This research examined the role of health centre committees in improving antenatal care services in Mutasa District. The study also examined the challenges faced by the Health Centre Committees (HCC) in the improvement of the antenatal care services. Health Centre Committee (HCC) is a mechanism through which community involvement can be efficiently incorporated to attain a sustainable people centred health system at the primary care level of the health system (Clive 2003). HCCs complement essential community level initiatives such as public health workers, and system of community contribution at all levels and areas of the health system. In Zimbabwe HCCs were initially projected by the Ministry responsible for Health and Child Care services in early 1980s. The major endeavour was to help communities in realising their major health problems, their needs and help them plan on how they can to raise their own resources or capital, sort out and administer public contributions as well as tapping the available funds for community improvement (Machingura, 2010). Antenatal care (ANC) refers to the services offered to an expecting woman in a way to reduce morbidity and mortality of both the mother and the unborn baby (Goodman, 2011).
In Mutasa district the HCC has taken the lead in collecting and organising financial and other material resources such as bricks, quarry, sand and labour in the building of waiting houses, maternity wards at Sakupwanya clinic and other infrastructures in the area under study. They help encourage and mobilise pregnant mothers to deliver at the nearest local RHCs. This contributed to the improvement of maternal and neonatal survival through offering improved ANC care services. ANC refers to the interventions done to curb maternal and infant morbidity and mortality (Zigora, 1996). ANC is defined as a planned programme of medical management of pregnant women directed towards making pregnancy and labour a safe and satisfying experience (Clive, 2003). This care service for expecting women has become an imperative pillar in safe and sound motherhood programmes. They develop the result of pregnancy for both the expecting woman and the baby. Health Sector Strategy plan phase two (HSSP ii) also recognises the significance of reinforcing the health system at each level (Chikumbirike, 2000). These include the growing demand at the community level practising and implementing outreaches of ANC as well as postnatal (PNC) packages, providing sophisticated higher levels of care services in clinics.
The absence of HCCs and their formal appreciation may augment the maternal and infant morbidity and mortality (Oeyedele, 2010). In 2009-2013, the National Health plan identified this hole and made exact indication of the benefits of establishing HCC in the health system in order to develop and improve the service delivery in the health systems. HCCs are termed by diverse names in Southern African countries. They are combined public or community health-service structures at the primary-care level of the health system, covering the catchment area of that primary-level facility (Loewensen, 2000). They are usually termed a clinic or health centre (Chikumbirike, 2000). They offer for contribution in the performance of the health centre, PHC activities, to engage communities in preparation and implementation of health care services, health actions, and to promoting community responsibility in health.
HCCs are mechanisms through which the public or the community contribution can be successfully incorporated to attain a sustainable people centred health system at the primary care level of the health system (Oeyedele, 2010). They complement critical public or community level initiatives such as the village health workers as well as mechanisms for community input at all levels in the health system. To add on, HCCs are accountable for supporting the public to recognize their health challenges. They also have the duty of helping the community with some vibrant ideas on how to mobilise resources, organise them and how to manage the community input for development purposes. HCCs refer to the interventions to curb maternal and infant mortality (Loewensen, 2000).
HCCs were reported to be present in more than 30% of all health districts in Zimbabwe, South Africa and Tanzania and they were reported to have met at least once a year whilst some were reported to be meeting four times annually is South Africa (Barron, 2006). HCCs found its lead in policy of approximately all countries in the region. The presence of HCCs in several countries’ activity and duties varies broadly inside and across Southern Africa countries (Loewensen, 2000).
Moreso, expecting mothers should be given greatest care and quality health care services so as to improve maternal and neonatal survival (Zigora, 1996). In response to this view pregnant or expecting mothers should be exposed to favourable and conducive environment and atmosphere that can completely add to the improvement of both the maternal and neonatal survival. Pregnant mothers should get quality ANC care services as well as delivering at health facilities within their reach where they can receive and get help from skilled personnel. For quality care services to be rendered, the community and health personnel should join their hands together (Kolk, 2003). The good and correct measures should be put in place so as to ensure proper preparation and execution of primary health care services in organised efforts with other significant members. This is very important because it may uphold health as an essential contribution to the development of quality life for each person, community and the family as part of socio-economic improvement and development. In this regard several stakeholders such as HCCs are a force to reckon in improving health outcomes. Poor ANC services leads to miscarriages, maternal and infant morbidity and mortality (Clive, 2003).
The health systems in sub-Saharan Africa have been in a state of decline since the debt crisis of the 1980s (Clive, 2003). It has been acknowledged that the downfall was as a result of the consequent negative effects of Structural Adjustment Programme (SAP), the constant public under-investment as well as the health sector reforms. Furthermore, Zimbabweans experienced a serious burden of epidemic diseases dominated by plethora of diseases. These diseases include but not confined to HIV and AIDS, nutritious deficiencies, malaria, diarrheal diseases, and tuberculosis, among others. Pregnant and neonates are also affected by vaccine preventable diseases (Clive, 2003). Zimbabwe Demographic and Health Survey conducted in 2009 shows that the number of women dying due to maternal causes for the past seven year period has increased in Zimbabwe from seven hundred and twenty five deaths for every hundred thousand live births, (2002-2009) to nine hundred and sixty deaths for every hundred thousand live births in 2010/11 (2003- 2010) (Goldwin, 2011).
