Community participation in health development in Nyandarua District, Kenya
Muriithi, Jackson Githinji
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Although community participation in health development exists III Kenya, Community perceptions and attitude towards its role in health development is unexplored. Similarly the effect of community participation on health development on health care provision is undermined and the waiver system meant to promote community participation in health development in the health care provision remains unevaluated. Hence, this study attempted to establish the existence of needs assessment, organization, leadership and resource mobilization as factors that influence community participation in health development in rural community setup in Nyandarua district. Both structured interviews and focus group discussion were used to collect data from Community Respondents, Rural Health Facility Staff and the Rural Health Facility Management Committees. In terms of knowledge, significant differences (X2 = 46.94972; P = 0.00007) on the role of community respondents in health development were found between rural health facility staff and community respondents. There were also significant differences in knowledge between age groups (X2 = 28.49994; P = 0.00150) but marital status and gender were insignificant. Significant differences were also noted in knowledge between those who attended barazas (X2 = 16.31502; p= 0.00029) and those who did not and also between those who accessed waivers and those who did not (X2 = 28.21035; P = 0.00001). Only 5.7% of the community respondents had good perception on their role in health care provision. There were significant differences (X2 = 14.10904; P = 0.00086) in perception between gender as well as baraza attendees and non-attendants (X2 = 109.69402; P = 0.0000). Almost all the Rural Health Facility Staff 94.7% had good knowledge of health care provision compared to only 5.3% who had fair knowledge. Majority of Rural Health Facility Staff interviewed 76.3% had fair perception of health care provision. Significant differences in leadership were noted between gender (X: = 9.87759; p = 0.00716), waivers (X2 = 33.45095; p = 0.0000) and education levels (X2 = 12.9204; p = 0.04432) of the community respondents. Further, significant differences (X2 = 14.38694; P = 0.00075) were found in organization between gender, baraza attendance (X2 = 35.56165; P = 0.0000) and waivers (X2 = 59.84615; P = 0.0000). There was a significant difference in resource mobilization between marital status (X2 = 6.62548; p = 0.03642) and those who accessed health service without payment (X2 = 32.59359; p = 0.0000). The overall level of community participation was fair (score 7.8) and the order of the indicator factors was leadership (score 2.2), organization (score 2.0) resource mobilization (score l.9) and needs assessment (score l.8). Since the community had gradually been involved in the work of the rural health facilities, the government should give the Rural Health Facility Management Committees legal status from which specific obligations and regulations should be laid down. In this way the community will be given the responsibility to increase their contribution to the financ ng of promotional, preventive and curative health care activities. Community participation takes place through the RHFMC, which are loosely established, in the public health organizational structures.