Community Involvement in Cohmtltlity Health Service
Creators: name: Wakbulcho, Mathewos
Publisher: name: National Academic Digital Repository of Ethiopia
Year: 1988

description: Nine hundred households from t ~ irt y separate c ommunities were surveyed in one urban district, Ketena 5 in t he city of Addis Ababa, and one rura l ri i strict, Chebo-Gurege , to assess c ommunity involvement i n decision-making , planning and implementation of sev,"n ~; p ec ific communi ty health act i vi ties. The health activities se lectcl were recruitment and support of CHAs and TEAs, construction of a he alth post, cons truction of lat rine and refuse pits, immunization program activity and provision of safe water sunply. The s t udy c ommunities were also assessed with respect to the ava i l abi lity of community health services by l ooking at the activi t ] of CHAs and TEAs and the existence of a health post and activity of t he local health committee, while the r a te of i mmunizat ion covera2:e in the under two year olds and pregnant women was a lso determined. In all three areas of community invo l vement i.e decisionmaking, implementa tion and planning , rur a l communities scored higher than urban communities, with the exception of environmental activities where urban communities were slightly more involved than rural communities in im o le~ A nt a ti o n but not in the decision-making an~ l ' l a ~ nt n ~ asnec ts . Lower c ommunit y invo lvcr",en t i ll l~ :: h "" '1 T i!" ] S VI"" '1ssoci'Jted ": .~ J. with lower activity in t.hc .ir "nmmIlJlit~- hp.tllt-h Sf'J'\-iJ'es and in some cases almost i::\ totn.l 1;1, -,, 1;; o f s ll r h rnmlllilnit.y h ~illt. h services , \..-hereas rural C'OfJlm\ lnTt i( ' ~ hnd fl higher l e\-e ] of activity and existence o f r.nmnll!llit~,: h p. &lt;1lth sp.rvi~es . However , d "spi te a lower l evpl of r:omml1ni t,' i nvol vement and lower activity in thp. communit:: h("alt.h sp.rvir.p.~, llrh:1n communi ties had modernteb' hi«h 1e,' e [" of immunization coverage in the undpr two ;.:p.nr .r\'Jd s , S \lt!gf' stin~ t hat immunization coverage can h" ;1 ,'h i (" ' e d de&lt;;pi te th" r ,.,co rded weakness in such are as. The clns~ association of commtJnity involve me nt and activity in tlH' c nmml1nit,' h ea lth servi c es does seem to be at l east partly rp&lt;;ponsih1c for t hp relatively high levels of immuni zation covprage ohtained th e re and may indicates t.he .o:rcater" i mportnnc(' o f &lt;;11"h features in rural life. Study of the fifteen rura l comml.nities in more detail revea led gradations of CHS activity, community in vo lv emen t and immunization coverage . Comparisons of "reas o f high, mod e rate and l ow coveragf' support.ed the over,.,11 eo n c 1usions and in addition r evp.aled somf' othrr int p. rf' sti nt! f0.,'1tll!'f"s. The fact thnt. n di stnnc0. of ll'ss t hall ~ l;; TI1 ~ t Il t 1\(" n r' :! n~st conve n t.ional health unit apppnJ"~rl to p~prt A n ~unt i ,' ~ effect on thn act i vlt.~· of ("OTl1lOllllit.:,-- h (.&gt;:'l lt h ~f" t~\'i("r~" prnvrrl to be a feature of r.ural :\'''; I , P ! \ " ; \ .. . ; ' 11 · ' ( 1 1l1· 111 '~1;ti ,-' s . v i 1 L community in CHS c oulrl h~ ~ lnt0rl to thr '-sY'inti n n s in d C'mog rnphi c , snC "jo -f'c'o llcHn i ' organi za tions n oted hrtlJl;f; f) ,· tI ,.. .. r . t," f) communit.ic:s. rn rurn I communities, most of I'".h(' 1l f';\f 1'~ of' households \",; c r 0. n Jdcr , male dominated. full emp 10;· .... .1, homo.,,,, nr.ous \,,; th rpspeet to cuI t.ure and ethnici t.y ns t-:" I I as I"' "r.,, t. ne .... d of he nl th service, with strollg 0 rganiz~tinl' o f ppnsant associat i ons, produ ce r s cooperatives Rnrl \ 11 l i"l z~t iol' schemes . Urban heads of h ousehold s ""r·~. on thle o therhanrl, c harn cterized b:v :voung0r :1~'" s;n .e:lf"' m~rit ;:d status , marC' f emn l (~ h ends, I'01nt:i\"0. 1:-- hi ~ h IIn r lllpl o :,--m0nt , gr0:lt. "' I~ h e t.erog eneity in et hni cit~' alld cultnrC' And l oose l ocal organization and coorrlination in he alth rlr.vel opmr.n t as well as greate r accessibility to conventional I,enlth unit.s. In both rural and urban communiti es. they still wou ld prefer external support of their hea lth sprvi ce , particularly from th e gov~rnment, ind i cati ng a npe rl for stre ngthening PHC manage me nt s nnd rnhnnc .... rl rommlllli t ;' education about the blenefits of sel f r le linnre in h .... nlth. as in other matters. In general t n ~urprising nppreci.ation and acceptance of community health workprs I'BS p~ prRss p d with the largest numbel' of complnintF h .... l n~ rlirr r t .... d t owards t he inadequate nllJT1h"I"" ( jf' th0m :l\' :l i l '1h l r- nnrl t h 0.ir inahil ity to trp :lt n h'i~( "' l " ,": 11 1'.." ()I h,"' ,'l! t! l p I'0h 1 0 nl S . l ,X