Community participation in health priority setting in Magarini division, coastal Kenya

Abstract

This thesis focused on community participation in health priority setting in Magarini division, Coastal Kenya. The main objective was to explore community participation in health priority setting in Magarini division in Malindi district of Kilifi County. The study. examined health priority setting processes in various institutions at the community level, community participation in health priority setting and factors that influence health priority setting at the community level in Magarini division. The study adopted a descriptive cross-sectional design which utilized qualitative methods of data collection. Focus group discussions were conducted with twenty (20) participants from the various groups representing the community while key informant interviews were done with twenty nine (29) people comprising of health professionals, opinion leaders, health committees and program managers. The study participants were selected through convenient sampling. Data from key informant interviews and focus group discussions records were transcribed, translated typed and exported to NVIVO software version 7 for processing and analysis. Using NVIVO, tree nodes and sub nodes were developed based on the thematic areas identified from the research questions. The findings suggested that health priority setting processes involved complex and difficult stages at the community level. There is a relatively low degree of community influence or control over organizations in which the community members participate and what the community members go through is an empty ritual of participation. The community has no power to influence the outcome of any process indicating that the community is not actively involved in health priority setting and the overall decision making processes in the study area. Where the community is involved, the level of involvement and participation is vague. Comparatively, community participation in the activities of health development partners including priority setting in the study area was found to be high. Health priority setting in the study area is characterized by passive involvement and participation of all the groups in the community as seen in the composition of the health committees from the district to the village level. Thus, current health priority concerns do not carry the wishes and feelings of the majority of groups in the community. This is against the spirit and the overall goal of decentralization approach of incorporating community participation in determining own health priorities as stipulated in the health sector reforms introduced in 2005. The study findings further showed that the health providers' attitudes and practices together with the socio-cultural issues, illiteracy, prevalence and burden of diseases such as HIVIAIDs, malaria, tuberculosis are the main factors influencing health priority setting and the general provision and utilization of health services in Magarini. Specific personal attitudes and practices of individual health workers and other staff are largely to blame for poor utilization of health services in many health facilities. It is concluded that the community is a major stakeholder in health priority setting and its involvement and I or participation in health priority setting processes ultimately lead to maximum benefits. The study recommends that for effective health priorities to bear meaningful results and impact positively in the provision of health services, the government and other stakeholders in health provision should recognize the contribution of the majority of the groups at the community level by giving them opportunities to participate in health priority setting processes. The Accountability for Reasonableness (AFR) is a useful framework for priority setting which ensures that fairness, trust and equity are taken into account during priority setting. It should be embraced to enhance community participation in health priority setting and thereby improved utilization of health services.