Community mobilization and maternal Care of Women Living with HIV in poor settings: the case of Mfuwe, Zambia

Abstract

BackgroundResearch has shown that community mobilization is a useful strategy in promoting maternal care of HIV negative women in resource poor settings; however, similar evidence for women living with HIV is missing. Therefore, in this study we provide this evidence by exploring the relevance of community mobilization in the promotion of maternal health care among women living with HIV in resource-poor settings by using Mfuwe, a rural district in Zambia as a case study.MethodsBy relying on Focus Group Discussions (FGDs), qualitative data were collected from Mfuwe, Zambia. The data were digitally recorded, transcribed and later translated from CheChewa (local language) to English. We relied on Thematic analysis to analyze the data.ResultsBy focusing on community mobilization, our results showed that within their social fabrics, resource-poor communities often contain unrecognized and sometimes ignored strategies which are contextually-feasible and have been used for generations to promote maternal care for HIV positive women. Further, it was evident that although the three forms of community mobilization were largely and uniquely useful in promoting maternal health care of women living with HIV, they also presented unique and various shortcomings.ConclusionWe demonstrated that community mobilization was largely and often characterized as a force for good (e.g. providing support, improving access to maternal care etc.) and sometimes for bad (e.g. reinforced harmful misconceptions, superstition and stigma). Thus we recommend that community mobilization needs to be factored into maternal health care policies for HIV positive women in resource poor settings either to optimize their potential benefits or to minimize their potential harm.

Local people’s views on the evidence-based skilled-maternal-care in Mfuwe, Zambia: a qualitative study

“…This is because in this way, TBAs cannot be monitored, regulated nor given further training. This may have worsened the quality of services offered by TBAs much to the detriment of local women [6, 10]. This observation is in line with what other scholars have continued to show elsewhere within SSA [15–19].…”

“…Out of necessity, women continued to covertly utilize them as they were the only feasible option. Our respondents including other studies from Mfuwe [10, 14] confirm that despite the ban, women continue to utilize services of TBAs out of necessity. TBAs continue to operate illegally making any possibilities of improving their potential benefits and minimizing their limitations impossible.…”

“…While it is true that skilled-care care was useful in handling complications, it however remained inaccessible to several women in Mfuwe [10, 14]. This means that there were several women who were unable to enjoy the benefits of this approach.…”

“…There exits only one hospital in Mfuwe (Kamoto hospital) catering for a population of over 207,000 people spread roughly around an arear of 370 km 2 . The settlement retains high HIV rates, including very high maternal and under five mortality rates in the country [5, 10]. It is for this reason that Mfuwe was selected as a case study.…”

“This conflict has turned me into a Doctor, Nurse and Nutritionist at the same time”: how peer support among HIV-positive IDPs created opportunities for care in conflict-stricken Kabaré, Congo DR

“…Further, the HIV response has mainly focused on formal responses with little focus on the role played by community support systems despite them being the most widely used by people on the ground given the weak health system in conflict regions [ 5 , 6 ]. In particular, indigenous social relations that help promote opportunities for care and support among internally displaced people (IDPs) with HIV [ 7 , 8 ]. Research has shown that in SSA, formal interventions only carry a small proportion of the burden; the bulk of the burden is carried by the communities in which the HIV-infected live their daily lives [ 9 , 10 ].…”