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Vollmer, Nancy (2023) Exploring the role of maternal social capital in overcoming barriers to primary healthcare during protracted displacement in northern Uganda, Thesis (Doctoral), Liverpool School of Tropical Medicine.
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N Vollmer_final thesis_Approved by Examiners_5.2024.pdf - Accepted Version Download (4MB) | Preview |
Abstract
Introduction
The global refugee population is continually increasing, reaching a new high in 2023. The majority of refugees live in low- and middle-income countries (LMIC) and are likely to remain in displacement for extended periods of time. Social capital may be among the few assets available to refugees through their social connections. Social capital is generally understood to represent the value of social relationships and the resources available through social networks. Relatively few studies have examined the role of social capital in humanitarian settings and how it may influence access to the community health system. This study explores the relationship between maternal social capital and health service access among refugees in protracted displacement in northern Uganda.
Methodology
This dissertation explores the role of maternal social capital in long-term refugee settlements in northern Uganda and its association with the use of maternal, newborn and child health (MNCH) services in refugee communities. We carried out a cross-sectional mixed methods study during May-July 2019 in four long-term refugee settlements in northern Uganda. A household survey (n=570) measured coverage of MNCH services and food security. The survey also incorporated maternal social capital indicators using an adapted social capital instrument. Analyses included descriptive statistics and regression models to test for associations between maternal social capital and utilization of MNCH services. Qualitative methods included focus group discussions (n=18) and in-depth individual interviews (n=48) with purposively selected mothers, foster mothers and adolescent mothers (n=230) in the same four refugee settlements. We performed thematic analysis using the framework approach.
Results
Findings identified several types of social capital relevant to mothers and caregivers in the West Nile refugee settlements. Maternal social ties served as a form of informal insurance, a source of mutual aid that was highly localized and available to mothers and caregivers when needed – provided they had invested in them through acts of reciprocity (e.g., sharing and informal exchange of social resources). Through their different social ties, refugee mothers and caregivers obtained a range of basic material, financial, informational and psychosocial resources that directly or indirectly influenced their access to the community health system. Refugee mothers and caregivers leveraged their social capital to overcome barriers to accessing the local health services. Using the social capital survey module, we also identified and measured four dimensions of social capital in our population. We found that different dimensions were significantly associated with different health services for MNCH.
Conclusion
Our qualitative findings offer insight into how maternal social capital develops and operates in the refugee study communities in northern Uganda. In addition, the adapted social capital survey module was useful for measuring the prevalence of distinct social capital dimensions in our population. Results can be used to identify vulnerabilities of the population in accessing the local health system in a protracted refugee setting. Using a social capital lens to understand healthcare access can provide guidance for adapting community health systems to the maternal social networks that arise during long-term displacement in LMIC settings
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