In addition, with such high trouble of ill health challenges, efforts to improve the situation make continued as well as reasonable improvements and developments in health sectors are being made and introduced by diverse state and from other varied non state stakeholders. One of the objectives is to revive the Primary Health Care (PHC) concept (Clive, 2003). Primary health care, as contained in the Declaration of Alma-Ata 1978, is, essential health care based on practical, scientifically sound, socially acceptable methods and technology made universally accessible to individuals and families in the community (Loewensen, 2000). This can be completed through full involvement of the society and the country at large, that can manage to maintain at every stage of their development. It forms a vital part, both of the country’s health system, of which it is the central function and main focus, and of the overall social and economic development of the community (Loewensen, 200). This is supported by Clive (2000) who articulated that, it is the first level of contact of individuals, the family and community with the national health system bringing health care as close as possible to where people live and work, and constitutes the first element of a continuing health care process.
Zimbabwe’s national health policy commits the Government to ensure that communities are equipped and empowered to take responsibility and be accountable for their own health and well being (Poku, 2008). They must actively contribute in the organization and administration of their nearest local health centre through the formation or establishment of HCCs. The HCC helps improve the health facilities and outcomes (Clive, 2003). However although these researchers outlined how HCCs came into existence as indicated above, there is need of outlining their roles in improving ANC services.
Studies carried out in Chiundura community about the effectiveness of the HCCs show that HCCs and strong primary care services support improved health outcomes (Golden, 2004). The study exposed that HCCs should have a constitution and a legal status for guidance and for it to effectively carry out its duties. The HCC constitution should cover things which include receiving, how to administer as well as accounting for public funds. The district health executives and local council authorities should ensure that HCCs are properly constituted, with members aware of their roles and responsibilities and with adequate supervision and support (Loewensen, 2000). This study did not highlight the roles of the HCCs in improving ANC, hence this gap need to be filled.
Another study on the ways that help improve people’s health was conducted in Nyanga communities (Poku, 2008). The study revealed and indicated that people in the communities have several roles that they should partake so as to improve the health sector at large. The study also found out that HCCs should be established so as to improve health outcomes. However, although this conducted study highlighted the necessity of HCCs in health sector, it did not bring to light the roles of HCCs in improving ANC services which will then be the intention of this study.
A study on improving primary health care through community participation in health was carried out in Gokwe (Mungurura, 2006). The study revealed that regardless of the potential impact, public participation is burdened with challenges and in some situations the participation can be both ineffective and limited. The study also revealed out that a number of HCCs in Zimbabwe are not functioning optimally. This is because of a number of factors such as lack of political commitment, limited resources, limited capacity and skills, attitudes of health workers, lack of clarity of the role and mandate of committees, limited co-operation from health services, and lack of support (Chikumbirike, 2000). This means that if HCCs are not well versed with their roles they will not effectively perform as expected.
Not all people consider the issue of health seriously and important (Ropi, 2000). This means that the HCCs face the challenge of lack of cooperation from the public. This is because some people have shallow knowledge and some lack the knowledge on how to attain good heath, some are religious objectors and they do not participate in certain health issues and others pursue traditional beliefs. HCCs also face challenges of lack of resources to fully implement strategies that will help them improve ANC services. Furthermore, conflict and resistance found among HCC members is also another challenge that may hinder the role of HCCs in trying to improve ANC services (Clive, 2003). It is against this background that this research seeks to identify the roles of HCCs in improving the utilisation of ANC services. Most RHCs have HCCs and there is need find how the HCCs help in ANC services. The study will also examine quality ANC services as a pillar in safe motherhood programme as the aim is to improve the outcome of the pregnancy as well as to reduce the morbidity and mortality rate.
STATEMENT OF THE PROBLEM
A number of studies have been done by George (2001) in Bindura on how morbidity and mortality can be reduced. The study indicated that the establishment of HCC was one of the ways that can be used to alleviate the problems. The study also revealed that about 25% of the maternal deaths that happen when women are pregnant are as a result abortions, diseases, as well as poor services given to expecting mothers. Several researches also focused on the ways to improve the antenatal care services, for example the one conducted by Ropi (2000) in Kazozo Area in Nyanga. The study revealed that the establishment of HCC is an effective way that can help improve ANC care services. This means that the prior studies concentrated much on how to reduce morbidity and mortality rate. In response to these studies HCCs came into existence in different communities in the country with the intention to improve ANC services. However, although prior studies done by several scholars encouraged the establishment of HCCs, they did not put to light the roles of these HCCs resulting in the persistence of the morbidity and mortality rate. This is because the established HCCs exist without knowing what they should do to curb the issue of high rate of morbidity and mortality. This research study aimed at putting to light the roles of the HCC in improving the utilisation of ANC services, ascertaining the problems or the challenges encountered by the HCCs in improving ANC care services and how HCCs can cope up with such challenges. This will help HCCs know their duties so as to effectively improve the ANC.
