Sustainability and Factors Affecting the Success of Community-Based Reproductive Health Programs in Rural North West Ethiopia
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Date
2002-06
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Addis Abeba Universty
Abstract
A comparative cross sectional study was carried out in February 2002 among women of reproductive
age group in rural South Gondar zone to assess the factors affecting the success and sustainability of a
Community based reproductive health program. The study was conducted in eight peasant associations
of the zone taking successful and weak/failed program areas for comparison of various characteristics.
Both quantitative and qualitative methods were used for data collection. The qualitative method
included key informants interview, and Focus Group Discussions with functional and non-functional
(drop out) Community-based reproductive health agents (CBRHAs). A multistage sampling technique
was employed to select 792 study subjects for the quantitative part.
The results indicated that about 92% of respondents know at least one Modern Contraceptive Methods
(MCM) in successful as compared to 83% in weak program areas. The difference was statistically
significant [OR(95% CI) = 2.35 (1.47, 3.8)]. The proportions of women who were using MCM
(14.65% & 4.55%) & attended antenatal care service at least once (17.4% & 10.8% ) were found to be
significantly higher in Successful than weak program areas respectively [OR(95%CI) =
1.74(1.10,2.76) respectively]. Large proportions of the respondents (94%) are aware of HIV/AIDS but
detail knowledge of transmission routes (mean score = 1.2/4) and prevention methods (1.9/4) were
found to be low.
Awareness to the presence of the CBRHA in the locality (61.1% & 40.4%), Participation in
selection of the agent (4.8% & 1.5%), Acceptance of the agent (90.4% & 59.4%), ever talk to
CBRHA about Family Planning or reproductive health (29.8% & 7.8%), Knowledge of a
functional village health committee (56.8% & 21.2%) in the locality were significantly higher
in successful than in weak program areas respectively. [OR(95%CI) = 2.32(1.74,3.08),
3.28(1.22,9.27), 6.65(3.59,12.43), 5.05(3.22,7.96), and 5.66(3.97,8.09) respectively]
On multivariate analysis acceptance of the CBRHAs, level of willingness to work as CBRHA, and
satisfaction by the CBRH service were significantly associated with CBRH service use [OR(95%CI) =
1.62 (1.75,3.48), 2.79(1.66,4.67), and 3.4(1.71,6.73) respectively]
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In general, community involvement in selection of the volunteers, acceptance of the CBRHAs,
interpesonal communication by the agents, satisfaction by the service and level of support to the
agents are found to be the major factors affecting the CBRHP. Therefore, program managers and
coordinators are advised to improve the level of community participation & the overall support
provided to the program in order to enhance the success & sustained delivery of quality & integrated
reproductive health services to the community.
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Keywords
Sustainability and Factors Affecting the Success of Community-Based