Knowledge as a Vehicle for Change in Reproductive Health & HIV/AIDS Prevention

Abstract

The study ascertains out the role of access to information and consequently of the generated knowledge in reproductive health utilization, HIV awareness and in participation in own health in Bahir Dar Special Zone, Amhara regional state, Ethiopia. These processes are discussed within the structure of health service planning, management and provision with special focus on awareness raising strategies and behavioural communication change. The study applied the case study approach while utilizing both qualitative and quantitative research methods. Field research period took place between February and June 2011. The introductory part of the data collection was held in Addis Ababa and briefly in Bahir Dar where qualitative data was collected through key-informant interviews in order to grasp the health service planning & provision structure while focusing on reproductive health and HIV/AIDS. Awareness raising strategies and behaviour communication channels were investigated in their relation to potential demand creation. In Bahir Dar Special Zone, two urban and two rural areas were sampled to execute the household survey, to carry out focus group discussions and selected services quality assessments. Semi-structured interviews were held with heads of the facilities. The household survey investigation focused on health care seeking behaviour of women in reproductive age, facility-based research collected data on health service provision and quality while identifying major challenges. Focus group discussions held mostly with female participants of reproductive age served as vital complement of each thesis objective. Both clinical and community-based reproductive health & HIV prevention services were found to be highly cluster-cumulated despite the decentralized framework. Aspects of policy analysis & evaluation were applied to the Health Extension Programme which represents promising government effort in bringing services closer to the poor although the factual capacities of Health Extension Workers turned out to be questionable, partially as an outcome of ineffective training mechanisms and deployment. Awareness raising strategies with aim to positively influence individual & community health care seeking behaviour were present in numerous traditional and innovative forms creating a complex structure. Mostly NGO-led strategies were highly taking advantage of existing network of Health Extension Workers and assisting volunteers. The crucial role of knowledge was indicated in HIV prevention and although achieving higher levels than in the recent national statistics, comprehensive HIV knowledge was found to be rather unsatisfactory which triggers the discussion on quality of provider → user communication in voluntary counselling and testing (VCT). The functioning prevention of mother to child transmission (PMTCT) modality of service which reaches mothers through their ante-natal care (ANC) investigation whereas mediating the issue of HIV prevention and treatment is considered as a positive empirical finding. The functionality of this service was reflected by its positive association to comprehensive HIV knowledge. The study reflects the low level of child birth preparedness and planning especially in rural areas which combines many issues from spatial inaccessibility to cultural determinants. Examining the level of citizen’s participation in own health, few forms of community participation and accountability mechanisms were found albeit largely NGOs-driven. Even though the level of accountability remains administrative and upwards, women are obviously gaining knowledge of basic mechanisms such as complaint procedure rather slowly while facing many structural difficulties. This thesis concludes that knowledge is crucial in all aspects of reproductive health service provision, HIV prevention and health participation. Making information on reproductive health and HIV prevention & treatment services as well as on accountability procedures available should be perceived as a way towards more equitable and responsive health system.