OBJECTIVES OF THE STUDY.
(i)To establish the roles of HCCs in improving the utilisation of ANC services.
(ii) To ascertain the problems or the challenges encountered by the HCCs in improving ANC care services.
(iii) To examine different strategies they invent in coping up with problems and challenges faced by the HCCs in improving ANC care services.
The researcher incorporated the Actor Oriented Approach Theory (AOP) in this study. The theory was propounded by Norman Long (1993). The actor oriented provides the give and take between actors of different networks (Holified, 2009). The AOP examines how the societal actors react to related structural conditions, even if the situation appears fairly uniform. Therefore it is not conflicting or at least not enough to put people into prefabricated groups or categories though from an outside point of view the patterns of local actors might appear to be of a certain outlook (Holified, 2006). In this light, it is very imperative to be aware of how the local actors make use of their linkages of known information to produce pleasing results. What appears to be fatalistic could be a complex of responses to transformations attempted from the outside that is deemed by the local actors incompatible with their life experiences (Norman, 1993).
In actor oriented approach (AOP), the group of fatalism is reconceptualised into a complex of network links that form a coping strategy, an agency of resiliency (Holified, 2006). Agency is the end result of actors’ ability to move abreast with the modification or their own conditions (Merton, 2003). This shows that AOP is a powerful instrument constituting the knowledge of the actors faced with change. Agency is the activities of a chain of agents each of whom translate it in accordance with his or her own project, power is composed here and how by enrolling many actors in a given political and social scheme (Holified, 2006). Therefore, the local actors might refuse outwardly strong coalition in opposition to capable aggressive transformations. According to the actor oriented approach theory, actors must not simply receive the information and absorb it without taking some actions but they should be energetic participants who hear act accordingly through processing the information they heard as well as strategising when dealing with different personnel (Merton, 2003). This means that the community should effectively respond to what HCC members are saying in as far as the improvement of ANC care services is concerned. They should not only hear but they should act in react in accordance with what they have heard to improve the ANC care services.
The community at large should participate in a number of roles in improving people’s standards of living (Collins, 2003). This means that the public every person in the community should play his or her part in upholding health issues such as the improvement of ANC services. The development and improvement of the community in several African countries also means that people in that community are healthy (Lloyd, 2005). This means that communities should consider health issues seriously for they also contribute to community development.
Long in his AOP stresses the significance of offering weight to and how the community such as the farmers and other recognised players in the community can shape and improve development themselves, although they are usually obstructed from living their visions and choices by scarcity of crucial resources (Johns, 2011). This means that people in the community should not passive recipients of health complains, but they should put their heads together as a community with the guidance of the HCC and reach a consensus in order to improve the ANC care services in their area. Every person in the community should contribute according to his or her capacity in as far as the development of ANC is concerned (Morgan, 1999). This is very crucial because it helps actors to create room as well as the platform for manoeuvre so as to serve their interests. Key to this analysis is the notion of agency which refers to the knowledge ability, capacity and social embeddedness associated with acts of doing and reflecting that impact upon or shape one’s own and others actions and interpretations (Holified, 2006).
Merton (2003) supports Long by saying, “In following and respecting the duties of my daily living, I help replicate communal institutions or organisations that I did not help in building or constructing them. In the same way, my performance comprises, reconstitutes the situations of others as their actions and performance do mine. This means that the community should treat people in a good and health manner, the community should work together to solve emerging issues in the society (Collins, 2003). For example, the community should effectively participate in building maternal wards, waiting house and roads through HCC so as to improve the ANC services. According to the AOP every member of the community has an important role to play in improving the community in all angles. This shows the importance of HCC in Health sector in any community.
The researcher used a qualitative design to explore the roles of the HCCs in improving the antenatal care services. Qualitative psychological approaches are essentially used in exploring and investigating personal as well as social experiences of respondents (Smith et al, 2008). Qualitative research is a broad name covering various forms of investigation that help one understand and give details the gist of social issue without or with little disturbance of normal setting (Miriam, 1998). Qualitative research approach incorporates the use of concepts as well as detailed meanings with the aim to interpret and understand the behaviour of people in a way that reflects not only the analysis view but also the views of the people under study (Kolk, 2006). Data collection is qualitative research is controlled and mediated with this human tool, the researcher, than the use of close inventory, computers, and questionnaires (Cohen, 2000).
These are instruments used to collect information so as to achieve the research objectives. In this research the researcher incorporated the use of unstructured interviews and Focus Group Discussions (FGDs).
