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CHAPTER ONE
INTRODUCTION
Background Of Study
In community development programs, community engagement now appears to be the “software.” Community participation as a developmental strategy is an important cog in the wheel of ensuring that community programs are well-planned, implemented, monitored, evaluated, maintained, managed, and financed for the benefit of the current generation and future generations, using human, natural, and man-made resources (Putman, 2000). There is no single definition of community engagement; rather, there are a plethora of definitions that vary based on the degree of participation. In this continuum, “participation” spans from minor or “co-opted” participation, in which community members serve as token representatives with no say in decision-making, to “collective” action, in which local people start actions, set agendas, and strive toward a common objective. The term “community participation” is frequently used to refer to merely asking people about their health needs. Delegating the actual planning execution and pretesting programs are key components of planning, and opinions are frequently limited to prepackaged formulas (Brunner, 2001). Community participation has been used in the Expanded Programme on Immunization activities as a proven strategy for tackling healthcare challenges. The quality of participation, on the other hand, differs from program to program. Moreover, despite the failure of many health programs that were developed without the input of target communities or groups, some experts continue to dispute the relevance of community members’ participation in the development, implementation, and evaluation of programs (Adinku, 2000). As a result, it is advocated that involvement be improved in two areas: setting realistic expectations between communities and health services in terms of their contributions to health and in health system governance. Dialogue between health-care providers and communities about their respective roles and the technical, resource, and social inputs required to fulfill them. The practical implementation of meaningful forms of participation has been hampered by ambiguous or vague roles, restricted authority, limited information availability, and weak representativeness, among other problems (Green & Ottoson, 1999). When several social groups demand that policymaking and execution be held accountable to the public, participation is frequently directed at management and implementation of systems. The term “participation” covers a wide range of connotations and goals. To some, it connotes a technique for increasing program efficiency or lowering costs, improving program sustainability, and developing local skills and knowledge essential for future interventions. This type of participation is a means to other development “ends,” a way to better attain goals and objectives. Participation, on the other hand, is viewed as a goal in and of itself, as it creates networks of solidarity and influences the decisions that affect their lives, legitimizing policy and practice, ensuring that they are more closely aligned with perceived public needs, and bolstering the incorporation of local knowledge (Marmot & Wilkinson, 1999).
Despite this, and despite the fact that participation is frequently used as both a means and an end in health policy, it is poorly operationalized in both health governance and accountability, as well as technical health interventions, so there is little systematic analysis of its specific contribution to health and health system outcomes (Green & Ottoson, 1999). The impact of collective action on community members is explained by community participation theories. According to the theory, community programs entail some form of collective activity on the part of the target group. The determinants of people’s participation make up a large group of determinants of action collection or subset. Oslon (1991), Buchanan and Tullock (1995), and McClusky (1995) investigated some of the theoretical approaches to collective action development (1990). According to community health theory and practice, planning is best done by people who will be the recipients of, or affected by, the resulting programs, policies, or services. A number of cases show a direct link between community engagement and health outcomes control. These findings suggest that improved prevention, treatment adherence, and rehabilitation necessitate participation. Public and professional concern over declining quality, access, and equity in health services, as well as increasing demand for people to finance and contribute to health services, community participation of both organized and unorganized groups is widely argued to be an important factor in improving health outcomes and the performance of health systems (Green & Ottoson, 1999). Rattray, Brunner, and Freestone (2002) developed a framework that describes the community participation ladder and provides a framework for health managers to plan, evaluate, modify, and extend their community engagement approaches in health programs. The year 2008 celebrated the 30th anniversary of Primary Health Care (PHC), the World Health Organization’s (WHO) health-care policy (WHO). One of the policy’s main tenets was community participation. “Community” is crucial in the context of public health, according to MacQueen et al. (2001).
1.At the community level, prevention and intervention are carried out.
2.Community is a significant factor in health outcomes.
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Immunization is defined as the artificial creation of disease immunity. Antiserum injections provide temporary passive immunity, whereas active immunity is achieved by causing the body to create its own antibodies. This is accomplished by the use of antigens that have been processed (vaccination or inoculation). Vaccines work by stimulating the body’s own immune system to safeguard the person from illness or sickness in the future. Vaccines are used to immunize people and can be made from live bacteria, viruses, dead organisms, or their by-products (Geddes & Grossette, 1997). As a result, vaccination coverage is an important performance metric for the entire health sector. Several factors influence or contribute to effective community participation in the EPI program. Community-based factors such as formal education, perspective, attitude, and religion, program-based factors, and health-worker factors are only a few of them. It’s crucial to look into the processes that influence involvement in a community-wide intervention once more. According to the Ghana EPI Review (2004), protection of children at birth from neonatal tetanus was very inadequate in the Central Region, with a total regional performance of 12.6 percent. Tetanol Toxoid card conservation was also 39.2 percent, with a 12.8 percent vaccine dropout rate. These poor results were attributed to low community engagement as a result of community members’ refusal to fully embrace the EPI program. According to a study conducted at Kano University in Nigeria, immunization rates in African countries have been as low as 30% in some areas participating in the program during the last decade (National Programme on Immunization, 2007).
