBRHP components, including community supported transport systems; village health workers; and changes in selected maternal health service use indicators at the district level.
4 Bhutta Z, et al. (2011) Pakistan: 2 towns in Sindh with 1400 villages (rural) P&I 2006–2008 Stakeholder committee and Community mobilizing Outreach Community-based intervention package principally delivered through training of Lady Health Worker (LHW) and Dais (traditional health workers) and promotion of liaison between them together with facilitation of the creation of voluntary community health committees (CHC). In addition to advocacy work with community elders and local political leaders, the CHCs were encouraged to organize an emergency transport fund and the use of vehicles using local resources. The CHCs facilitated the LHWs in accessing women and in conducting group education sessions in the intervention villages.
5 Paxman J, et al. (2005). The India Local Initiatives Program: A Model for Expanding Reproductive and Child Health Services India: 4 northern states in Kolkata, the hills of the Himalayas, Punjab plains, and mountains of Himachal Pradesh (urban & rural) P&I 1999–2003 Stakeholder committee Involve NGOs help to organize or strengthen a reproductive and child health committee composed of influential community members. The committees recruit, train and oversee the work of community health volunteers (CHVs), raise money for health activities and support, and enlist support of local government, social and religious leaders. CHVs provided health information to households and kept track of their health status, provided some basic health services including some family planning methods, organized educational activities and referred clients to additional services outside their communities. CHVs tracked health status making use of a pictorial map to facilitate use by people with limited literacy skills, which helped project staff to monitor performance.
6 Kaufman J, et al. (2012). Improving reproductive health in rural China through participatory planning China: Dafang and Zhenning counties in Guizhou Province, Luoping County in Yunnan Province (rural) P&I 2002–2006 Community outreach Involve The Gender and Health Equity Network (GHEN) project aimed to improve health further for poor rural women by increasing women’ s participation in planning and resource allocation through capacity building through training of township women’s representatives and local officials in gender and health. Women’s health promotion groups and demonstration households were established. Demonstration households collected information on local health service needs and shared this with the health promotion team who communicated to higher-level health authorities. Women and their families were taught how to prevent and treat common health problems and were motivated to use services. Health education activities were organized at least once per month. County and township supervision meetings were held once every two months to provide direction, identify and solve problems.
7 Harkins T, et al. (2008). The health benefits of social mobilization: experiences with community-based Integrated Management of Childhood Illness in Chao, Peru and San Luis, Honduras Peru: Chao district (peri-urban) and
Honduras: San Luis district (rural)
P&I 2004–2005 Stakeholder committee, community outreach Involve Multiple government agencies, private sector and non-governmental organizations along with representatives of community-based organizations established or strengthened existing committees that were tasked by the project with disseminating key Integrated Management of Childhood Illness health messages to their various constituencies through their networks with the aim of involving families and communities in maternal and child health approaches. Members of the committee were trained and they in turn capacitated community members. The committees could be creative about how they disseminated the messages. The committee was responsible for organizing the training and events and the supporting logistics for their activities.
8 Sood S, et al. (2004). Measuring the effects of the SIAGA behavior change campaign in Indonesia with population-based survey results Indonesia, West-Java P&I 1999–2004 Community mobilizing Involve Social mobilization campaign consisted of a mass media component that targeted husbands (Suami SIAGA), birth attendants (Bidan SIAGA), and communities (Warga SIAGA) and villages (Desa SIAGA) with radio and television spots and shows that modeled the desired attitudes and behaviors of “alert” husbands, midwives and communities that support the health of their mothers and babies. There was also a community participation component for the “alert village” that built on a traditional concept of the value of community help. This component aimed at motivating people to establish life-saving systems in their villages (transport, emergency funds, blood)
9 Mathur, et al. (2004). Youth Reproductive Health in Nepal – is participation the answer? (See also Malhotra, 2005) Nepal: Nawalparasi and Kawasoti Districts (rural Terai) & two urban suburbs of Kathmandu P&I 1998–2004 Stakeholder committee Shared Leadership A youth centered participation project was initiated through a formative research process, which included a needs assessment on how issues of youth reproductive health were relevant in the communities of interest. The project staff facilitated an action planning process through which results of the needs assessment were shared with community members. The project established two community-based advisory groups, the Adolescent Coordination Team (ACT) and the Project Advisory Committee (PAC) consisting of adults. This was followed by formation of separate task forces consisting of youth representatives to develop interventions and an intervention plan. The task forces then came together to integrate their plans after seeking advice from resource people in the community. This was followed by implementation of the interventions. This study documents the process and results of the project.
10 Malhotra, et al. (2005). Nepal: The Distributional Impact of Participatory Approaches on Reproductive Health for Disadvantaged Youth (See also Mathur, 2004) Nepal: Nawalparasi and Kawasoti Districts (rural Terai) & two urban suburbs of Kathmandu P&I 1998–2004 Implementation planning through youth involvement taskforces Shared Leadership This study reports on the impact of participatory approaches in improving youth reproductive health as reported by Mathur (2004). The authors examine whether the participatory or the non-participatory intervention approach is more successful in reducing the gaps between the disadvantaged and the advantaged in access to youth reproductive health services and in outcomes.
