FACTORS HINDERING THE SUCCESSFUL OUTCOME OF RURAL COMMUNITY PROJECTS. Washington: The World Bank; 2005. BMC Pregnancy Childbirth. 2002;10(6):48591. statement and Health Policy Plan. (KI 12: chairperson of dispensary GC). -, Rosato M, Laverack G, Grabman LH, Tripathy P, Nair N, Mwansambo C, et al. That sounds too self-evident. We would like to gratefully acknowledge the contributions of the participants of the WHO Technical Consultation on Health Promotion Interventions for Maternal and Newborn Health that took place between 15 and 17 of July 2014 at WHO headquarters in Geneva, for discussing the preliminary outcomes of the systematic reviews and for their contributions to the first version of the report. Federal government websites often end in .gov or .mil. Health Policy Plan. Health Sci Rep. 2022 Apr 26;5(3):e611. Community involvement in health: assessing the first steps in Mpumalanga and the Western Cape, Community voice and role in district health systems in East and Southern Africa: a literature review, Community involvement in health development: challenging health services, Health development structures: an untapped resource, Discussion paper 19: effectiveness of district health boards in interceding for the community. They reported of never hearing or having been introduced to CCHP and its processes before. LKv
Resource constraints also presented challenges to effective implementation [14, 14, 17, 18, 20, 21]. 1998;13(4):28595. The findings indicated that there was poor communication and information sharing between CHMT and lower level health facilities in all subjects related to the CCHP. (KI 2: CHMT member). Health Sector Reform in Tanzania places emphasis on the participation of lower level health facilities and community in health planning process. Guijt I, Kaulshah M. The myth of community, gender issues in participatory development. However, the committees are reportedly performing or involved partially with other roles such as sensitizing the community to join the CHF, receiving and opening new drug kits, creating awareness on health problems, monitoring disease outbreaks, and giving advice to communities on health matters. The process of developing Comprehensive Council Health Plan (CCHP) shows that the HFGCs are consulted in the initial stage of health planning, which involves identification of priorities and needs to be included in the annual plans. Principles and processes behind promoting awareness of rights for quality maternal care services: a synthesis of stakeholder experiences and implementation factors. (KI 3: member of health center GC). 13, Decentralization and health care prioritization process in Tanzania: from national rhetoric to local reality, Community participation in local health boards in a decentralized setting: cases from Philippines, The impact of health centre committees on health equity in Zimbabwe, Health policy planning: a look at consumer involvement in Nova Scotia, Power to the people: evidence from a randomized field experiment on community-based monitoring in Uganda. MASCOT. In this article we explore different factors. Just to remind you, the facilities do not have a budget or bank account, so how can they be involved? 2013;1(4):1526. Furthermore, little is known about the attitudes and characteristics of the local leaders, particularly members of the CHSBs and HFGCs, who form part of the health planning and decision-making process. For that reason, they lack financial and management skills to perform their duties in the development and implementation of CCHP as narrated by one of the respondents: We were elected to form HFGC in 2010. However, largely, such plans are prepared at the council level by Council Health Management Team (CHMT). A key factor influencing implementation in most studies included whether interventions helped communities address the issues that affected them. Bhutta ZA, Soofi S, Cousens S, Mohammad S, Memon ZA, Ali I, et al. We used an inductive approach to identify themes as they emerge from the data (17). Karim AM, Fesseha Zemichael N, Shigute T, Emaway Altaye D, Dagnew S, Solomon F, Hailu M, Tadele G, Yihun B, Getachew N, Betemariam W. BMC Pregnancy Childbirth. Manage cookies/Do not sell my data we use in the preference centre. Careers. Webin 1990s peoples participation has strengthened into a well established principle of development which has received support from government, international developmental Bethesda, MD 20894, Web Policies https://doi.org/10.15270/43-3-269 More Citation Formats Issue Vol. The analysis of the factors influencing community participation in the development and implementation of CCHP has generated five main categories, which Many programmes worked with committees and stakeholder groups that helped facilitate the participation process. People also read lists articles that other readers of this article have read. There is no priority of evangelism. LHG, ASM, CM and AP drafted the article. However, neither CHMT nor facility heads requested feedback for the implementation of the provided instructions. 2003;82(2):23140. <>
