Community involvement is one way to help schools produce a more capable workforce. Jobs in the 21st century operate in an increasingly complicated environment and require a workforce that is competent beyond the basic skill level.
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School—community partnerships, specifically those that involve relationships with businesses, business leaders, managers, and other personnel, are uniquely equipped to assist schools with the preparation of students for the changing workplace. Berg, A. Community and family engagement: Principals share what works.
Adelman, H. Fostering school, family, and community involvement. Includes chapters on aspirations and expectations, self-efficacy, homework and study habits, engaging families in reading, reading and literacy, college and career readiness, partnerships, and more. Includes materials to create a community event using promising bullying response strategies.
Contains resources to conduct an assessment before the event, a sample template agenda for the day of the event, and follow up steps.
Community capacities and resources must be harnessed to complement supply side initiatives addressing high maternal and neonatal mortality rates in Uganda. This paper reflects on gains, challenges and lessons learnt from working with communities to improve maternal and newborn health in rural Uganda. A participatory action research project was supported from to in three eastern districts. This project involved working with households, saving groups, sub county and district leaders, transporters and village health teams in diagnosing causes of maternal and neonatal mortality and morbidity, developing action plans to address these issues, taking action and learning from action in a cyclical manner.
This paper draws from project experience and documentation, as well as thematic analysis of 20 interviews with community and district stakeholders and 12 focus group discussions with women who had recently delivered and men whose wives had recently delivered. Women and men reported increased awareness about birth preparedness, improved newborn care practices and more male involvement in maternal and newborn health.
However, additional direct communication strategies were required to reach more men beyond the minority who attended community dialogues and home visits. Saving groups and other saving modalities were strengthened, with money saved used to meet transport costs, purchase other items needed for birth and other routine household needs.
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However saving groups required significant support to improve income generation, management and trust among members. Although village health teams were a key resource for providing information, their efforts were constrained by low levels of education, inadequate financial compensation and transportation challenges. Ensuring that the village health teams and savings groups functioned required regular supervision, review meetings and payment for supervisors to visit. This participatory program, which focused on building the capacity of community stakeholders, was able to improve local awareness of maternal and newborn health practices and instigate local action to improve access to healthcare.
Collaborative problem solving among diverse stakeholders, continuous support and a participatory approach that allowed flexibility were essential project characteristics that enabled overcoming of challenges faced. Critical resources such as qualified health workers, drugs, equipment and supplies are needed to improve the delivery of quality health services.
Community capacities and resources must also be harnessed to support maternal and neonatal health, which is the focus of this paper. The Alma Ata declaration emphasised the importance of community participation in the planning, organization, operation and control of primary health care services [ 2 ]. Community participation and empowerment can improve access to health services and health service outcomes [ 3 ], however the literature also shows significant variations regarding the interventions implemented, the nature of the communities involved and inputs provided and how participation is defined [ 4 ], with implications for effectiveness [ 5 ].
When community participation is minimal and focused only on raising awareness of health issues, this may not necessarily improve access to skilled care services [ 6 , 7 ]. Factors that can facilitate increased community participation include pre-existing intrinsic motivation among individuals in the community, community-level trust, strong external linkages, and supportive institutional processes such as decentralization reforms and engagement with social movements [ 4 ]. Conversely, community participation can be hindered by a lack of training, interest and information, along with weak financial sustainability and low community accountability [ 4 ].
Rassekh and Segeran [ 8 ] found that the most successful community engagement strategies were those that provide feedback through sharing results with communities; foster local adaptive learning; harness community resources and promote equity. These processes and factors when brought together strengthen community capability. We followed a participatory action research approach [ 10 ], which emphasises community participation in the collaborative identification and resolution of community problems, as a key way of strengthening community capability, program relevance and effectiveness.
While not comprehensively covering all domains of community capability [ 11 ], this paper provides insights into the gains realized, challenges faced and lessons learnt in supporting community efforts to improve maternal and newborn health. Our work is situated in rural eastern Uganda, with a total estimated population of 1,,, consisting of Kamuli district population , , Pallisa district , , and Kibuku district , Kibuku was carved out of Pallisa in and the two districts share similar economic activities, mainly crop farming and animal husbandry.