In this research, the researcher used unstructured interviews to collect information from the respondents. Unstructured interview is one of the interview types that are conducted without a guideline or interview schedule to be followed (Gattawa, 2010). Unstructured interview is a research tool used for gathering data as well as making decisions regardless of the evidence of its invalidity. Moreso, unstructured interviews does not involve the use of questions as guidelines when asking respondents some questions but it involves direct interactions of the interviewer who is the researcher and the interviewee who is the respondent.
When using the unstructured interviews to gather information, the interviewees answer questions according to a random system. Reliable with sense making, random interviews did not trouble predictions or reduce perceptions of the quality of information that the interview yielded (Gattawa, 2010). In this study, the researcher interviewed ten participants (5 females and 5 males) who were members of the HCCs at Sakupwanya clinic in Mutasa district. The researcher opted for unstructured interviews because they provide the interviewee with the platform to liberally communicate and express themselves on the roles of the HCCs in improving ANC care services. The tool also allows the interviewer to show some flexibility by explaining, rephrasing and repeating the asked questions. Unstructured interviews provide the researcher with the opportunity to probe the respondents for more information.
The researcher opted for unstructured interviews since they help him gather useful first hand information without delaying. Through the use of unstructured interviews the researcher will be able to record, read some body gestures and expressions. Unstructured interviews are not harmful; and they are useful because they convey some benefits, such as growing dedication from an applicant to accept if given an offer of admission (Clive, 2003). In addition, even if interviewers do not consistently exploit it to increase overall accuracy, the unstructured interview may sometimes uncover important information that is special to a candidate (Campron, 1997). They also gave the researcher the opportunity to read body language and the tone of the pupils. Therefore unstructured interviews were flexible in this study of exploring the role of HCCs in improving antenatal care services.
FOCUS GROUP DISCUSSIONS.
Defining feature of Focus Group Discussions (FGDs) is the use of the group discussion to generate data and other important insights that might be difficult to gather without mixing and mingle with the participants (Gattawa, 2010). The group position can arouse participants to open up their ideas, perceptions as well as their views. In this research, participants were grouped regardless of their gender. This means that one focus group discussions (FGD) was held with HCCs members on the roles of HCCs in improving ANC services.
Furthermore, it is assumed that group discussion would manufacture and generate more responses enabling respondents to probe, build and expand on other participants’ views, comments and ideas. This therefore provides an in-depth analysis on the matter understudy (Clive, 2003). Thus the researcher will collect adequate and valid information in a short period of time and at a low cost and this is suitable to the researcher. FGDs allow the researcher and participants to interact directly and this provides the researcher with the platform to clarify some questions which might be difficult to conceptualize by the participants. In addition, the researcher accommodated the use of focus group discussions because they accommodated illiterate respondents.
Sampling is the structure or plan on how elements or participants to be incorporated in the research are selected (Smith, 1981). In some cases, the population might be too large; hence it will be difficult to manage. Probabilistic sampling and non-probabilistic sampling are two types of sampling. In this research, the researcher employed a non-probabilistic sampling in form of purposive sampling because she had opted for qualitative research method.
Purposive sampling technique is a method used to recognize cases for certain features so as to capitalize on variations (Morgan, 2004). Purposive sampling is accommodated when researchers are concerned with getting and acquiring a little priced estimation of the truth. Purposive sampling is commonly used in educational researches because it helps the researcher to reach a number of participants in a short period (Smith, 1981). In this study, the researcher purposively targeted the members of the HCCs at Sakupwanya clinic in Mutasa district. Purposive sampling is frequently used during initial research efforts to obtain a gross estimation of the outcomes with no cost, unlike selecting a random sample (Smith, 1981).
Purposive sampling entails that the researcher engage in the field with specific perspectives in mind which the researcher wanted to examine and seeks for research participants that can cover a full range of perspectives (Morgan, 2004). In this study of exploring the roles of the HCCs in improving antenatal care services, the researcher has plethora of ideas which guided her from waffling. Purposive sampling technique was accommodated because it is cheap; the technique saves time since the selection participants is done in a short space of time. The researcher chose ten respondents from both males and females who constituted the HCCs at Sakupwanya Clinic.
The following ethics will be considered:
Seeking permission – after granted the permission to carry out the research by the faculty authorities, the researcher will seek permission from Mutasa district Administrator, Sakupwanya Clinic authorities to carry out the study with the expecting mothers and the HCCs members at the Clinic as participants.
Consent forms-Informed consent to talk and interview expecting mothers and HCCs members who will be the respondents will be sought and all participants will sign a consent form showing that they are willing to participate in the study. Participants will be informed that they are willing to withdraw from the study whenever they feel like.
Confidentiality- confidentiality was maintained up to its highest degree. All information gathered was made privacy and reserved under lock and key. Each person’s responses, insights, recommendations as well as opinions, insights were kept secretly. Pseudonyms were used to guarantee anonymity and confidentiality. This means that participants’ real names were not used throughout the research process. Participants were informed that the data collected will be for educational use only.
