Abstract

Community participation has been recognized as crucial for the attainment of "Health For All by the Year 2000". Primary health care (PHC) and community participation were the two main pillars identified by the government of Botswana to attain this goal in the country. This project will gather in-depth information on community participation, PHC, and the role of the nurse in community participation. The teams will work in three rural communities. The findings will be used to assess and reorient health care planning, policy making, and nursing education.

Post-Project Summary

The study was carried out in two rural and two urban communities, one "effective" and the other "less effective" in terms of community participation. The study combined qualitative and quantitative research methodologies. These included focus groups, participant observation, semi- structured interviews, ethnographic community profiles, and surveys of representative samples of household members, members of the district health team, key individuals in community and national structures, and all traditional healers and nurses in the four communities.

The study found that several factors contributed to the varying levels of community participation in primary health care. The most significant concerned the nature of the community; nursing and health care delivery and administration factors were of secondary - although not inconsequential - importance. It was noted that in certain communities, a larger percentage of individuals and households took the initiative in improving community health in general and their own individual and household levels of hygiene, diet and clinic attendance. Empowerment in one area, such as formal sector employment, tended to spill over into other areas and was manifested in collective activity channeled through, for example, the village health committee. It was further noted that a community was better able to socialize clinic staff into a participatory model of health care than the reverse. Such was the case in the effective rural community, which was noted for its positive nurse-village health committee relations.

Nurses were frequently given postings away from their families and there was a high turn-over rate, especially in rural areas. The nurses in the study consistently expressed dissatisfaction with the degree to which they could implement primary health care. Personnel shortages, role ambiguity and lack of support from superiors all contributed to apathy and job dissatisfaction. They perceived their role in health care to be primarily clinic-based and curative in nature. And, while the majority expressed satisfaction with their level of participation in the community, there as a general consensus among the other four target populations that the nurses could be more active. A number of recommendations flowing from these findings were set down in the final report.

Recipient Institution(s)