As Kenya hosted the first ever Africa Social and Behaviour Change (ASBC) Conference in February, the most important take out from the conference was that social and cultural contexts in most African communities are key influencers of health seeking behaviour.
They are a major barrier to health access and utilisation that should not be ignored in design and implementation of programmes that intend to create health impact for communities.
The perceptions, attitudes, beliefs and trust of the health system have been greatly influenced by social networks and cultural practices. Most delays in decision making to seek care are caused by gender-related powers and roles at family level.
These social-cultural determinants are the conditions that we live, learn, work, and play in, influencing the health and wellbeing of communities.
We have in many instances heard of parents who refuse to take their children for immunisation or to hospital while ill due to cultural or religious beliefs; of women giving birth at home because it is a cultural norm, or a spouse not consenting for cultural reasons. Most of us blame ignorance for this, but there is deeper reasoning that may lead one to forego medical care despite the risks.
Bearing this in mind, it is imperative that activities that tie back to culture are used to change perceptions around health and improvement. According to the World Health Organisation (WHO) Beyond Bias Report of 2016, a growing number of voices in the public health sector have been calling for the need to reconsider the important role that cultural contexts play in the provision of equitable health care.
Most notably, Lancet Global Health recently published an extensive commission report on culture and health in which a claim is made that the neglect of culture is the single largest obstacle to developing equitable health care.
Social cultural approaches such as Turkana County’s integrated cross-sector mobile service delivery model known as Kimormor (all in one/all under one roof) should be encouraged. Under this model, human and animal health services as well as social development services are provided together for hard-to-reach pastoralist communities. This platform is helping to promote positive lasting health change and wellbeing among pastoralist communities and increasing acceptability, access and utilisation of health services.
The approach is being implemented by Amref Health Africa through USAID funding and in collaboration with individuals and communities to influence positive attitudes and promote the adoption of new or improved behaviour. This has in turn enabled a more structured way of addressing the resulting demand for services while ensuring quality and accessibility.
This is a good example of how community-based participatory approaches to community mobilisation can help to achieve reliable and sustainable healthy lifestyles and behaviour change. Intended outcomes can only be achieved by building on the community’s knowledge and beliefs through continuous dialogue, and not by dictating to them what they should do.
Stimulating community dialogue by encouraging discussions on health and the underlying factors that contribute to poor health outcomes such as risky behaviours, harmful cultural practices and poor health seeking behaviour should be a key focus in ensuring progressive health outcomes within communities.
A lesson learned is that it should be done through structured dialogue to promote the active participation of communities in development matters. It should also include interaction with decision-makers to make sure their opinions are taken into account when defining programmes and policies. The process involves engagement of elders from village level to the supreme body of elders which is the highest governing body within the community as they are the custodians of culture.
This will enable greater community mobilisation for capacity building through which individuals, groups and families can plan, carry out and evaluate activities on a participatory and sustained basis to achieve set health goals thus stimulating change at both individual and community level.
Enabling communities to increase control and improve their health outcomes through health promotion can aid in reaching a state of complete physical, mental and social well-being.
In the context of management, health promotion involves working with people to prevent, prepare and respond to outcomes so as to reduce risk, increase resilience and mitigate the impact of disasters on health.
For Kenya to achieve UHC and ensure that health care reaches every Kenyan, much emphasis should be put in ensuring that practices that prevent access to health are eliminated by providing platforms to engage at community level. Social and behaviour change and communication should also be considered among the pillars of health systems strengthening.
Gilbert Wangalwa, Chief of Party, Amref Health Africa in Kenya.