Community Involvement to Increase Utilization of Maternal Health Services: Experiences from Rural Bangladesh

In Bangladesh, utilisation of maternal health care is low among economically poor women. This study aimed to investigate the effects of community involvement in a maternal health care financing (voucher) scheme to improve utilisation of pregnancy and delivery care - including antenatal care (ANC), delivery, and post-natal care (PNC) - from trained service providers. Community participation was ensured through a voluntary community support group (CSG) strategy.

Community members were engaged to select economically poor pregnant women, create awareness in the community through several behaviour change communication (BCC) activities, and organise regular monthly meetings for identifying barriers and possible solutions to improve the utilisation of maternity care. Meetings were found to be participatory, with male Union Council (local government) members playing critical roles. As part of one activity by CSG members, dramas were staged in the community to convey messages on importance of utilisation of maternal health care services from the health facility, family planning issues, maternal health care issues, early marriage, reproductive health, service provider and fieldworkers' activities, and the role of community members in promoting health care services. CSG members assisted in organising dramas in the community.

Periodic documentation and in-depth interviews were carried out. Baseline and endline surveys were conducted among economically poor mothers to document the effects of the intervention. Findings suggest that utilisation of antenatal, delivery, and postnatal care from trained service providers has increased significantly - in part due to the active participation of community members in the study.

Amongst the findings:

• Utilisation of ANC increased from 41 to 89%.
• Institutional delivery increased from 2.3 to 18%.
• PNC increased from 10 to 60%.

Lessons learned:

• "Motivated community leaders and/or members could be effective contributors in improving physical infrastructure of health facilities, which is fundamental for increased maternal heath utilization.
• Community leaders can provide guidance and support to the mothers to enhance utilization of services from health facilities.
• Community leader's involvement in monitoring field activities can improve utilization of maternal health care service.
• Community support group (CSG) was a viable strategy that provided community people sense of ownership."

This Population Council study was presented at a poster at the Population Association of America Annual Meeting, March 31-April 2 2011. Funding for the study was provided by the Canadian International Development Agency (CIDA) through the United Nations Population Fund (UNFPA).