Evaluating a community engagement intervention to improve maternal health and prevent fistula in Guinea

Through a retrospective program evaluation, EngenderHealth/Fistula Care applied a conceptual framework to explore the outcomes of a community-level intervention on community capacities and assets, as well as the association between enhanced community capacities and maternal health knowledge, attitudes and care-seeking behaviors at the population level.

In intervention and matched comparison villages, semi-structured key informant interviews were held with community leaders and resource persons to explore community capacities and assets in key areas related to the intervention. A representative population-based survey was conducted among women of reproductive age and their husbands to explore maternal health knowledge, attitudes and care-seeking practices. Data from key informant interviews were used to create indices of community capacity related to maternal health. The association between high and low community capacity scores and outcome data related to women's and men's knowledge, attitudes, and care-seeking was explored through bivariate and multivariate analysis. Preliminary findings indicate that the intervention, which established and supported village committees to monitor pregnancies and promote health care-seeking, had concrete intermediary outcomes on several key domains of community capacity, and on the population level in terms of maternal health knowledge, attitudes, and care-seeking.

Interventions that enhance the capacity of community-level resource persons to explore and address health concerns in their communities can increase community leadership and attention to the issue and can result in population-level impacts on knowledge, attitudes and behaviors. Evaluation findings confirm the importance of engaging community partners as direct agents of their own change — not simply audiences for behavior change messaging.