Facilitating community participation in family planning and contraceptives service provision and uptake: community and health provider perspectives

Abstract Background: Although community participation has been identified as being important for improved and sustained health outcomes, the challenge of designing and successfully implementing it in large scale public health programmes, including family planning and contraceptive (FP/C) service provision remains. Zambian participants in a multi-country project (the UPTAKE project) took part in the development of an intervention involving community and healthcare provider participation in FP/C services provision and uptake. This study reports key thematic areas identified by the study participants as critical to facilitating community participation in this intervention. Methods: This was an exploratory qualitative research study, conducted in Kabwe District, Central Province, in 2017. Twelve focus group discussions were conducted with community members (n=114), two with healthcare providers (n=19), and ten in-depth interviews with key community and health sector stakeholders. Data were analyzed using thematic analysis approach. Results: Four thematic categories were identified by the participants as critical to facilitating community participation in FP/C services. Firstly, accountability in the recruitment of community participants and incorporation of community feedback in FP/C programming. Secondly, engagement of existing community resources and structures in FP/C services provision. Thirdly, building trust in FP/C methods/services through credible community-based distributors and promotion of appropriate FP/C methods/services. Fourthly, promoting facilitative strategies that address structural failures such as feminisation of FP/C services and the lack of FP/C services responsive to adolescent needs. Conclusions: Understanding and considering community members’ and healthcare providers’ views regarding contextualized and locally relevant participatory approaches, facilitators and challenges to participation, could improve the design, implementation and success of participatory public health programmes, including FP/C.