Participation of women in primary health care in Swaziland : a study of factors influencing health-related decisions

It focused mainly on women as health care providers and users at two levels: the homestead and the maternal and child health (MCH) clinic. Primary health care as examined in this study is defined with both small letters (phc) and capitals (PHC). The former refers to the level of the homestead, that is, health as it pertains to the every day lives of rural women and what actions they take when they themselves, or very young children in their care, fall sick. The latter refers to the formal MCH services that are provided at the clinics and are an integral part of the PHC Program in Swaziland. The study population consisted of 185 women with children below the age of six in their care. They resided in two rural areas, one with a Rural Development Program (RDP) and one without a RDP. It was hypothesized that women in the RDP would be more involved in developmental activities, via women"s groups, and that this involvement would greatly enhance their health (and other) decisionmaking power within the home. In-depth interviews with 53 women in the sample were conducted on the concepts of PHC, community participation in health, and Health for All by the Year 2000 (HFA/2000). All the 185 women in the sample were also asked to name the MCH services available, and specifically to explain the relevance of vaccinations and weight monitoring, if these were mentioned by the respondents. The in-depth interviews revealed that 68% of the women had never heard the slogans of PHC and HFA/2000. The remaining 32% were not certain what they meant, and were skeptical about the possibility of attaining health for all by the year 2000. More than 90% of the 185 women were aware of at least five MCH services, although some components were more well-known than others. For example, 90% mentioned vaccinations and weighing for women, whereas delivery services were mentioned by 37% and postnatal services by just 1%. Approximately 95% were familiar with children"s preventive services. However, 87% did not know why children were weighed, and 85% did not know why pregnant women were vaccinated. The hypothesis that women in the RDP area are more involved with women"s groups was found to be untrue. In fact, more women in the non-RDP area were found to be involved in women"s groups. Moreover, the majority of health care decisions concerning women and children in both areas were made by women. In this regard, a relatively high utilization of specific services was found, such as vaccination of children (62% of the 288 children were found to be fully vaccinated at the beginning of the study). This suggests that in evaluating women"s participation in PHC programs, their involvement in family health at the household level is relevant and should be taken into account. Not surprisingly, their involvement at the clinic level was found to be limited to the role of consumer. Careful planning is required if women are to transcend this role and actively partake in the planning and management of MCH services. (Author abstract)