Debriefing- Respondents were informed about the reason why the research was been carried out prior to their participation. The researcher wanted to keep away from leaving the participants in confusion and doubt as to how the research findings are going to be used as well as raising false expectations in the participants by stating the objectives as well as the aim of the Focus Group Discussion and unstructured interviews.
PRESENTATION OF FINDINGS.
The data was presented using the thematic approach. Themes were formulated in relation to the study objectives.
THE ROLES OF THE HCCS IN IMPROVING ANC SERFVICES.
In this study the first question was of indicating what a HCC is. In response to such, it was revealed that Health Centre Committee is the means by which people get implicated in health service planning at village, community, or district. The researcher observed that, HCCs report on society grievances concerning quality of health services as well as discussing health related matters with health workers. Most of the respondents revealed that, health issues require team work to ensure that quality health services are offered to people. This clearly shows that all respondents were aware of what a HCC is.
A question premised on the roles and responsibilities of Health Centres Communities in improving antenatal care services was posed during the interview session. Responding to this question, it was revealed that HCCs have several roles. Most respondents indicated that these roles indeed improve the ANC services as the hospital has poor maternal rooms, poor roads in the district among others. Sekuru Sango who is one of the HCC members articulated that,
“HCC inofanira kugamuchira zvichemo zveveruchinji ichiendesa kumahofisi makuru ezveutano.” (Health Centre Committee should take up people’s grievances and present them to higher offices). Respondents also indicated that HCC should monitor the quality of services or care given to people of the community.
Mai Madziro who is one of the members of the HCC said, “HCC inofanira kuita basa rekutsvaga rubatsiro nekuunganidza zvinhu zvekushandisa pachipatara”. (HCC should plan ways of raising resources, collecting donations of things that might be used to develop the hospital). HCC should encourage people of the community to donate things for the development of the hospital. They should mobilise resources like quarry, concrete, bricks among others.
Most respondents aired the views that, “HCCs aise and talk about issues of patient care and stand for the public on matters they raise on services presented to observe how these can be tackled”.
To add on, from the focus group discussion, participants agreed that HCCs play several crucial roles in improving ANC services since they ensure that expectant mothers received quality services prerequisite for them to freely deliver their babies in a health ,manner. Respondents put forward that, “HCC should be a channel for information stream from the public or people in the community to the Rural District Committee (RDC) and back to the public.
Responding to the question, what are the roles of HCCs in improving the ANCs services? Most of the respondents alluded that HCCs help organise the public in the district to recognize their health challenges and problems and what should be done to alleviate them using the participatory methods. Kudakwashe Gwese said that, HCCs should play the role of assessing whether the health interventions being used in the area are making a difference to people’s health using health information system and community information. He went on to say that HCCs should co-coordinate programmes about health. Participants said that HCCs have the role of working with the RDC so as to motivate and apply public health standards, which include water supply and sanitation among others.
Respondents also said that, Health Centre Committees have the role of educating people in the community about health issues, which is very important and central in the advancement of achieving good health.
BENEFITS OF HCCs IN IMPROVING ANC CARE SERVICES.
Most participants acknowledge and appreciated health centre committees in improving ANC care services. The respondents said that they get and witnessed several benefits from the HCCs. They articulated that they get water and sanitation, more maternal wards and houses were built at Sakupwanya clinic, from the effort exhibited by the HCC in Mutasa District. Mai Rutendo Sajanga who is one of the HCCs members said that,
“HCC inobatsira kwazvo nokuti inoita kuti madzimai akazvitakura avane dzimba dzekugarira nekusunungukira”. (HCC is very important because it builds waiting houses and maternal wards for expecting mothers). These waiting houses and maternal wards create conducive and favourable environment for expecting mothers to deliver their babies with the assistance of qualified health personnel).
Furthermore, Tendai Nyamayaro also shared the same conviction with Mai Rutendo Sajanga, who said, “HCC inoita basa rokugadzira migwagwa yakanaka inoita kuti motokari dzifambe zvakanaka”. (HCC helps in the development of roads that are suitable for ambulances and other cars). These roads are very important when expecting mothers are being ferried to hospitals.
On the same issue, baba Takudzwa who is the chairperson of the HCC indicated that, “through health centre committees, expecting mothers receive important and prerequisite knowledge that help them to deliver health babies, for example food they should eat when pregnant, encouraged to do some exercises, he went on to say that her wife was ill treated by the nurses at Sakupwanya clinic during the delivery of her second born and the complain was forward through the HCC from the community to the RDC and it was solved”. In support of the above view, during interview session, one of the respondents indicated that, “I have managed to get quality care at Sakupwanya clinic due to the HCC’s role of monitoring quality of care rendered to expectant mothers and the taking up of community grievances. Most participants also cemented the above view by indicating that their voices were heard after HCC forwarded the community’s grievances RDC.
