Developing guidelines to promote community participation and local accountability for pregnant women’s access to basic antenatal care in Mpumalanga Province South Africa

English: The study sought to collect empirical evidence on local perceptions, needs, views on and experiences of antenatal care services, community participation and local accountability for health in Bushbuckridge sub-District, Mpumalanga Province with a view of promoting basic antenatal care. The sub-District is located in Ehlanzeni District which one of the districts in the country with the highest institutional maternal mortality rate. The aim of the study was to develop guidelines to enhance community participation and local accountability for health by exploring ways to involve the community in basic antenatal care to increase antenatal uptake. This would contribute to reduction of maternal mortality and morbidity in the area. It was an exploratory qualitative study to explore and describe the perceptions, experiences and needs in promoting community participation and local accountability for pregnant women to access basic antenatal care in the area. The study was conducted in two phases where purposive sampling was used to select the participants. In phase 1 data was collected through focus group discussions and face-to-face indepth individual interviews. The participants were pregnant women, community leaders, members of governance structures and midwives. Data was analysed, category scheme developed and coded resulting into eleven themes. The findings showed perceived barriers which prevented pregnant women to attend antenatal care services. The barriers were related to health systems, socio-demographic factors, cultural beliefs and myths, and pregnant women's unmet financial, physical, psychosocial needs. The governance structures were perceived to be functional and informally accountable to the community. The identified perceived needs were: community involvement and participation in promoting antenatal care attendance; training of the identified stakeholders to be involved in health promotion activities to strengthen their knowledge and skills; collaboration of the facility staff and the community in identifying local health problems affecting their community and seeking health care solutions. The eleven identified themes were integrated with Comprehensive Community and Home-based Health Care CCHBHC model in the context of the relevant literature. The process resulted into a modified conceptual framework of the CCHBHC model which served as the basis for, and provided guidance towards formulation and development of the preliminary guidelines by the researcher. The objective for phase 2 was to develop guidelines that could promote community participation and local accountability for pregnant women’s access to basic antenatal care. The set of preliminary guidelines were further developed and refined into the final guidelines by involving experts using the Delphi technique which completed the process of guideline development. Implementing the developed guidelines could contribute in promoting community participation and local accountability for pregnant women’s access to basic antenatal care in Bushbuckridge sub-District. A set of recommendations was developed for the Department of Health, policy makers, nursing education and practice and the community as role players in the study. Sepedi: Dinyakišišo di be di nyaka go kgoboketša bohlatse bja diphihlelelo ka ga ditemogo tša selegae, dinyakwa, dipono ka le maitemogelo a ditirelo tša tlhokomelo ya pele ga pelego, go kgatha tema ga setšhaba le boikarabelo bja selegae bja maphelo ka Seleteng sa ka fasana sa Bushbuckridge, Profenseng ya Mpumalanga ka nepo ya go tšwetša pele tlhokomelo ya motheo ya pele ga