Table 4 Perceived changes in health services

At baseline, the majority of the community members in Ilara had expressed great dissatisfaction with their health facility—it had poor environmental conditions, functioned poorly and did not provide antenatal and delivery services. At endline, bushes around the facility had been cleared and chemicals sprayed to impede their growth; the toilet in the facility had been fixed; temporary measures to ensure water availability had been instituted. More health workers and midwives had been deployed to the health facility, and final-year medical students on their community medicine posting were also deployed to the facility; antenatal and delivery services had commenced and drugs were frequently reported as now available in the facility. Health workers were described as very responsive to the community members, especially the young mothers, and many expressed their utilization of the health and immunization services as a result of a “revitalized” health facility

At baseline, community members in Ipara were more (but not completely) satisfied with their health facility. Young mothers in Ipara were happy with delivery services but wanted the facility to be upgraded to also take deliveries for women in their first pregnancies. At endline, many stakeholders in Ipara reported that the health facility now takes deliveries for women in their first pregnancies

Formerly, we only have one staff available here, and after two weeks, we won’t see the staff again and the facility will be locked, but now thing aren’t like that anymore. Whenever you come it is either you meet one or two or three persons on duty

—Young woman, Ilara

One woman in my house fell sick around 1.00 am; they took her to the health centre and they attended to her. If it was before, as at last year, it was not like that; but we thank God for the relationship between the joint action committee and the community, it brings about good results.

—Older man, Ilara

Health workers were now usually found at the health centre, and in a rare event where they were not available, the JAC community members were notified and the issue addressed. The health workers were described as being so responsive to the community members that they sometimes followed up pregnant women through home visits

Many respondents in Ipara reported greater availability of health workers and larger numbers as well. However, some older men and women asked for more “professionals” to be sent to their centre

R: Health workers are not enough. Where there are supposed to be three people doing a job, we find only one person

I: Do you always meet the ones available on ground?

R: Yes, but they are not enough

—Older women, Ipara

At endline, a recurring area of discontentment frequently mentioned by many respondents in the FGD and IDI in Ilara was the issue of a water source in the health facility. This was a target in the Ilara JAP that had not been met due to financial constraints. All the measures used at endline to obtain water in the health facility were temporary and were reported as usually funded by the chairman JAC and the health workers

At baseline, unavailability of running water in the Ipara health facility was a source of discontentment among many community respondents. By endline, an arrangement had been made to route water from the borehole in the adjacent compound (belonging to the Ipara Development Committee) to the health centre, so water was now available in the facility. This development, which was an achieved target in the Ipara JAP, was frequently mentioned by Ipara respondents in the FGD and IDI as a source of joy to community members and the health workers

The issue of water is already solved. We have been able to connect water to the health facility, and with that, health workers are happier and mothers are happier to know that they would not have to bring buckets of water to the facility

—Chairman JAC, Ipara