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International Journal for Equity in Health

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Open Access 01-12-2018 | Research

Perceptions and experiences related to health and health inequality among rural communities in Jimma Zone, Ethiopia: a rapid qualitative assessment

Authors: Nicole Bergen, Abebe Mamo, Shifera Asfaw, Lakew Abebe, Jaameeta Kurji, Getachew Kiros, Muluemebet Abera, Gebeyehu Bulcha Duguma, Kunuz Haji Bedru, Manisha A. Kulkarni, Ronald Labonté, Sudhakar Morankar

Published in: International Journal for Equity in Health | Issue 1/2018

Abstract

Background

The Safe Motherhood Research Project studies the implementation and scale-up of maternal, newborn and child health (MNCH) initiatives in Jimma Zone, Ethiopia. This qualitative rapid assessment study was undertaken to explore community perceptions and experiences related to health, health inequality and other MNCH themes.

Methods

We conducted 12 focus group discussions and 24 in-depth interviews with community stakeholder groups (female and male community members, Health Extension Workers, members of the Women Development Army and Male Development Army, and religious leaders) across six rural sites in Jimma Zone. Data were analyzed through thematic coding and the preparation of content summaries by theme.

Results

Participants described being healthy as being disease free, being able to perform daily activities and being able to pursue broad aspirations. Health inequalities were viewed as community issues, primarily emanating from a lack of knowledge or social exclusion. Poverty was raised as a possible contributor to poor health, however, participants felt this could be overcome through community-level responses. Participants described formal and informal mechanisms for supporting the disadvantaged, which served as a type of safety net, providing information as well as emotional, financial and social support.

Conclusions

Understanding community perceptions of health and health inequality can serve as an evidence base for community-level initiatives, including MNCH promotion. The findings of this study enable the development of audience-centered MNCH promotion activities that closely align with community priorities and experiences. This research demonstrates the application of rapid qualitative assessment methods to explore the context for MNCH promotion activities.

The Safe Motherhood Project is an intervention trial that supports the implementation and scale-up of MNCH initiatives in selected districts of Jimma Zone. For more information about the Safe Motherhood Project, please see: https://www.idrc.ca/en/project/promoting-safe-motherhood-jimma-zone-ethiopia-imcha.

The Women Development Army is a voluntary community health workforce that supports the work of Health Extension Workers. One women out of every five households is a Women Development Army member, responsible for promoting health among the five households under the supervision of Health Extension Workers.

The Male Development Army has a similar structure to the Women Development Army, with a greater focus on aspects of community development related to physical infrastructure or agriculture.

Ethiopia Federal Ministry of Health. Health Sector Transformation Plan - I: Annual performance report. Addis Ababa: Ethiopia Federal Ministry of Health; 2016.

Downie R. Sustaining improvement to public health in Ethiopia. In: Centre for strategic and international studies (CSIS); 2016.

Ministry of Health. Visioning beyond: revised policy and health sector transformation plan. Policy planning directorate [Internet]. 2014 [cited 2017 Jul 8]. Report No.: ARM 16-Doc 08/14.

Teklehaimanot HD, Teklehaimanot A. Human resource development for a community-based health extension program: a case study from Ethiopia. Hum Resour Health. 2013;11(1):1.CrossRef

Banteyerga H. Ethiopia’s health extension program: improving health through community involvement. MEDICC Rev. 2011;13(3):46–9.CrossRefPubMed

Medhanyie A, Spigt M, Kifle Y, Schaay N, Sanders D, Blanco R, et al. The contribution of Health Extension Workers in improving the utilization of maternal health services in rural areas of Tigray, Ethiopia. In: Labonte R, Sanders D, Packer C, Schaay N, editors. Revitalizing health for all: case studies of the struggle for comprehensive primary health care. Toronto: University of Toronto Press and International Development Research Centre; 2017. p. 237–54.

Central Statistical Agency. Ethiopia demographic and health survey 2016. Rockville: The DHS Program; 2017.

Haileamlak A. Ethiopia Successfully Attaining the Millennium Development Goals. Ethiop J Health Sci. 2015;25(2):109–10.CrossRefPubMedPubMedCentral

Ambel AA, Andrews C, Bakilana AM, Foster E, Khan Q, Wang H. Ethiopia health equity: reaching the bottom 40%. Maternal and child health inequalities in Ethiopia: The World Bank Group; 2015. [Cited June 12, 2018]. Available from: https://elibrary.worldbank.org/doi/pdf/10.1596/1813-9450-7508.

10.

Environmental Protection Authority. National Report of Ethiopia. In: The United Nations Conference on Sustainable Development (Rio 20+); 2012. [Cited June 12, 2018]. Available from: http://web.mit.edu/12.000/www/m2017/pdfs/ethiopia/UN.pdf.

11.

Thaddeus S, Maine D. Too far to walk: maternal mortality in context. Soc Sci Med. 1994;38(8):1091–110.CrossRefPubMed

12.

Berhan Y, Berhan A. Reasons for persistently high maternal and perinatal mortalities in Ethiopia: part III: perspective of the three delays model. Ethiop J Health Sci. 2014;24:137–48.CrossRefPubMedPubMedCentral

13.

