الفهرس 
AcknowledgementOnly 14 pages are availabe for public view
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Abstract
a) The key to attaining the goal of health for all is, in the view of the Alma-Ata Conference, primary health care. The conference highlighted the relationship of PHC and socio-economic development and defined the main pillars for its implementation, mainly equity and equality, community involvement, intersectoral collaboration and the use of appropriate technology. To be successful, PHC needs individual and community self-reliance and the maximum community involvement or participation. In community involvement individuals and families assume responsibility for their, and the community’s, health and welfare and develop the capacity to contribute to their own and the community’s development. Yemen has a history of effective community mobilization for development (through local development councils) during the 1970s and first half of the 1980s e.g. they built roads, schools, health clinics, water systems and numerous other local basic services. However, these councils lost their effectiveness in the late 1980s due to over-centralization and the loss of local funding. Local health committees (LHCs) are a totally new phenomenon in the Yemeni health sector, but part of the current national policy. They tend to consist of high level officials and health staff only, not really representing the communities, which make use of the health services offered. Community participation in health is mainly limited to the payment of user fees, without involving communities in the management of their resources. The success of national immunization days provides evidence regarding the importance of community involvement for achieving the desired results. So, raising and sustaining Expanded Program on Immunization (EPI) coverage requires the mobilization of Yemeni society on an ongoing and permanent basis. • The aim was to study the impact of community involvement on infancy vaccination coverage in rural areas of Hodeidah by: 1- Assessment of resources, process and outcome of community involvement in rural areas of Hodeidah governorate. 2- Assessment of the PHC immunization activities in rural areas of Hodeidah. • The study was conducted in 4 rural PHC centers located in four different health districts of Hodeidah governorate Local health committees have been already organized in 2 of them (Al-Dhehi and Al-Marawa’a). The other 2 did not have any organized local structures for community participation (Al-Jarrahi and Al-Zaidiah). • The data were collected using the following material and methods: 1- The available resources for community participation, at the health districts with local health committees, were assessed by a predesigned checklist for both human and non human resources. 2- An interview questionnaire was designed to all LHC members in the study rural health districts (Al-Dhehi and Al-Marawa’a) to assess their knowledge, attitude and practice concerning community involvement. 3- The process of community involvement was assessed by describing the series of action factors (e.g. assessment of needs, leadership, organization, resource mobilization and management) these factors were ranked from 1-5 according to their breadth as follows: narrow, restricted, mean, open and wide. 4- The quantitative indicators of community involvement were measured by interviewing of the LHC members and reviewing of their records. These indicators included organization indicators e.g. frequency of attendance at the organization meetings, participation indicators e.g. person-days of labor, development impact indicators e.g. links established with related groups. 5- An interview questionnaire was designed to 400 consumers attending for PHC services other than immunization (100 from each study rural PHC center) to assess their awareness about community participation. They were selected by systematic random sampling taking every fifth consumer. 6- The available human and non human resources for vaccination were assessed by a predesigned checklist to determine the extent of resource mobilization by the community. 7- The trend in infancy vaccination coverage was studied by retrospective reviewing of vaccination records till 1995 (2 years before and 2 years after organization of LHCs, which was in 1997). 8- An interview questionnaire was designed and subjected to 200 consumers attending the vaccination clinics of the rural PHC centers (50 from each health center) to assess the satisfaction of PHC consumers about the immunization services. They were selected by systematic random sampling taking every fifth consumer. • Collected data were subjected to statistical analysis by suitable techniques to achieve the aim of the study. • The results could be summarized as follows: 1- Deficient community participation resources were found e.g. absent plan for implementation of both PHC services in the context of its principles as well as immunization on implementary levels of PHC, in addition to un-availability of the following resources: religious, mass media and agricultural sectors were not represented in the LHCs, a place (room) for LHC meetings, health education materials, record or register for community contributions, and budget for local health committee (used for community mobilization).