Kamuli has more diverse economic activities, which include crop farming, animal husbandry, ranching, fishing, fish farming, bee keeping, quarrying and retail trading. The main goal of the project was to improve maternal and newborn health by increasing community awareness, action and access to maternal and neonatal health MNH services.
District stakeholders involved actors at the community, parish, sub-county, and district levels. The MAKSPH team comprised of a multidisciplinary group of researchers and specialists including health systems experts, obstetricians, paediatricians, statisticians, sociologists and micro finance specialists. PAR involves diagnosing a problem, planning action to address the problem, taking action and learning from this action in a cyclical manner.
These stages are detailed in the sections that follow. It is important to include all stakeholders especially the end users, i. We conducted a series of consultation workshops and focus group discussions with community members to identify problems that women face when seeking maternal health services and to identify feasible solutions to these problems. These discussions were held along three main themes: quality of maternal health services, birth preparedness and transport for maternal health. The findings from these consultations were used to develop key components of the interventions implemented.
Following the design stage, implementation manuals and training materials were developed by MAKSPH and district based staff. These manuals and training materials were designed to be used by different implementing actors while conducting community dialogues, home visits and radio talk shows and while managing saving groups. The project strengthened the capability of community stakeholders through community mobilization and supportive mechanisms Fig. Community mobilization involved improving awareness about maternal and newborn health and improving maternal and newborn health practices in the home, specifically promoting birth preparedness; appropriate home care for pregnant women and newborns, and supportive male involvement.
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Awareness was raised through VHT home visits, community dialogues, talk shows, and radio spots. The radio sports covered a wide range of topics including: the importance of attending antenatal care, delivering in a facility, and receiving postnatal care; encouraging male involvement in maternal health; birth preparedness; the benefits of saving money to enable healthcare spending during pregnancy, childbirth and the neonatal period; and newborn danger signs, referral and caring for newborns.
The radio spots and messages, developed in conjunction with the district health educator based on feedback from the design phase, were aired on local radio stations in respective local languages.
The spots were run daily and the talk shows were conducted on a monthly basis. The talk shows were delivered by the district health officials and political leaders. Concurrently, support was provided for community development officers public servants responsible for community development work including providing support to saving groups and VHTs community health workers. This support consisted of skills based training on how to assist saving groups in improving their management, their abilities to generate income and their link with local transport providers.
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In addition, quarterly supportive supervision of VHTs and quarterly review meetings at both sub county and district levels were supported to both build capacity and strengthen local accountability. As shown in Table 2 , during these meetings government actors VHTs, community development officers, health assistants, sub county and district managers were asked by local stakeholders politicians, religious representatives, development partners, and local council leaders to explain cases of poor service delivery in their respective areas.
The government actors were informed about these cases through their community activities such as home visits and community dialogues.
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Solutions to these problems were then discussed and agreed upon. The MAKSPH research team and the district teams documented these meetings, noting issues discussed, achievements and challenges. General findings and learning events from the project were identified and documented on an ongoing basis. This included how planned activities were carried out, challenges experienced, how these challenges were resolved, and whether the objectives of the meetings or activities were met. The implementation of the program was undertaken in a phased manner to ensure learning from the roll out of the program.
There was engagement with stakeholders at all levels to share experiences and lessons learned during the action cycle. This continuous assessment helped to inform decisions to improve outcomes of the programme and to increase chances for sustaining the initiatives. Stakeholders identified problems and suggested solutions; the program was then adjusted based on these suggestions. All study procedures were documented, as well as any deviations or changes that were made, in addition to any intended and unintended positive and negative consequences and steps taken to mitigate negative consequences.
Twenty KIIs were carried out across the three districts with members of the sub county implementation committee who were involved in the implementation of the project at the beginning of the study and at the end of it, e. KIIs were also conducted with community leaders who were mainly involved in community mobilisation, such as local council chairmen and VHTs. In addition, KIIs were done with members of the district health team who took the lead in overseeing implementation. Written informed consent was sought from the key informants before conducting the interviews.
Furthermore, 12 FGDs across the three districts were carried out at the beginning and end of the project.
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