11 Kaseje D, et al. (2010). Evidence-based dialogue with communities for district health systems’ performance improvement Kenya:
6 districts in Nyanza Province: Nyando, Siaya, Kisumu, Rachuonyo, Suba, Bondo (urban & rural)
P&I, QI 2005–2007 Stakeholder committees, facilitation of dialogue, community based monitoring Collaborate An evidence-based dialogue model was introduced to community members, district health management teams, and service providers through a series of three, three-day workshops. The intervention package included the development of committees at the village, community and health facility levels; identify, train and deploy Community Health Extension Workers (CHEWs) as facilitators of dialogue at the community level, supporters of CHWs, and maintainers of a community-based information system; identify and train CHWs to support households in health improvement activities, maintain village register and facilitate dialogue at household level; establishment of village registers of all households; improvement and timeliness of analysis, dissemination and utilization of health management information system data; analyze suggestions collected from suggestion boxes on a monthly basis; and, hold dialogue sessions based on data from the community and health facilities every month at household and community levels and every four months at health facility and sub-district levels. In dialogue sessions, data were displayed, discussed and consensus was built on what was acceptable and what needed to be improved.
12 Bjorkman M, and Svensson J (2009). Power to the People: Evidence from a randomized field experiment on community-based monitoring in Uganda Uganda: 50 communities from 9 districts in all four regions of Uganda (rural) P&I, QI 2004–2006 Community-based monitoring Collaborate (most villages),
Shared Leadership (some villages)
With the aim to strengthen providers’ accountability to citizen-clients an NGO-facilitated approach was implemented. First community members were presented with baseline information (a “report card”) which was a summary of information gathered from both community members and service providers as well as data collected from service registers to reflect the status of health service delivery relative to other providers and the government standards. During community meetings community members developed a shared view on how to improve service delivery and monitor the providers. A facility meeting was held with health facility staff to present the results of the household survey and contrast the results to the results of the information provided by services providers. An interface meeting between community representatives elected at the earlier community meeting and health service providers discussed proposed suggestions for improvement and came to agreement on an action plan and a plan for how the community would monitor progress. After six months, health facility staff and community members jointly assessed and analyzed progress.
13 Sinha D (2008). Empowering communities to make pregnancy safer: an intervention in rural Andrha Pradesh. India: Mominpet in Rangareddy District in Andhra Pradesh (rural) QI 2004–2006 Community mobilizing and community based monitoring Shared Leadership (some villages) Community organizers raised awareness of village councils and youth organizations about the powerful role they could play in ensuring that public health facilities provide the services they are required to deliver and instructed them on how to use a monitoring tool to compare actual performance with expected service delivery. Village councils then held regular monthly meetings to which they invited representatives of local organizations, youth groups, schools, mother’s committees, and community level health workers. Participants in the meetings reviewed service performance, health data and service utilization statistics, identified problems and worked to solve them. When solutions did not work, they initiated action with higher authorities. Meetings were also held at the lower levels. Youth leaders, initially young men but later joined by young women, organized meetings in the villages to raise awareness of young people to hold providers accountable for good service. Eventually, the young people formed a “Youth Committee for Right to Health” that met monthly.
14 Gabrysch S, et al. (2009). Cultural adaptation of birthing services in rural Ayacucho, Peru. Peru: All 17 villages in the Santillana district, Ayacucho region (rural) QI 1997–2001 Facilitation of dialogue Consult, Collaborate Program cycle approach to engaging pregnant women and health providers in the development of maternity services that met both service provider and community expectations for quality care. Phase 1: detailed formative research by project team to understand perceptions and practices related to reproductive health and health services. Phase 2: 3 facilitated meetings of pregnant women, TBAs, CHWs and health providers to design a birthing service that was ` to all parties. Phase 3: Implementation of newly designed birthing service through capacity building workshops for health providers and TBAs to teach each other; sharing of evidence-based practices; informing of the population about the new service. Phase 4: Project evaluation followed by minor adaptation to the model. Phase 5: Routine monitoring and assessment of sustainability until 2007.
15 Barbey A, et al. (2001). Dinajpur SafeMother Initiative Final Evaluation Report
(see also Hossain & Ross, 2006)
Bangladesh: Dinajpur & Panchagarh in northwestern Bangladesh (rural) QI 1998–2001 Stakeholder committees and community based monitoring Involve This study reports on an evaluation of the Dinajpur Safe motherhood Initiative (DSI) to examine and validate the achievements, and explain the attribution of the specific project interventions. The DSI had the primary aim of testing the impact of a defined package of interventions. Facility interventions included facility upgrades to provide basic Emergency Obstetric Care (EmOC) and improvements of quality of care through the creation of Stakeholder Committees, with representation of health providers and 11 community members (leaders, active TBAs, CBOs) to build rapport between the community and the health care system and through the enhancement of health service provider capacity. The stakeholder committee met regularly and monitored service cleanliness and client perceptions of services, as well as reviewed maternal death or near-miss cases. Community interventions included: birth planning education through home visits and group discussions at clinic and village meetings by SBAs, fieldworkers and village doctors who were trained to disseminate BP messages that were also incorporated into a variety of visual aids; the establishment of Community Support System (CmSS) including emergency funds for EmOC, emergency transportation for referral to another health facility, identification of volunteers to accompany women to facilities or to provide financial support and a list of volunteers who are available to donate blood in case of emergency. DSI specifically aimed to ensure quality services for all women subjected to violence, particular during pregnancy.
16 Hossain & Ross (2006). The effect of addressing demand as well as supply of emergency obstetric care in Dinajpur, Bangladesh
(see, also Barbey et al., 2001)
Bangladesh: Dinajpur & Panchagarh in northwestern Bangladesh (rural) QI 1998–2001 Stakeholder committees and community based monitoring Involve This study reports on the impact of the Dinjpur Safe motherhood Initiative (DSI) as reported by Barbey (2001) on utilization of EmOC services.
  1. aCP – Community Participation in P&I (Programme planning and implementation), QI (Quality Improvement) and/or MDSR (Maternal Death Surveillance and Response)