The absence of capacity building in interpersonal skills for health professionals, as well as the existing immunization schedules of the health system, were determined to be major inhibitors to a successful immunization campaign. Three factors were cited by MacQueen et al. (2001) as to why incorporating community engagement into health programs was so difficult. These explanations include:
1.the use of a participatory planning tool as an intervention;
2. lack of in-depth examination of community people’s perspectives on the implementation of health programs such as the Expanded Immunization Program (EPI).
Difficulties to community engagement in EPI, according to MOH (2002), fall into three categories: hurdles with the program (or agency), obstacles within the community, and obstacles with society. Physical, biological, economic, political, social, cultural, and historical barriers might also be considered. Immunization is frequently viewed as a public health intervention in terms of vaccine availability and cost, storage and handling, and the ability to prevent, control, and monitor diseases. Communication efforts should be inextricably linked to and complement the other immunization technical components, including provision and quality of services, health worker capacity-building and skills, disease reporting and surveillance experts and communication specialists, according to recommendations from the Ghana EPI Review (2004a). One issue that program managers have is determining how to assess community engagement. What should be examined in particular in a health-care program? Community engagement must be able to facilitate rather than direct a process. Program managers and implementers should be able to seek out local expertise and build on it as needed, reinforcing knowledge and abilities. Community participation by community members is one of the techniques put in place to help meet targets established on the EPI program at the Komenda-Edina-Eguafo-Abrem (KEEA) sub-District levels. It will be crucial for program managers to establish and track participation metrics. One of the EPI program’s objectives is to achieve high community participation in the program. As a result, it’s critical for EPI program health planners to track changes in community selfefficacy or local capacity to detect and remedy problems (Green & Ottoson, 1999). Despite the fact that the EPI program has received tremendous support from a variety of governmental and private organizations, including the WHO, the Global Alliance on Vaccines, the World Bank, the Vaccine Industry, and others, there are some barriers to community participation in the EPI program in the Elmina sub-District (Clements, Greenough & Shull, 2006).
ย Statement Of Problem
Over the years, the District Health Management Teams (DHMTs) and Regional Health Management Teams (RHMTs) have worked to engage communities in health-related activities. During talks at two consecutive District Annual Review Meetings conducted in Elmina in 2007 and 2008, it became obvious that communities were not participating in EPI programs as intended. The majority of health-care providers expressed concern that communities do not use immunization services. Effective community participation in EPI programs would enable service providers to reach every eligible kid in the EPI program and fully immunize them against childhood immunizable illnesses (Ghana Health Service, 2008). According to reports from service providers in the Elmina sub-District on community participation, (a) community members do not come for EPI services during outreach services, (b) pregnant women, mothers, and care givers do not come for routine immunization services as expected despite the fact that immunization is free, and (c) community members do not appear to be ready to mobilize and organize (Elmina Urban Health Centre, 2011; 2008). In Elmina, the DHMT (KEEA) and SDMT have attempted to organize district assemblies, community development, area committee members, the women’s wing, and other sectors in order to increase community engagement in EPI operations. To support this, every year a week is set aside (called “Health Week”) to enhance community awareness of health issues and programs through health education campaigns. All of these measures have failed to have the anticipated effect of encouraging communities to participate actively in EPI activities.
ย Objective Of Study
The following are primary objectives of the study:
1. To assess the extent of community involvement in EPI.
2. To examine if community members in the Elimina sub-district participate in EPI differently depending on their educational level.
3. To investigate community-based factors influencing community participation in the EPI programme in Elimina sub district.
Research Question
The following research question guides this study:
1. What is the extent of community involvement in EPI?
2. Do community members in Elmina Sub-District participate in EPI in different ways depending on their educational levels?
3. What are the community-based factors influencing community participation in the EPI program?
Significance Of Study
The EPI programme needs high community participation in order to achieve its expected goal. Therefore, it is vital for health planners to measure changes in community self-efficacy or changes in local capacity to identify and solve problems facing the EPI programme. The findings may be useful to stakeholders such as the regional director of health services, SDHMTs, DHMTs, communities, and some policy makers like the public health division (GHS) for review and to be used to improve community participation in EPI activities. This study will therefore add to the existing literature on factors that influence community participation in the EPI programmes. Again, the study will serve as a platform for further investigation into community participation in EPI programmes in Ghana. Findings of the study would also serve as a guide for future researchers in the field of health in Ghana.
ย Scope Of Study
This study focuses on assessing ย the extent of community involvement in EPI. The study will also examine if community membersย participate in EPI differently depending on their educational level. And lastly investigate community-based factors influencing community participation in the EPI programme. Based on the nature of the study, it will therefore be delimited to selected health care centres in Elimina sub district in Ghana.
Limitation Of Study
Finance,inadequate materials and time constraint were the challenges the researchers encountered during the course of the study.
ย Definition Of Terms
Community participation:ย Is the process by which individuals, families, or communities assume responsibility for their own welfare by contributing actively to planning, implementation of health intervention programmes in their communities (Burns, Heywood, Taylor, Wilde & Wilson, 2004).
Community:ย This comprised a group of people with similar or near similar socio-cultural or ethnic identities, and values
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