This paper explores whether community participation through health committees can advance the right to health, and what constitutes best practice for community participation through South African health committees. The paper reports on a series of 32 indepth interviews with members of three Community Health Committees and health service providers in the Cape Metropolitan area and provides some valuable insight into these areas. The most prominent barriers to participation mentioned by participants, included underrepresentation of vulnerable and marginalised groups, and the absence of a formal mandate giving Health Committees clear objectives and the authority to achieve them. A number of characteristics of Health Committees were identified that promoted more meaningful participation: a facility manager who helps tip the balance of power from health professionals towards the community by sharing decision-making with the Health Committee and by involving the Committee in facility operations; a form of apprenticeship in which newer Health Committee members learn skills and procedures from more experienced members; intersectoral activity through the regular involvement of ward councillors and environmental health officers in Health Committee meetings and activities; a mechanism for the Health Committee to be involved in the reviewing and resolution of patient-based complaints at health facilities; the use of the media and written sources of information by Committees to increase their visibility in the clinic and in the community, disseminate important health-related information, inform the community of Health Committee activities and broaden participation. Achieving small gains appeared to act as positive reinforcement and strengthen the Health Committees to achieve bigger gains.
Governance and participation in health
Local East African programmes are discovering the benefits of bringing HIV services closer to rural communities, with mobile drug distribution improving HIV-positive patients' adherence to antiretroviral treatment (ART). Health facilities in rural areas are normally remote, but by using mobile care and treatment centres, it is easy to reach populations who may not otherwise have access to services, according to the Support for International Change (SIC), a local HIV-focused non-governmental organisation in Tanzania. SIC reports using mobile drug distribution in northern Tanzania and witnessing a reduction of cases lost to follow up, compared to local health facilities that are recording higher levels of drop-out amongst patients. Patients must visit a hospital for their initial diagnosis and ART prescription, and are required to visit the health centre periodically, but in between visits, SIC uses community-based volunteers and trained medical workers to drive around villages refilling prescriptions as well as providing education on condom use and the prevention of opportunistic infections. SIC in Tanzania reaches nearly 2,500 people with mobile ART clinics and has so far trained around 200 health workers in Babati District in northern Tanzania.
Are reproductive health and HIV prevention outcomes for young people better when a project makes an explicit effort to involve community members? This briefing paper summarises the findings of a range of studies that have sought to investigate this question. Most evaluations reviewed identify positive effects including empowerment of participants, increased sustainability, greater acceptance of the initiative, and improved knowledge and attitudes. However, while studies that compared programmes that involved communities with standard programmes found these positive effects, some noted little or no differences in young people’s behaviour. The paper also provides references and links to resources on community involvement and youth reproductive health and HIV prevention.
The aim of this study was to assess malaria prevalence and knowledge, attitude and practice (KAP) about malaria in the ShewaRobit Town community in northeastern Ethiopia. In October and November 2011, 425 individuals were examined for malaria using thin and thick Giemsa stained blood film, and 284 of the participants were interviewed to assess their KAP about malaria. All respondents had heard of malaria. Most of the respondents (85.2%) attributed the cause of malaria to mosquito bite. However, some of the respondents (>20%) identified the causes of malaria as a lack of personal hygiene, exposure to cold weather, hunger, chewing maize stalks, body contact with a malaria patient and flies. Sleeping under mosquito nets, draining stagnant water and indoor residual spraying were the most frequently mentioned malaria preventive measures perceived and practiced by the respondents. Of the individuals examined for malaria, only 2.8% were positive for Plasmodium parasites. Although a respondents had a high level of knowledge about the cause, transmission and preventive methods of malaria, a considerable proportion of them had misconceptions about the cause and transmission of malaria, suggesting the necessity of health education to raise the community’s awareness about the disease.
Care of the mentally ill in Botswana is provided at different levels of coverage and sophistication. There is a single mental hospital in the country. Attached to the district hospitals are psychiatric outpatient clinics run by psychiatric nurses and a psychiatrist who visits them on monthly basis. Mental health care in Botswana has gone through a paradigm shift, from the prepenal years, penal years and institutional to community based care, which reflects a philosophy of citizen involvement and collaboration. The purpose of this article is to provide an insight into the developmental trends in community mental health care in Botswana. Different approaches are discussed and the opportunities that have emanated from them.
The WHO 3 x 5 plan envisages that community-based organisations, including groups of people living with HIV, will play a key role in scaling up treatment. This is not just a measure to plug gaps in the health services of heavily affected countries, but a response to evidence from early pilot programmes. These programmes have demonstrated that community participation is a key element in ensuring the acceptability of treatment. Making treatment part of the social fabric rather than a hidden enterprise is the only way to ensure long-term adherence.