Moreso, during the focus group discussion, a question about the merits of HCC in improving ANC was posed. Responding to this question, participants said, through HCC the public voice about health complains can be heard, through HCC there will be improved ANC resulting in reduced morbidity and mortality of both the expectant mother and the child. Respondents also aired that HCC are locally available hence everyone in the community will have the accesses to forward his or her grievances.
CHALLENGES FACED BY THE HCCS IN IMPROVING THE UTILISATION OF ANC SERVICES.
Diverse views on the challenges faced by HCCs in improving ANC emerged from unstructured interviews and focus group discussions. Most of the respondents indicated that that they lack strong financial muscle that is prerequisite for the development of the ANC care services through building enough house required for the expectant mothers to stay at the hospital, to build enough maternal wards and other necessities required for heath delivery. During the focus group discussion, Mr Nhamoinesu aired the view that some of the developments they might thing of doing are hindered by lack of strong financial muscle. This is the most challenge that is affecting the HCC from offering the service that greatly improve the ANC care services.
The respondents argued that the government and its management should interfere and help HCC with financial support through the health ministry. The participants said that they lack finance to buy cement, timber, and asbestos. They end up building poor quality buildings without enough cement which might cause danger to expecting mothers. This greatly affects the improvement of ANC. In addition, respondents also indicated that financial mismanagement is another challenge they are facing that is hindering them from effectively improving the ANC care services at Sakupwanya clinic. Some of the treasurers of the HCC are corrupt to an extent that they tend to converts money collected from the community for their personal interests. The respondents also alluded that most of the people who constitute big number in the HCC are not well educated resulting in them indulging in poor planning and wasteful expenditure.
During the interview session, baba Takudzwa who is the chairperson of the HCC said that,
“Vamwe vanhu vari muHCC havagoni kutaura zvakanaka nevanhu wemudunhu kuti vabatirane pamwe nevamwe”. (Some HCC members have poor communication skills to an extent that they are not able to communicate with the public in expected manners). Some HCC members harass people when encouraging them to cooperate with others in upholding health issues. Therefore members of the public tend to fear them and they will fear to air out their problems to HCC members, hence it becomes difficult to forward and address such matters).
In the focus group discussion, participants also indicated that some of the members of the HCC do not have the important knowledge about their roles. This will let them leave several problems and complains unattended which hampered the improvement of the ANC care service delivery at Sakupwanya Clinic in Mutasa District. In the focus group discussion, Mr Nhamoinesu revealed that,
“Vamwe vanhu vari muchikwata cheHCC havazive mabasa avanofanirwa kuita”. (Members of the HCC are not aware of their roles or duties). They are not aware of their roles as HCC members and some of them think that their duty is only to collect money from the public.
STRATEGIES IN COPING WITH CHALLENGES FACED BY THE HCCS IN IMPROVING ANC SERVICES.
Furthermore, apart from the answers forwarded by respondents from the unstructured interview and focus group discussion indicated above. the researcher posed a question, how are you solving these challenges?, Baba Takudzwa who is the chairperson of the HCC said that they carry out some training and development programmes to educate HCC members about their roles and management of funds so as to alleviate problems emanating from poor management of funds as well as lack of expertise.
In the focus group discussion, Mr Nhamoinesu disclosed that,
“Dzimwe nguva tinotsvaga rubatsiro rwakasiyana- siyana kubva kune vanamuzvinabuzimusi nema NGOs”. (Sometimes we seek assistance from businessmen and Non Governmental Organisations (NGOs). The people in the community indicated that sometimes businessmen and NGOs assist them so that they might be able to provide adequate services that indeed improve the ANC care services).
DISCUSSION OF FINDINGS
The analysis of results or the findings obtained in this study was based on the themes deduced from the objectives of the study. Central to the debate is the roles of the HCC in improving ANC, related literature and the researcher’s views on the outcomes of the research of the roles of HCC and the improvement of ANC at Sakupwanya Clinic in Mutasa District.
JUSTIFICATION OF THE EMERGENCE OF HCCS IN TRYING TO IMPROVE ANC IN MUTASA DISTRICT.
It was revealed through this research study that high morbidity and mortality rate in the district alerted the community to be active and execute its roles in as far as the improvement of the ANC is concerned. This is supported by Collins (2003) who articulated that the improvement of health issues is not an individual task but the community at large. The research also noted that there were shortages of maternal wards and waiting room at Sakupwanya clinic. This escalated the rate of morbidity and mortality in the study area as poor services were rendered to expecting mothers. This is augmented by the view put forward by Lloyd (2005) that, high morbidity and mortality rate is sometimes resulted from poor maternal and waiting wards in health centres despite the fact of having qualified health personnel providing services. The exposure to danger of the expecting mothers has been found to be responsible for the establishment and formation of the HCC in the study area.
