Community participation and challenges to implementation of health programmes: the case of community-based management of acute malnutrition in Tolon District, Ghana

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This study investigated the challenges and motivation in accessing CMAM, the challenges CMAM workers face in implementing CMAM in the rural communities, the level of community involvement in CMAM, as well as CMAM beneficiaries’ perspective on how access to CMAM can be improved. 3 CMAM centres formed part of the study. Mothers and Community Health Volunteers (CHVs) at the various centres were selected by convenience. Consequently, spouses (fathers) of these mothers formed part of the study. The assemblymen for the communities in which the centres are situated, and the CMAM implementers at the selected centres also formed part of the study. The study employed in-depth interviews and used semi-structured interviews to obtain qualitative data from the study participants. Questionnaires were used to obtain quantitative data on beneficiaries’ demographics. Descriptive statistics such as frequencies and percentages were used to analyze demographic characteristics of beneficiaries and the results presented in tables, while the spider gram framework and thematic analysis was used to analyze the level of community participation. Through a process of reading and familiarization with the data, data collected was grouped into codes, basic themes and global themes. Challenges and motivation in accessing CMAM, challenges in CMAM implementation, as well as beneficiaries’ perspective of how to improve access to CMAM were analyzed based on these themes. Results from the study showed that majority 83.6% of the beneficiaries had no basic education, agriculture was the dominant occupation, and 21.8% of the beneficiaries did not have a source of income. The study also revealed that the level of involvement of beneficiaries in designing and implementing CMAM was very low (had a score of 1 in all the spider gram indicators). For mothers, challenges in accessing CMAM included geographic accessibility, delay at the CMAM centre, social events, cultural/social barriers and as well as no money for transportation and food when there is a delay at the centre. Challenges to implementation of CMAM in the district included poor logistics in the form of shortages of plumpy nut, problem transporting plumpy nut to the various CMAM centres, few teaching and learning materials for educating mothers, illiteracy/ poor enlightenment of the community, no incentives for Community Health Volunteers (CHVs), and ridiculing of CHVs by the communities. Lastly, gaining a source of income, receiving money from the government, provision of accessible drinking water, increasing rationing quantity, constant reminders from husbands and household members to attend CMAM and help with means of transport were the various ways beneficiaries thought access to CMAM can be improved. The study recommends improving community involvement in CMAM through involving traditional, religious, and opinion leaders as well as other interest groups in the decision making activities of CMAM. Decentralization is recommended to provide CMAM in more communities, good drinking water should be provided by the government for the communities in the district, Ghana health Service should create a well-structured delivery system for the CMAM programme and CHVs should be motivated with incentives such as means of transport/transport allowances.
A thesis submitted to School of Graduate Studies, Kwame Nkrumah University of Science and Technology, Kumasi, in partial fulfilment of the requirements for the award of Master of Philosophy in Sustainable Integrated Rural Development in Africa, 2016