Joanna Paula Cordero,^1,* Petrus S. Steyn,¹ Peter Gichangi,^2,3 Yolandie Kriel,⁴ Cecilia Milford,⁴ Margarate Munakampe,^5,6 Irene Njau,⁷ Theresa Nkole,⁸ Adam Silumbwe,⁵ Jennifer Smit,⁴ and James Kiarie¹

Affiliations

¹UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training Human Reproduction, Avenue Appia 20, 1202 Geneva, Switzerland

²International Centre for Reproductive Health – Kenya (ICRH-K), P.O.Box 91109 – 80103, Mombasa, Kenya

³Technical University of Mombasa, Tudor, Tom Mboya Street, P.O. Box 90420 – 80100, Mombasa Kenya

⁴MatCH Research Unit (MRU), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, 40 Dr AB Xuma Street, 11th Floor, Suite 1137, Commercial City Building, Durban, 4000, South Africa

⁵Department of Health Policy and Management, School of Public Health, University of Zambia Nationalist Road, P.O Box 50110, Lusaka

⁶Strategic Centre for Health Systems, Metrics and Evaluations (SCHEME), Department of Epidemiology and Biostatistics, University of Zambia Nationalist Road, P.O Box 50110, Lusaka

⁷KEMRI-Wellcome Trust Research Programme, CGMRC, PO Box 230-80108, Kilifi, Kenya

⁸Department of Obstetrics and Gynaecology, Levy Mwanawasa University Teaching Hospital, Lot 1222, Great East Road, Chainama Area, Lusaka, Zambia

^*For Correspondence: tni.ohw@joredroc Phone: +41227912111

Abstract

Unmet need for contraception remains a challenge especially in low and middle-income countries. Community participation or the “active involvement of affected populations in all stages of decision-making and implementation of policies, programs, and services” is a precondition for attaining the highest standard of health. Participation as a key component of rights and quality of care frameworks could increase met needs. However, it has been inadequately addressed in contraceptive programs. A qualitative, exploratory methodology that included focus group discussions and in-depth interviews with community members, healthcare providers, and other stakeholders were conducted to identify domains or key thematic areas of action through which stakeholders could be engaged. The study conducted in Kenya, South Africa, and Zambia explored knowledge and use of contraceptives, barriers and enablers to access, quality of care, and participatory practices. Thematic analysis was used, facilitated by NVivo (version 10 QSR International) with a single master codebook. Comparing the thematic areas that emerged from the county data, four domains were selected: quality of care, informed decision-making, acceptability, and accountability. These domains informed the theory of change of a participatory programme aiming to meet unmet needs. Identifying possible generalizable domains establishes measurable and comparable intermediate outcomes for participatory programs despite diverse African contexts.

Link

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7613330/