This is very important because HCC play a crucial role in encouraging and educating the public to abide by health rules, to air out their health complains and to actively participate in upholding their health (Johns, 2011). HCCs are mechanism through which communities can participate at primary care level to support people-centred health system, working with other community personnel, and they also help expecting mothers to receive quality care and services (Department of South Africa, 2013). The reliance on the community’s participation for reducing morbidity and mortality rate in the study area is similar to the research study conducted by Cowi (2007) in Natal province where the study noted that expecting mothers were facing challenges of shortages of waiting house at Ngoltal hospital. In response to this issue, the HCC built two waiting home which include two-four bedded wards, a three bed-nursery, a rest room, kitchen, laundry and a room for the HCC to improve the ANC care services.
Furthermore, studies conducted by Cehurd (2013) in Tete region in Mozambique revealed that the high morbidity and mortality rate which was prevailing due to poor ANC care services was reduced through the establishment of HCC. This is because hospitals alone cannot alleviate the problems of morbidity and mortality but the community at large should take its roles in upholding health issues. This serves to highlight the view that HCC plays a pivotal role in reducing high morbidity and mortality through the improvement of ANC services since they interact with the whole community educating the public not to sit and relax but to be active in any way possible for the improvement of the ANC. Therefore, it is from this background that because of amplified rate of morbidity and mortality in Mutasa District, people resorted to the establishment of HCC.
The study also found out that HCCs lack strong financial muscle. This in turn hinders them from effectively improving the ANC in Mutasa District. For HCCs to effectively deliver their services they need strong financial backup (Collins, 2003). In light with this view, HCCs need money to partake some of their roles for example the building of maternal houses, waiting rooms among others, meaning without money they will not be able to do them. This view is supported by Campbell (2007) who elaborated that strong financial muscle is key for the community members to put their vision of developing into existence. In light to this view, for development to take its course in the community, there should be strong financial support.
The research also revealed that the government and NGOs supported the HCCs through sponsoring them with finances and management. The government should participate in helping several stakeholders to uphold as well as educating people to consider health issues serious since they help in the development of the country’s economy (Morgan, 2007). This means that without the government’s intervention, HCCs might not effectively play their roles. In response to this view, for development to take place, assistance is very crucial. This view was augmented by Collins (2003) who indicated that, communities might have strong, clear and straight forward vision but they need assistance for development and improvement to take place. This means that HCC should receive assistance from various stake holders in this country. This is awfully imperative since it was noted that HCC can play important part in improving ANC care services (Campbell, 2007). In addition, this is witnessed by the study conducted by Machingura (2013) in Mazarura Village of Nyanga were it was revealed that NGOs play a pivotal role in helping and supporting community development. HCC in Mazarura Village of Nyanga was sponsored with money to build two maternal houses, a borehole and this really improved the ANC services (Collins, 2003). The improvement of ANC services in this village marked the development of the community at large as people tend to have improved health as well as infrastructure development. This clearly shows that every individual has a role to play in as far as the development and improvement of important issues in the community (Long, 1993). It is in light with this backdrop that one came to recognize that government and NGOs play a pivotal role globally as well as locally in improving the ANC in the study area.
To add on, the study also revealed that there is an improvement in ANC care services at Sakupwanya clinic due to the roles played by the HCC. When HCCs effectively play their roles, ANC services will improve (Kolk, 200). In light with this connotation, when people in the community put their heads together in response to an issue of concern, development and improvement will take its course (Long, 1993). The HCC can forward people’s grievances and can build waiting rooms and maternal wards that can be used to deliver much needed services to expecting mothers in Mutasa District (Collins,2003). It is important in this sense to acknowledge that the waiting house and some of the wards are built from materials gathered and donated by villages so as to improve ANC, hence every individual in the community is responsible for the development of any angle needed. In this light, the improvement helps expecting mothers to have quality waiting rooms, quality services, and clean water among others. HCCs are found to be the major players in improving ANC.
Furthermore, another significance of HCC in the improvement of ANC is that expressed in the study conducted by Bredenkamp (2013) in Honde Valley where he recognized that HCCs result in road construction from Sagambe to Hauna Hospital so that ambulances will be able to ferry expectant mothers to the hospital. This means that when one person cannot improve and develop the community alone but every individual should participate for the betterment of the community (Long, 1993). Clear roads in the community make it easy to ferry expecting mothers using various means of transport to and from hospital (Morgan, 1999). This clearly shows that HCC is very important in the improvement of ANC. Thus as the HCC is formed from the public, it can effectively improve people’s hygiene as they can work together with the community to improve their health.
HEALTH CENTRE COMMITTEES VERSUS ANTENATAL CARE SERVICES IMPROVEMENT.
The results of the study revealed that HCC played a crucial role in improving ANC services in Mutasa district. They indicated that through HCC they benefited roads, waiting houses, maternal wards, having their grievances addressed thereby improving reducing the morbidity and mortality rate through offering quality ANC services. This is because when quality services are being rendered to expecting mothers, the rate of morbidity and mortality will be reduced or eliminated and this will result in community development (Collins, 2003).in this regard, when people are health they will effectively develop their community as they will be physically fit numerically able to develop their community.