Jackson R, Tesfay FH, Gebrehiwot TG, Godefay H. Factors that hinder or enable maternal health strategies to reduce delays in rural and pastoralist areas in Ethiopia. Tropical Med Int Health. 2017 Feb;22(2):148–60.CrossRef

14.

Ethiopia Federal Ministry of Health. National Health Promotion and communication Strategy 2016–20. Addis Ababa: Ethiopia Federal Ministry of Health; 2016.

15.

Cookey PE, Darnswasdi R, Ratanachai C. Local people’s perceptions of Lake Basin water governance performance in Thailand. Ocean Coast Manag. 2016;120:11–28.CrossRef

16.

Popay J, Escorel S, Hernandez M, Johnston H, Mathieson J, Rispel L. Understanding and tackling social exclusion: final report to the WHO Commission on social determinants of health: Social exclusion knowledge Network; 2008. [Cited June 12, 2018]. Available from: http://www.who.int/social_determinants/knowledge_networks/final_reports/sekn_final%20report_042008.pdf?ua=1.

17.

Johns Hopkins Center for Communication Programs. Ethiopia baseline report: communication for health: Johns Hopkins University Center for communication programs. Baltimore; 2017.

18.

Tegegn A, Yazachew M, Gelaw Y. Reproductive health knowledge and attitude among adolescents: a community based study in Jimma Town, Southwest Ethiopia. Ethiop J Health Dev EJHD. 2016;22(3) Available from: http://www.ejhd.org/index.php/ejhd/article/view/508 [Cited June 12, 2018].

19.

Tesfaye T, Tilahun T, Girma E. Knowledge, attitude and practice of emergency contraceptive among women who seek abortion care at Jimma University specialized hospital. southwest Ethiopia BMC Womens Health. 2012;12(1):3.CrossRefPubMed

20.

Beekle AT, McCabe C. Awareness and determinants of family planning practice in Jimma, Ethiopia. Int Nurs Rev. 2006;53(4):269–76.CrossRefPubMed

21.

Asheber Gaym MD, Luwei Pearson MD. Khynn win win Soe MD. Maternity waiting homes in Ethiopia: three decades experience. Ethiop Med J. 2012;50(3):209–19.PubMed

22.

Baker C, Campbell B. Context matters: An Ethiopian case study. Adapting leadership development methods to serve different cultures. 2013 . Available from: http://www.ccl.org/wp-content/uploads/2015/04/ContextMatters.pdf [Cited June 12, 2018].

23.

Cherie A, Mitkie G, Ismail S, Berhane Y. Perceived sufficiency and usefulness of IEC materials and methods related to HIV/AIDS among high school youth in Addis Ababa, Ethiopia. Afr J Reprod Health. 2005;9(1):66–77.CrossRefPubMed

24.

Kok MC, Kea AZ, Datiko DG, Broerse JEW, Dieleman M, Taegtmeyer M, et al. A qualitative assessment of health extension workers’ relationships with the community and health sector in Ethiopia: opportunities for enhancing maternal health performance. Hum Resour Health. 2015 Dec;13(80):1–12.

25.

Teklehaimanot A, Kitaw Y, Girma S, Seyoum A, Desta H, Ye-Ebiyo Y, et al. Study of the working conditions of health extension workers in Ethiopia. Ethiop J Health Dev EJHD. 2007;21(3) Available from: http://www.ejhd.org/index.php/ejhd/article/view/536 [Cited June 12, 2018].

26.

Gebrehiwot T, Goicolea I, Edin K, San Sebastian M. Making pragmatic choices: women’s experiences of delivery care in northern Ethiopia. BMC Pregnancy Childbirth. 2012;12(1):113.CrossRefPubMedPubMedCentral

27.

Jackson R, Tesfay FH, Godefay H, Gebrehiwot TG. Health extension workers’ and mothers’ attitudes to maternal health service utilization and acceptance in Adwa Woreda, Tigray region, Ethiopia. PLOS ONE. 2016;11(3):e0150747. Roy JK, editorCrossRefPubMedPubMedCentral

28.

Maes K, Closser S, Vorel E, Tesfaye Y. Using community health workers. Discipline and Hierarchy in Ethiopia’s Women’s Development Army Ann Anthropol Pract. 2015;39(1):42–57.

29.

Østebø MT, Cogburn MD, Mandani AS. The silencing of political context in health research in Ethiopia: why it should be a concern. Health Policy Plan. 2018 Mar 1;33(2):258–70.CrossRefPubMed

30.

Morse JM. Determining sample size. Thousand Oaks, CA: Sage Publications Sage CA; 2000.

Title: Perceptions and experiences related to health and health inequality among rural communities in Jimma Zone, Ethiopia: a rapid qualitative assessment
Authors: Nicole Bergen
Abebe Mamo
Shifera Asfaw
Lakew Abebe
Jaameeta Kurji
Getachew Kiros
Muluemebet Abera
Gebeyehu Bulcha Duguma
Kunuz Haji Bedru
Manisha A. Kulkarni
Ronald Labonté
Sudhakar Morankar
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: International Journal for Equity in Health / Issue 1/2018
Electronic ISSN: 1475-9276
DOI: https://doi.org/10.1186/s12939-018-0798-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Perceptions and experiences related to health and health inequality among rural communities in Jimma Zone, Ethiopia: a rapid qualitative assessment

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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