What is the role of community capabilities for maternal health? An exploration of community capabilities as determinants to institutional deliveries in Bangladesh, India, and Uganda

Abstract

BackgroundWhile community capabilities are recognized as important factors in developing resilient health systems and communities, appropriate metrics for these have not yet been developed. Furthermore, the role of community capabilities on access to maternal health services has been underexplored. In this paper, we summarize the development of a community capability score based on the Future Health System (FHS) project’s experience in Bangladesh, India, and Uganda, and, examine the role of community capabilities as determinants of institutional delivery in these three contexts.MethodsWe developed a community capability score using a pooled dataset containing cross-sectional household survey data from Bangladesh, India, and Uganda. Our main outcome of interest was whether the woman delivered in an institution. Our predictor variables included the community capability score, as well as a series of previously identified determinants of maternal health. We calculate both population-averaged effects (using GEE logistic regression), as well as sub-national level effects (using a mixed effects model).ResultsOur final sample for analysis included 2775 women, of which 1238 were from Bangladesh, 1199 from India, and 338 from Uganda. We found that individual-level determinants of institutional deliveries, such as maternal education, parity, and ante-natal care access were significant in our analysis and had a strong impact on a woman’s odds of delivering in an institution. We also found that, in addition to individual-level determinants, greater community capability was significantly associated with higher odds of institutional delivery. For every additional capability, the odds of institutional delivery would increase by up to almost 6 %.ConclusionIndividual-level characteristics are strong determinants of whether a woman delivered in an institution. However, we found that community capability also plays an important role, and should be taken into account when designing programs and interventions to support institutional deliveries. Consideration of individual factors and the capabilities of the communities in which people live would contribute to the vision of supporting people-centered approaches to health.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1861-0) contains supplementary material, which is available to authorized users.

Do community scorecards improve utilisation of health services in community clinics: experience from a rural area of Bangladesh

“…Studies in Afghanistan, Democratic Republic of Congo and Malawi found that CSCs have facilitated in increasing community participation and awareness, accountability of providers and utilisation of services [ 15 , 16 , 22 ]. The findings in this paper, that active community participation has a positive effect on improving community awareness and provider accountability and thus enhance utilisation of health services are also consistent with other studies [ 11 , 12 ] in the study area. Findings from the study regarding service utilisation rate in intervention and control CCs at baseline are consistent with findings from a study on assessment of CCs supported by the World Health Organisation [ 23 ].…”

“…Community engagement in the management of healthcare delivery and local level planning has been seen as a successful strategy to improve health service delivery and increase utilisation [ 10 , 11 ]. Strong cohesion of community and social network have also helped to improve healthcare delivery and utilisation of health services in similar settings [ 12 , 13 ]. Social accountability approaches such as citizen report cards, village health committees and community score cards (CSC) have helped in increasing accountability in health facility monitoring [ 14 ].…”

“Midwives do not appreciate pregnant women who come to the maternity with torn and dirty clothing”: institutional delivery and postnatal care in Torit County, South Sudan: a mixed method study

“…The way women and their families perceive the benefit and/or the need for an institutional delivery with skilled attendance influences their decision-making process to seek skilled care for either a routine delivery or a complication during delivery. This perception is in turn influenced by their general awareness of the risks of labor and delivery and their capabilities, in terms of material resources, to access health care [7]. The strong correlation between health institution delivery and mother's education and wealth quintile has also been well documented in the literature on Sub-Saharan Africa [8].…”

“…A sample size of 383 was calculated for a 95% confidence level, using OpenEpi version 3 for sample size calculation for the proportion of women who deliver in the facilities assuming a hypothesized facility delivery rate for South Sudan of 21% [7] and design effect (for cluster surveys) of 1.5, and allowing 10% for missing data.…”

Social Capital: Higher Resilience in Slums in the Lagos Metropolis

“…Furthermore, we study social capital as an asset that a slum community can employ to encourage higher resilience, i.e., to maintain their current location. Social capital in this study is seen as a form of collective community capability, which is defined as an asset that is available to a community for achieving their goals [66]. The extent to which a community can mitigate a risk is based on its capability [44].…”