pelego. Selete sa ka fasana se Seleteng sa Ehlanzeni seo e lego se sengwe sa dilete ka nageng seo se nago le kelo ya godimo ya mahu a bomma bao ba imilego dihlongweng. Maikemišetšo a dinyakišišo tše e be e le go hlama ditlhahli tša go godiša go kgatha tema ga setšhaba le maikarabelo a selegae a maphelo ka go hlohlomiša mekgwa ya go akaretša setšhaba tlhokomelong ya motheo ya pele ga pelego go oketša go amogelwa ga pele ga pelego. Se se be se tla tsenya letsogo go fokotšeng ga mahu a bomma bao ba imilego le kelo ya malwetši tikologong. E be e le dinyakišišo tša boleng tša go nyakišiša go hlohlomiša le go hlaloša ditemogo, maitemogelo le dinyakwa ka go tšwetša pele go kgatha tema ga setšhaba le maikarabelo a selegae go basadi ba baimana go fihlelela tlhokomelo ya motheo ya pele ga pelego ka lefelong leo. Dinyakišišo di dirilwe ka dikgato tše pedi moo go šomišitšwego go dira sampole ka nepo go kgetha bakgathatema. Mo kgatong ya 1 datha e kgobokeditšwe ka dipoledišano tša sehlopha sa nepo le dipoledišano tša motho ka o tee ka o tee tše di tseneletšego tša go lebana ka mahlo. Bakgathatema e be e le basadi ba baimana, baetapele ba setšhaba, maloko a dibopego tša taolo le babelegiši. Datha e ile ya sekasekwa, peakanyo ya magoro ya hlabollwa le go khoutiwa gomme ya feleletša ka dihlogotaba tše lesometee. Diphihlelelo di bontšhitše mapheko ao a lemogwago ao a thibelago basadi ba baimana go tsenela ditirelo tša tlhokomelo ya pele ga pelego. Mapheko a be a amana le ditshepedišo tša maphelo, mabaka a leago le palo ya batho, ditumelo tša setšo le dinonwane, le dinyakwa tša basadi ba baimana tšeo di sa fihlelelwago tša ditšhelete, mmeleng, tša monagano le tša leago. Dibopego tša taolo di be di lebelelwa e le tšeo di šomago le tšeo di ikarabelago ka tsela yeo e sego ya semmušo go setšhaba. Dinyakwa tše di lemogilwego e be e le: go kgatha tema ga setšhaba le go tšea karolo go tšwetša pele go ba gona ga tlhokomelo ya pele ga pelego; tlhahlo ya bakgathatema bao ba lemogilwego go kgatha tema medirong ya tšwetšopele ya maphelo go maatlafatša tsebo le mabokgoni a bona; tirišano ya bašomi ba lefelo le setšhaba go šupa mathata a maphelo a selegae ao a amago setšhaba sa bona le go nyaka ditharollo tša tlhokomelo ya maphelo. Mrero ye lesometee ye e lemogilwego e kopantšwe le motlolo wa CCHBHC wa Tlhokomelo ya Maphelo ye e Akaretšago ya Setšhaba le ye e theilwego ka Gae ka gare ga maemo a dingwalo tše di lebanego. Tshepedišo e feleleditše ka tlhako ya kgopolo ye e fetotšwego ya motlolo wa CCHBHC yeo e šomilego bjalo ka motheo wa, gomme ya fa tlhahli go ya go tlhamo le tlhabollo ya ditlhahli tša mathomo ke monyakišiši. Maikemišetšo a kgato ya 2 e be e le go tšweletša ditlhahli tšeo di ka tšwetšago pele go tšea karolo ga setšhaba le boikarabelo bja selegae bja phihlelelo ya basadi ba baimana go tlhokomelo ya motheo ya pele ga pelego. Sete ya ditlhahli tša mathomo e ile ya tšweletšwa gape le go kaonafatšwa go ba ditlhahli tša mafelelo ka go akaretša ditsebi tšeo di šomišago thekniki ya Delphi yeo e phethilego tshepedišo ya tlhabollo ya ditlhahli. Go phethagatša ditlhahli tše di hlamilwego go ka tsenya letsogo go tšwetša pele go kgatha tema ga setšhaba le maikarabelo a selegae a phihlelelo ya basadi ba baimana go tlhokomelo ya motheo ya pele ga pelego ka Seleteng se senyenyane sa Bushbuckridge. Lenaneo la ditigelo le ile la tšweletšwa go ya ka Kgoro ya Maphelo, bahlami ba dipholisi, thuto le tiro ya booki le setšhaba bjalo ka bakgathatena dinyakišišong tše. Afrikaans: Die studie het gepoog om empiriese bewyse in te samel oor plaaslike persepsies, behoeftes, sienings oor en ervarings van voorgeboortesorgdienste, gemeenskapsdeelname en plaaslike aanspreeklikheid vir gesondheid in die Bosbokrant- plaaslike munisipaliteit, Mpumalanga, met die oog op die bevordering