Niyongabo Prosper, Douwes Renate, Dieleman Marjolein, Irambona Frédéric, Mategeko Jimmy, Nsengiyumva Georges, De Cock Buning Tjard
Institut National de Santé Publique, Avenue de l'Hôpital 3, Bujumbura, Burundi.
, Fonteinlaan5, 2012 JG, Haarlem, The Netherlands.
BMC Health Serv Res. 2018 Jan 29;18(1):46. doi: 10.1186/s12913-017-2822-y.
Increased availability of maternal health services alone does not lead to better outcomes for maternal health.The services need to be utilized first.One way to increase service utilization is to plan responsive health care services by taking into account the community's views or expressed needs. Burundi has a high maternal mortality ratio, and despite improvements in health infrastructure, skilled staff and the abolition of user fees for pregnant women,utilization of maternal health services remains low. Possible reasons for this include a lack of responsive healthcare services. An exploratory study was conducted in 2013 in two provinces of Burundi (Makamba and Kayanza), with the aim to collect the experiences of women and men with the maternal health services,their views regarding those services, channels used to express these experiences, and the providers' reaction.
Semi-structured interviews were used to collect data from men and women and key informants, including community health workers, health committee members, health providers, local authorities, religious leaders and managers of non-governmental organizations. Data analysis was facilitated by MAXQDA 11 software.
Negative experiences with maternal health services were reported and included poor staff behavior towards women and a lack of medicine. Health committees and suggestion boxes were introduced by the government to channel the community's views. However, they are not used by the community members, who prefer to use community health workers as intermediaries. Fear of expressing oneself linked to the post-war context of Burundi, social and gender norms, and religious norms limit the expression of community members' views, especially those of women. The limited appreciation of community health workers by the providers further hampers communication and acceptance of the community's views by health providers.
In Burundi, the community voice to express views on maternal health services is encountering obstacles and needs to be strengthened,especially the women's voice. Community mobilization in the form of a mass immunization campaign day organized by women fora, and community empowerment using participatory approaches could contribute towards community voice strengthening.
仅增加孕产妇保健服务的可及性并不能带来更好的孕产妇健康结局。这些服务首先需要得到利用。提高服务利用率的一种方法是通过考虑社区的意见或表达的需求来规划响应式医疗服务。布隆迪的孕产妇死亡率很高，尽管在卫生基础设施、技术熟练的工作人员以及取消孕妇的用户费用方面有所改善，但孕产妇保健服务的利用率仍然很低。造成这种情况的可能原因包括缺乏响应式医疗服务。2013年在布隆迪的两个省（马坎巴省和卡扬扎省）进行了一项探索性研究，目的是收集妇女和男子在孕产妇保健服务方面的经历、他们对这些服务的看法、用于表达这些经历的渠道以及提供者的反应。
采用半结构化访谈从妇女和男子以及关键信息提供者那里收集数据，这些关键信息提供者包括社区卫生工作者、卫生委员会成员、医疗服务提供者、地方当局、宗教领袖和非政府组织的管理人员。数据分析借助MAXQDA 11软件进行。
报告了孕产妇保健服务方面的负面经历，包括工作人员对妇女态度恶劣以及药品短缺。政府设立了卫生委员会和意见箱以收集社区的意见。然而，社区成员并不使用这些渠道，他们更愿意通过社区卫生工作者作为中间人来表达意见。与布隆迪的战后背景、社会和性别规范以及宗教规范相关的表达自我的恐惧限制了社区成员意见的表达，尤其是妇女的意见。提供者对社区卫生工作者的认可度有限，这进一步阻碍了医疗服务提供者对社区意见的沟通和接受。
在布隆迪，社区表达对孕产妇保健服务意见的声音遇到了障碍，需要得到加强，尤其是妇女的声音。以妇女论坛组织的大规模免疫接种活动日的形式进行社区动员，以及采用参与式方法增强社区权能，有助于加强社区的声音。
