Background
Methods
Indicators | Muanda | Bolenge |
---|---|---|
Province | Kongo Central | Equateur |
Location in DRC | Southwest | North central west |
Population | 137 178 | 79 648 |
Number of health centers | 9 | 15 |
Number of referral health facilities | 2 | 1 |
Health facility attendance rate (%) | 43.8 | 46.5 |
Antenatal health care attendance rate | 98.0 | 91.3 |
Proportion of pregnant women with more 4 visits and more | 46.2 | 40.2 |
Health providers’ attendance at birth rate (%) | 95.1 | 78.4 |
Main population occupations | Agriculture | Agriculture |
Fishery | Fishery | |
Small trade | Small trade | |
Oil Firm employment | ||
Population composition | Bantu ethnic groups | Bantu ethnic groups |
Pygmies | ||
Existence of other basic services | ||
Safe water supply | Yes | No |
Electric power supply | Yes | No |
Benefitting from a health intervention with social accountability components | Yes | No |
Enabling elements | Socio-cultural characteristics | Legal and regulatory framework and Governance context | Socio-economic conditions |
---|---|---|---|
Association | - Existence of social structures supportive of community participation - Existence of actors involved in maternal health issues in local settings - Existence of community network, organizations or groups - Existing local experience of participation or of citizen engagement - Women’s status /Gender barriers - Level of women participation in communities’ activities | - Existing political system - Existing of national/local political context supportive of community participation - Freedom of association - Existing recognition and accreditation policies and practices related to the freedom of association, of information, of convening meetings | - Socio-economic characteristics of population - Impact of local economy on members’ contribution, on association autonomy and advocacy - Impact on contribution by members and cost of convening meetings - Cost of legal registrations and accreditation |
Resources | - Social mobilization capacity within the community - Co-memberships - Existence of a history of community mobilization or social/citizen engagement - History of interactions between associations/groups - Decision making process within groups | - The individual capacity to collective action (social mobilization) - Decentralization | - Availability of basic services such as water supply, electricity/Infrastructures - Main occupations of the population/Earning potential of the population/ Size of and stresses in the economy unemployment |
Voice | - Existing media/Access to media/ Communication practices in local settings (use of media by different social groups) | - Level of political control of means of expression/media - Freedom of expression - Media related laws | - Cost associated with expressing views in media |
Information | - Access to Information - Information network - Literacy | - Freedom of information - Rights to access public information/Ability to demystify information | - Cost for access to information |
Negotiation | - Existing social values and hierarchies - Distribution of ethnicity and tribes - Existence of excluded or marginalized population/social inclusion - Existing social structures in place that enable women to actively participate - Social capital/social pressures capacity/capacity of actors or groups to negotiate change - Level of women’s participation in decision making | - Existence of legally established dialogue spaces such as referendum or forum in local level/Existence of health committee - Level of trust officials have in the demand or the organization mobilizing citizen action - Local government authorities’ capacities to engage | - Bargaining power - Impact of economic constraints in autonomy and advocacy |
Results
Expertise | Location | Sex | ||||
---|---|---|---|---|---|---|
Categories | Bolenge | Muanda | Male | female | Total | |
Community health workers/Health committee | Community participation, local organization | 3 | 2 | 4 | 1 | 5 |
Community groups | Community organization, community development activities, networks, social activities, health-related problem support | 6 | 7 | 7 | 6 | 13 |
Community leaders and traditional authorities | Community knowledge, social organization | 2 | 1 | 3 | 0 | 3 |
Health partner | Local health service development, health interventions, community-based organization support, | 1 | 1 | 2 | 0 | 2 |
Health providers | Health center management, community participation supervision, health provision | 2 | 1 | 2 | 1 | 3 |
Health zone management officers | Health service organization and management, community participation, health service supervision | 2 | 3 | 5 | 0 | 5 |
Local public administration officers | Community administration, local development | 1 | 1 | 2 | 0 | 2 |
Total | 17 | 16 | 25 | 8 | 33 |
Socio-cultural characteristics
Existing community associations and groups
Experiences in social mobilization and networking
“Local associations did not sufficiently manifest their capacity to be the voice of the community in front of authorities or other persons. We think that the community voicing does not function and authorities would not response to our request. We had not yet identified a community group that could speak up and influence the decision-making.”(Male, community group member)
Cultural diversity and marginalized population
“Our village comprises inhabitants that came from other tribes such as …The cultural identity and customs of each person do not affect the functioning of our community groups. This large variety of cultures does not influence the function of our groups.”(Male, community group member)
“Here, we sometimes have some problems. Natives are …and did use to call other people foreigners and sometimes marginalize them.”(Female, community group member)
Women’s status and participation in community groups’ activities
“The women participate in management or within the associations, a woman can be president, vice president, advisors and men are members as well.”(Male, community group member)“In the community, it is true that before women were less considered than men. However, nowadays with the action of non-governmental organizations, the effort of the state through the education of women, they are equal. A woman can realize what she wants depending on competences and skills she has. For example, the in-charge of the health center is a lady…”(Female, community group member)
“Women are not really involved in decision making. It is the culture. Very often, when they are sick, they are always accompanied by them husbands when coming to the hospital. But I am not informed with regard to the decision-making within the associations where the women and the men are members”(Female, Health provider)
“In reality, men and women are equal. The issue is that women in our environment…do not have the required competences or educational level for being effectively involved in decision-making.”(Male, community group member)
“Yes, women are very important, women here often work in fishery, the land/field or trading, thus they don’t study. We don’t really have women capable of working or expressing themselves very well. Often when women go to …there, that is all, they get married there and they have their life there. Here, women are not emancipated, maybe less than 20 % of them work, mainly as small traders.”(Female, Women’s community organization)
Existing media and access to information
Governance context
“Nothing more has changed with respect to the decentralization, and it is not effective yet.”(Male, community group member)
“The political level currently does not cause a problem for community groups. Existing groups have to respect the law. They must make themselves known to the political authority and follow the political and administrative regulations… by paying taxes and charges prescribed by the law.”(Male, public officer)
“Community groups have to refrain from “bad” activities. If not, the state will intervene. The state can get involved if the groups address political matters, speak negatively of the government, or in case of public disturbances as well or open conflicts among members or in the community.”(Male, public officer)
“The negative influence of the political context occurs during electoral propaganda, several people follow politicians who could give them money and gifts instead of getting involved in community engagement. They are sure to be beneficiaries of the generosity of politicians… The community participation disappears almost entirely during these periods of intense political activity.”(Male, Health Zone management team)