van basiese voorgeboortesorg. Dié plaaslike munisipaliteit val binne die Ehlanzeni-distrik, een van die distrikte in die land met die hoogste institusionele moedersterftesyfer. Die doel van die studie was om riglyne te ontwikkel om gemeenskapsdeelname en plaaslike verantwoordelikheid vir gesondheid te verbeter deur maniere te ondersoek om die gemeenskap by basiese voorgeboortesorg te betrek om só voorgeboortelike opname te verhoog. Dit sal daartoe bydra om moedersterftes en morbiditeit in die gebied te verminder. Hierdie was ’n verkennende kwalitatiewe studie om die persepsies, ervarings en behoeftes in die bevordering van gemeenskapsdeelname en plaaslike aanspreeklikheid vir swanger vroue om toegang tot basiese voorgeboortesorg in die gebied te verkry, te ondersoek en te beskryf. Die studie is in twee fases uitgevoer, waarin doelgerigte steekproefneming gebruik is om die deelnemers te kies. In Fase 1 is data ingesamel by wyse van fokusgroepbesprekings en diepgaande onderhoude wat individueel en van aangesig tot aangesig gevoer is. Die deelnemers was swanger vroue, gemeenskapsleiers, lede van bestuurstrukture, en vroedvroue. Data is ontleed, 'n kategorieskema is ontwikkel en gekodeer wat tot elf temas gelei het. Die bevindinge het vermeende hindernisse getoon wat swanger vroue verhinder het om van voorgeboortelikesorgdienste gebruik te maak. Die hindernisse het verband gehou met gesondheidstelsels, sosio-demografiese faktore, kulturele oortuigings en mites, en swanger vroue se onvervulde finansiële, fisieke en psigososiale behoeftes. Die bestuurstrukture is as funksioneel en informeel verantwoordbaar teenoor die gemeenskap beskou. Die geïdentifiseerde waargenome behoeftes was: gemeenskapsbetrokkenheid en deelname aan die bevordering van voorgeboortesorgbywoning; opleiding van die geïdentifiseerde belanghebbendes om betrokke te wees by gesondheidsbevorderingsaktiwiteite om hul kennis en vaardighede te versterk; samewerking tussen die fasiliteit se personeel en die gemeenskap om plaaslike gesondheidsprobleme wat hul gemeenskap raak, te identifiseer en na gesondheidsorgoplossings te soek. Die elf geïdentifiseerde temas is binne die konteks van die relevante literatuur met die model vir omvattende gemeenskaps- en tuisgebaseerde gesondheidsorg (OGTGG-model) geïntegreer. Die proses het gelei tot ’n gewysigde konseptuele raamwerk van die OGTGG-model, wat as basis gedien het en rigtinggewend was in die navorser se formulering en ontwikkeling van die voorlopige riglyne. Die doelwit vir Fase 2 was om riglyne te ontwikkel wat gemeenskapsdeelname en plaaslike aanspreeklikheid vir swanger vroue se toegang tot basiese voorgeboortesorg kon bevorder. Die stel voorlopige riglyne is verder ontwikkel en tot finale riglyne verfyn deur kundiges te betrek wat die Delphi-tegniek gebruik het, wat die proses van riglynontwikkeling afgehandel het. Die implementering van die ontwikkelde riglyne kan bydra tot die bevordering van gemeenskapsdeelname en plaaslike aanspreeklikheid vir swanger vroue se toegang tot basiese voorgeboortesorg in die Bosbokrant- plaaslike munisipaliteit. ’n Stel aanbevelings is ontwikkel vir die Departement van Gesondheid, beleidmakers, verpleegonderwys en -praktyk, en die gemeenskap as rolspelers in die studie. IsiZulu: Ucwaningo lwalufuna ukuqoqa ubufakazi obuphathelene nemibono yendawo, izidingo, ukubukwa kanye nokwenzeke empilweni kwezinsiza zokunakekelwa kwangaphambi kokubeletha, ukubamba iqhaza komphakathi kanye nokulandisa kwendawo ngempilo eSifundazweni esingaphansi kwe-Bushbuckridge, esifundazweni saseMpumalanga ngombono wokukhuthaza ukunakekelwa okuyisisekelo kwangaphambi kokubeletha. Isifunda esincane siseSifundeni sasEhlanzeni esinye sezifunda ezweni esinezinga eliphakeme kakhulu lokushona komama. Inhloso yalolu