Maternal mortality remains a major public health problem worldwide especially in low income countries [1
]. The reduction of maternal deaths by three-quarters, between 1990 and 2015, is a global concern, articulated as the fifth millennium development goal. Direct causes including haemorrhage, unsafe abortion, pregnancy induced hypertension, obstructed labour and sepsis contribute to 70% of maternal deaths, [1
] while indirect causes include malaria, anaemia hepatitis, rheumatic heart disease or HIV and AIDS and factors related to health systems.
Uganda has high maternal mortality ratio estimated at 435/100,000 live births [3
]. This is mainly attributed to direct causes of maternal deaths. Several factors including delay in seeking care, reaching health facilities, low socio-economic status, negative cultural beliefs and practices, and poor geographical access influence the high maternal mortality in the country [1
Emergency Obstetric Care refers to a proven set of essential interventions geared towards reducing maternal deaths [4
]. The core elements of emergency obstetric care include availability of essential drugs and supplies, patient referrals and the availability of skilled personnel to carry out effective interventions. Skilled health professionals working in favourable environment should be available and able to attend to every pregnancy and delivery [1
Community involvement in health systems has been defined variably [9
]. In this study, community involvement in obstetric emergencies' management are supportive measures/activities that influence/include making decisions towards seeking care; referring women; provision of essential physical and financial support, provision of transport and awareness creation by discussing issues on obstetric emergencies, communicating to health facilities/ambulance using available means like a telephone, bell, drum and or to community members regarding obstetric emergencies management so as to mobilize support for action.
The World Health Organization recognizes the importance of community involvement in health systems for several reasons [9
]. First community involvement in health programs nurtures the aspect of ownership and individual self worthiness. Second, community resources can be leveraged to complement the available resources. Third, community involvement can expand the coverage of health interventions. Furthermore, community involvement promotes the identification of needs and delivery of health services including for obstetric emergencies' management for the beneficiary populations. Community involvement has been shown to enhance obstetric health outcomes [10
] and improve utilization of emergency obstetric care, health seeking behaviour for obstetric care services and decision making process. Community involvement in health programs for obstetric emergencies strengthens health systems that promote utilization of services by women with obstetric emergencies [15
Strengthening community involvement in health programme implementation has been identified as a key link towards improving maternal health through addressing the delays in seeking health care and reaching health facilities [1
]. Thus community interventions including provision of men and women with information on sexuality and maternal health issues so that they may adopt and practice healthy sexual life style, empower women to recognize danger signs of obstetric complications.
Despite poor maternal health indices in low income countries, evidence indicates low community involvement in their management [6
]. Knowledge about symptoms and or signs of obstetric emergencies [8
], involvement and influence of men [15
], lack of money and demographic characteristics [20
], limited women autonomy in decision making to seek health care [8
], level of women's education [8
], perceptions on quality of health care [8
], community support activities and programmes [6
] are possible explanations in various settings. Successful community groups in facilitating access to emergency obstetric care have established funding schemes [6
Evidence in Uganda, indicates that community organizations play an important role in health programmes [30
]. Such institutions include burial groups, clans, insurance groups and Engozi
groups (local name for community initiated and based groups for responding to a specific need of transporting the sick to a health facility using a locally made stretcher). In the Engozi
groups for example membership of every household is compulsory. Members contribute cash for the purchase of a stretcher that is kept in the community for use in transporting the sick to a health facility [30
Despite these, Uganda has inadequate comprehensive emergency obstetric care services at both primary and tertiary levels [31
]. In response, the government of Uganda put in place a framework for accelerating the measures towards attainment of fifth millennium development goal target by 2015 [32
]. Rukungiri district has limited health facilities that provide basic and comprehensive emergency obstetric care with two level IV health centres and two hospitals. Nearly, three quarters (77%) of the population lives within 5 km of a health facility [33
]. The health indices in the district were poor, with doctor: population ratio of 1:18,513; nurse: population ratio of 1:895; midwife: child-bearing women ratio of 1:987 [34
], while only 44.3% mothers deliver at health facilities [35
]. So without information on how the community was involved in the management of obstetric emergencies including prevailing types of community involvement and factors influencing level of community involvement in the management of obstetric emergencies, the Rukungiri District Health Team could not design appropriate, effective and cost-efficient strategies for its improvement in efforts to reduce maternal morbidity and mortality. The study aim was to investigate community involvement in obstetric emergency management so as to inform strategies for improving maternal health status in the district. The objectives of this study were: to identify types of community involvement available/undertaken; and examine factors influencing level of community involvement in obstetric emergency management in the district.