The same scenario is revealed in the study conducted by Boulle (2014) in Namibia. The study revealed that nearly ¾ of 70 Hospitals in Namibia have HCCs and they offer quality ANC services. This means that HCCs are very important in the improvement of ANC. This also means that HCCs should be established in Mutasa district so as to improve the ANC at Sakupwanya clinic. To add on, studies by Cohred (1997) in Mozambique revealed that HCC contributed much in improving the care services given to expecting mothers. This means that community participation in the health issues is very crucial for it leads to development easily. All these studies serve to confirm that HCCs are awfully imperative in improving the ANC care services.
Moreso, infrastructural in form of roads has been promoted through HCC in the community as this development improves the services given to the ANC and this should be appreciated. This is related to the study conducted by CWG (2014) in Kenya where he indicated that the development of the Kwaito community was as a result of the HCC with the aim to improve ANC services in the same area. Infrastructural development is crucial in the development and improvement of health services (Morgan, 1999). Furthermore, other research conducted by Johnes (2007) concurs that HCC has led to the improvement of ANC services in Tanzania Kalingo district were 50% of the hospitals have adequate waiting house and enough maternal wards. For development and improvement to be established, the concepts that united we stand and divide we fall should be applied because this allows every person to be active in participating in communal duties. This means that if HCCs are established in Mutasa district and educated about their roles, ANC will improve. Without HCCs, it becomes difficult for the public or the community to know what they are expected of doing to uphold issues as well as to reduce the rate of morbidity and mortality (Collins, 2003). It is in light with this connotation that ANC can be improved through HCC.
CHALLENGES FACED BY HCC IN IMPROVING ANC SERVICES.
Since it has been revealed in the study findings that HCC members lack sufficient expertise to make strategic plans as well as sufficient and useful budgeting plans to protect the funds of the committee, it becomes difficult for the HCC members to implement ideas and the budgetary tactics that improves the ANC. For development and improvement to take place, people of the community should have much needed skills and knowledge that help them facilitate and organise things in proper and expected manner (Collins, 2003). Members of the HCCs should be educated and equipped with much needed ideas that help them manage the collected funds and ideas on how to collect raise funds (Lloyd, 2005). For instance, the data gathered perambulated that some HCC members had no good and effective communication skills prerequisite for them to talk to the public. HCC members should have good communication skills which enables them to effectively talk with others (Collins, 2003). This means that when HCC members have poor communication skills, they will not be able to talk with the public in an expected manner.
The study also reviewed that HCC members face lack of strong financial muscle that help put their dreams and visions into reality. It is clear in this light to recognize the ideas put forward by Mach (2011) that community participation in upholding health issues is very important in improving ANC services. This means that ANC is not the baby for individuals but the whole community should actively participate for its improvement. Moreso, related studies conducted by Johnes (2007) indicated that poor or lack of communication skills, managerial skills and lack of corporation by the 30% of the communities in Tanzania in improving the ANC care services resulted in high morbidity and mortality rate. In response to this people in Mutasa district should team up for the improvement of ANC. To add on, other related studies are those conducted by Machingura (2011) in Buhera. These studies established that several communities failed to improve ANC care services due to the donor syndrome and lack of knowledge of individuals. People in the community should put their heads together and they should work together to alleviate the challenges that are hindering ANC development (Kolk, 2003). Therefore, it is of great value to acknowledge that human capital such as managerial skills is very crucial in improving ANC care services.
Furthermore, it has been noted that HCC in Mutasa district fails to live their vision of improving ANC due to some of the reasons outlined above. This has unhelpful effects on the improvement of ANC care services as people in the community will not be able to play their expected roles and forward their grievances (Lloyd, 2005). Improved ANC care services play an important role in serving people’s lives especially of the expecting mother and the baby (Clive, 2000). It is from this connotation that one noted that HCC should be established so as to improve ANC in Mutasa district. This also means that development and improvement of ANC cannot be achieved by an individual person but the whole community should participate. The gathered data resonates well with analysis used in relation to what is happening in Mutasa district. This is based on the issue that ANC is poor due to inadequate knowledge of the HCC.
It is awfully imperative and legitimate to acknowledge that Health Centre Committee has played an important role in the development of ANC in many areas across the globe. The establishment of HCC by health practitioners becomes a strong move to the upgrading and the upholding of health issues in several communities. HCC has several roles are key to the improvement of the ANC which reduces morbidity and mortality rate in all countries. However, although HCC is very crucial as indicated above, there is need of different supporters in the improvement of ANC to chip in with financial support, expertise skills, and communication skills for the improvement to be sustainable. From the resulted obtained by the study, it is revealed that there is still a journey in the improvement of ANC in Mutasa District. The HCCs are yet to know their important roles for the improvement of the ANC in the study area. It has also been noted that community cooperation is very important in the improvement of ANC. This is supported by the old adage which say that together we stand and divided we fall.