Sustainability and Factors Affecting the Success of Community-Based Reproductive Health Programs in Rural North West Ethiopia

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Addis Abeba Universty


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] viii 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.



Sustainability and Factors Affecting the Success of Community-Based