Is there a relationship between people’s degree of community involvement and participation and their sexual behaviour? If this is the case, it may help to identify possible areas of HIV/AIDS intervention at community level. Researchers from the London School of Economics (LSE) investigated this relationship in a mining town in South Africa. The results were mixed. Whereas some forms of community participation were associated with safer sexual behaviour and lower levels of HIV infection, others acted in the opposite way. The findings highlight the need for further research.
The Global strategy for women’s, children’s and adolescents’ health (2016–2030) recognizes that people have a central role in improving their own health. The authors propose that community participation, particularly communities working together with health services (co-production in health care), will be central for achieving the objectives of the global strategy. Community participation specifically addresses the demand to transform societies so that women, children and adolescents can realize their rights to the highest attainable standards of health and well-being. This paper examines what this implies in practice. The authors discuss three interdependent areas for action towards greater participation of the public in health: improving capabilities for individual and group participation; developing and sustaining people-centred health services; and social accountability. They outline challenges for implementation, and provide policy-makers, programme managers and practitioners with illustrative examples of the types of participatory approaches needed in each area to help achieve the health and development goals.
Global discussion on the post-2015 development goals, to replace the Millennium Development Goals when they expire on 31 December 2015, is well underway. While the Millennium Development Goals focused on redressing extreme poverty and its antecedents for people living in developing countries, the post-2015 agenda seeks to redress inequity worldwide, regardless of a country’s development status. Furthermore, to rectify the UN’s top-down approach toward the Millennium Development Goals’ formulation, widespread negotiations are underway that seek to include the voices of people and communities from around the globe to ground each post-2015 development goal. This reflexive commentary, therefore, reports on the early methodological challenges the Go4Health research project experienced in its engagement with communities in nine countries in 2013. Led by four research hubs in Uganda, Bangladesh, Australia and Guatemala, the purpose of this engagement has been to ascertain a ‘snapshot’ of the health needs and priorities of socially excluded populations particularly from the Global South. This is to inform Go4Health’s advice to the European Commission on the post-2015 global goals for health and new governance frameworks. Five methodological challenges were subsequently identified from reflecting on the multidisciplinary, multiregional team’s research practices so far: meanings and parameters around qualitative participatory research; representation of marginalization; generalizability of research findings; ethical research in project time frames; and issues related to informed consent. Strategies to overcome these methodological hurdles are also examined. The findings from the consultations represent the extraordinary diversity of marginal human experience requiring contextual analysis for universal framing of the post-2015 agenda. Unsurprisingly, methodological challenges will, and did, arise. We conclude by advocating for a discourse to emerge not only critically examining how and whose voices are being obtained at the community-level to inform the post-2015 health and development goal agenda, but also how these voices are being translated and integrated into post-2015 decision-making at national and global levels.
This paper explores the extent, nature and quality of community participation in health systems intervention research in low- and middle-income countries.
It used peer-reviewed, English language literature published between January 2000 and May 2012 through four electronic databases. Search terms combined the concepts of community, capability/participation, health systems research and low- and middle-income countries. Most articles were led by authors in high income countries and many did not consistently list critical aspects of study quality. Articles were most likely to describe community participation in health promotion interventions (78%, 202/260), even though they were less participatory than other health systems areas. Community involvement in governance and supply chain management was less common (12%, 30/260 and 9%, 24/260 respectively), but more participatory. Articles cut across all health conditions and varied by scale and duration, with those that were implemented at national scale or over more than five years being mainstreamed by government. Most articles detailed improvements in service availability, accessibility and acceptability, with fewer efforts focused on quality, and few designs able to measure impact on health outcomes. With regards to participation, most articles supported community’s in implementing interventions (95%, n = 247/260), in contrast to involving communities in identifying and defining problems (18%, n = 46/260). Many articles did not discuss who in communities participated, with just over a half of the articles disaggregating any information by sex. Articles were largely under theorized, and only five mentioned power or control. Majority of the articles (57/64) described community participation processes as being collaborative with fewer describing either community mobilization or community empowerment. Intrinsic individual motivations, community-level trust, strong external linkages, and supportive institutional processes facilitated community participation, while lack of training, interest and information, along with weak financial sustainability were challenges. Supportive contextual factors included decentralization reforms and engagement with social movements. Despite positive examples, community participation in health systems interventions was variable, with few being truly community directed. Future research should more thoroughly engage with community participation theory, recognize the power relations inherent in community participation, and be more realistic as to how communities participate and cognizant of who decides that.