Logics of community health actors at the crossroads of contraceptive promotion in Gagnoa (Ivory Coast)

Abstract

In Côte d'Ivoire, geographical disparities in contraceptive prevalence (estimated at 15% in rural areas and 21% in urban areas) have led health authorities to involve Community Health Workers (CSO) in the promotion of modern methods of contraception. It is in this capacity that the project of «Community-based distribution of contraceptives» (CBD) was initiated in 2016 in the health areas of Gagnoa under the leadership of UNFPA. However, this state issue is thwarted by the differential logic of these agents acting as an interface between local sexual and reproductive health services and their respective communities. To this end, this paper aimed to understand the influence of community health workers' logic on contraceptive promotion in Gagnoa. To achieve this ambition, we conducted a qualitative study in 10 health districts expressed by literature research and in-depth individual interviews with community health workers (20), health supervisors (05), and members of the district management team (05) In terms of results, it appears that the issue of adopting the DBC project in Gagnoa was to reduce the high rate of maternal mortality linked to high-risk pregnancies. However, the local CSAs have developed perceptions of the project related to mercantilist logic. This has negatively impacted their engagement in promotional activities throughout this initiative.