Community Empowerment Through Community Awareness and Mobilization: Hearing the Voice of the Community

This 14-page presentation for the Post Abortion Care (PAC) Technical Meeting, Washington, DC, United States, March 2008, illustrates the post-abortion care (PAC) model of the United States Agency for International Development (USAID), which consists of three components: community empowerment through community awareness and mobilisation; emergency treatment; and family planning (FP) counselling, including provision of selected reproductive health care, sexually transmitted infection, and HIV testing and treatment. The presentation lists indicators of breadth of involvement as: the number of non-governmental organisation (NGO)/faith-based organisation (FBO)/community-based organisation (CBO) networks or coalitions providing PAC services; the number of communities with established referral systems; the number of communities with established transport plans for obstetric emergencies; the percentage of people who can cite one danger sign of an obstetric emergency; and the number of PAC programmes that involve members of vulnerable or underserved populations. The document presents a comparison of the problems and resolutions of PAC model programmes within three countries: Bolivia, with 48 community groups involved; Kenya, with 16 groups; and Senegal, with 16 groups.


The needs specific to each country situation are presented, and include: accessing funding for infrastructure (roads, bridges, health facilities); staff training and supply of materials for training; and information dissemination on danger signs and on availability of health services. Results of pre- and post-knowledge, attitudes, and practices (KAP) surveys are included. The programmes emphasise the theme of the three delays: delay in recognising the problem; delay in seeking care; and delay in receiving appropriate care.


The sections on "recognising the problem" identify the following communication-specific challenges: ignorance of FP and lack of FP information; lack of understanding of contraception (particularly among youth and adolescents); and prevalence of rumours and myths preventing contraception use. Communication strategies used in these cases were: workshops, health fairs, public awareness activities, workshops with psychology students, and work with health care directors. Community workshops on parent-child communication on sexuality, community debates related to issues of sexuality and reproductive health, neighbourhood group involvement, and posters on care during pregnancy were also applied strategies. In addition, meetings for drawing on community-based grassroots involvement included the following types of organisations: CBOs, mothers' clubs, and popular health committees. Health centre directors were encouraged to implement: use of name tags for doctors, a whiteboard noting staff entry and leaving times at the centres, monthly staff meetings, and suggestion boxes for clients reviewed regularly. Links between health facilities and CBOs were created through monthly meetings. Transportation strategies included meeting with drivers in the communities, locating a cart for transport, negotiating acceptance of patients at private hospitals, building roads for access, and increasing minibus zones.


Other issues needing future attention include:

• "Know rights and responsibilities as users of health care (youth, women).
• Men and adolescents do not have access to condoms at [health centres] HC.
• No system to take care of poor clients.
• Mothers-in-law carry women to traditional healer when haemorrhage occurs.
• Missed opportunities by health staff to educate youth about RH.
• Men’s ignorance of pregnancy danger signs.
• Peer pressure leading to abortion.
• Parents assisting and encouraging their school-going daughters to abort.
• Use of illegal substances and alcohol leads to violence to pregnant women."