cwaningo kwakuwukusungula imihlahlandlela yokuthuthukisa ukubamba iqhaza komphakathi nokuziphendulela kwezempilo endaweni ngokuhlola izindlela zokubandakanya umphakathi ekunakekelweni kwangaphambi kokubeletha okuyisisekelo ukuze kwandiswe ukuthathwa kwangaphambi kokubeletha. Lokhu kuzoba nomthelela ekunciphiseni ukushona komama kanye nokushona kwabantu endaweni. Kwakuwucwaningo lokuhlola izinga lokuhlola nokuchaza imibono, okuhlangenwe nakho nezidingo ekukhuthazeni ukubamba iqhaza komphakathi kanye nokulandisa kwasendaweni kwabesifazane abakhulelwe ukuthola ukunakekelwa okuyisisekelo kwangaphambi kokubeletha endaweni. Ucwaningo lwenziwe ngezigaba ezimbili lapho amasampula enhloso asetshenziselwa ukukhetha ababambiqhaza. Esigabeni 1 idatha yaqoqwa ngezingxoxo zamaqembu okugxilwe kuwo kanye nezingxoxo ezijulile zomuntu ngamunye. Ababambiqhaza babengabesifazane abakhulelwe, abaholi bomphakathi, amalungu ezinhlaka zokubusa kanye nababelethisi. Idatha yahlaziywa, uhlelo lwesigaba lwasungulwa futhi lwafakwa ikhodi ngenxa yalokho lwaba yizihloko eziyishumi nanye. Okutholakele kubonise izithiyo ezibonakala zivimbela abesifazane abakhulelwe ukuthi bahambele izinsiza zokunakekelwa kwangaphambi kokubeletha. Izithiyo zazihlobene nezinhlelo zezempilo, izici zenhlalo yabantu, izinkolelo zamasiko nezinkoleloze, kanye nezidingo zabesifazane abakhulelwe okungahlabezwana nazo ngokuphathelene nezezimali, ngokomzimba, nangokwengqondo. Izinhlaka zokubusa zazibhekwa njengezisebenzayo futhi ziziphendulela ngokwethukela emphakathini. Izidingo ezikhonjiwe yilezi: ukubandakanyeka komphakathi nokubamba iqhaza ekukhuthazeni ukuba khona kokunakekelwa kwangaphambi kokubeletha; ukuqeqeshwa kwababambiqhaza abakhonjiwe ukuthi babandakanyeke emisebenzini yokukhuthazela impilo ukuze baqinise ulwazi kanye namakhono abo; ukubambisana kwabasebenzi besikhungo nomphakathi ekutholeni izinkinga zempilo zendawo ezithinta umphakathi wabo futhi bafune izixazululo zokunakekelwa kwezempilo. Izihloko eziyishumi nanye ezikhonjiwe zahlanganiswa nemodeli ye-Comprehensive Community ne-Home-based Health Care CCHBHC esimweni sokubhaliwe okufanele. Inqubo yaphumela ohlakeni lomqondo olushintshiwe lwemodeli ye-CCHBHC eyasebenza njengesisekelo, futhi yanikeza isiqondiso ekwakhiweni kanye nasekuthuthukisweni kwemihlahlandlela yokuqala ngumcwaningi. Inhloso yesigaba 2 yayiwukuthuthukisa imihlahlandlela engakhuthazela ukubamba iqhaza komphakathi nokulandisa kwasendaweni ngokufinyelela kwabesifazane abakhulelwe ekunakekelweni okuyisisekelo kwangaphambi kokubeletha esifundazweni saseMpumalanga eNigizimu Afrika Iqoqo leziqondiso zokuqala lakhiwa futhi lacwengisiswa eziqondisweni zokugcina ngokubandakanya ochwepheshe abasebenzisa inqubo ye-Delphi eyaqeda inqubo yokuthuthukiswa kweziqondiso. Ukuqaliswa kwemihlahlandlela ethuthukisiwe engakhuthazela ukubamba iqhaza komphakathi nokulandisa kwasendaweni ngokufinyelela kwabesifazane abakhulelwe ekunakekelweni okuyisisekelo kwangaphambi kokubeletha esifundazweni esingaphansi Kwesifundazwe saseBushbuckridge. Kusungulwe iqoqo lokwenza izincomo loMnyango Wezempilo, abenzi bezinqubomgomo, imfundo nokusebenza kwabahlengikazi kanye nomphakathi njengabadlala indima kulolu cwaningo.

Grantor dc:publisher

University of Pretoria

Year dc:date.issued

2017

Advisor dc:contributor.advisor

• Peu, Mmapheko Doriccah

• UCTD

Statement dc:rights

• © 2017 University of Pretoria. All rights reserved. The copyright in this work vests in the University of Pretoria. No part of this work may be reproduced or transmitted in any form or by any means, without the prior written permission of the University of Pretoria.

Language dc:language.iso

en

Handle dc:identifier.uri

http://hdl.handle.net/2263/63042

OAI identifier oai:identifier

oai:repository.up.ac.za:2263/63042