Implementation requires careful consideration of the context: previous experience with participation, who will be involved, gender norms, and the timeframe for implementation. Disclaimer, National Library of Medicine For instance, five studies highlighted the importance to health facilities of having accurate data on population health, health services and case studies of maternal deaths and near-misses to improve quality and planning within services, as well as to share with the broader community to raise awareness about health priorities and to monitor progress over time [15, 17,18,19, 25, 26]. /Type /Page MeSH Unpublished Med thesis: University of Nairobi. Members of committees in India and Kenya were reported to appreciate having a better understanding of their own roles and responsibilities, for instance in the decision making process for resource allocation and financial management [15, 19]. In addition to the available evidence on the impact of participation, it is also important to understand which factors influence implementation of community participation interventions for maternal and newborn health. PLoS One. (KI 15: in-charge of dispensary). Culturally-appropriate materials in local languages are needed that are suitable for a range of literacy and numeracy skills for programmes where community members participate in analysis of health data as a basis for decision-making and action [14, 15, 17, 18, 24, 28]. Bhutta, et al. Community participation in in health programme planning, implementation and quality improvement was recently recommended in guidelines to improve use of skilled care during pregnancy, childbirth and the postnatal period for women and newborns. how community participation. 2010;71(6):11021109. For instance, in-charges of health facilities, who are also secretaries of HFGC, were partially informed on CCHP and plans of health facilities and most of them had heard about the CCHP through attending certain workshops/training. In Indonesia, the SIAGA social mobilization project intentionally built on the traditional value of collective help (gotong royong) as the foundation for their alert community campaign. Given the low level of education for most of the committee members, it was difficult for them to analyze issues and fully participate in planning of health activities. The systematic reviews themselves are not the topic of this paper. Methods: un-implementable or end up being partially implemented. The researchers selected this type of study design based on the type of information desired. Soc Sci Med. Provided by the Springer Nature SharedIt content-sharing initiative. The study found that there were no official documents available at the lower level health facility level regarding roles and responsibilities, which could guide the daily operations of the committees. Community participation; Health programme planning and implementation; Maternal and newborn health; Quality improvement. Nelson N, Wright S. Participation and power. For studies where communities played more active roles, particularly in planning and implementing health programmes [19,20,21, 25,26,27], rather than more passive roles as recipients of community outreach [13, 14, 16], development of community capacity to address programme challenges and barriers and increase programme ownership was a key factor, whether or not this was an intended programme goal. 4 0 obj
[Unpublished paper], Durban, South Africa: Health Systems Trust, Hospital governance in Latin America. This study intended to find out factors that hinder community participation in developing and implementing Comprehensive Council Health Plan (CCHP). Decentralization of public health planning is proposed to facilitate public participation in health issues. Rifkin argues that approaching community participation as a process rather than an intervention influences how the effect of community participation should be evaluated [7]. -. The CHSBs and CHMTs are responsible organs for receiving and reviewing the annual plans and budget projections from the health facilities (hospital, health centers, and dispensaries). Community participation ranged from outreach educational activities to communities being full partners in decision-making. In 1978, the Alma-Ata Declaration set principles to guide the planning, implementation, and evaluation of community-oriented health programs. CAS (KI 2: CHMT member). Moreover, this study found that the HFGCs did not conduct their scheduled quarterly meetings as per the CHSB's establishment tool of 2001. 2013;8(2) doi: 10.1371/journal.pone.0055012. Matern Neonatal Heal. Butterfoss FD. The identified challenges call for policy makers to revisit the decentralization by devolution policy by ensuring that local governance structures have adequate resources as well as autonomy to participate in planning and managing CCHP in general and health facility plans in particular. 2011. __tx?_Wk!G/8>{6k _)#bPun!0PV ,c^3; s|u9 Google Scholar. While many of the studies opted to involve leaders and influential people in quality improvement stakeholder committees and groups, some authors emphasized the importance of ensuring representation for those who often did not have a voice in community planning and implementation. Tran, Xuan Canh Indochinese parents and the Indochinese community tend to avoid participation in school activities and in the process of making decisions for their children's education. 2010;71(6):11029. We identified the following factors to consider when supporting community participation programmes: Enabling or not-so-enabling environment the extent to which political will, community awareness and sentiment, policies and available resources are supportive of maternal and newborn health and community participation; Community leadership and governance characterized by stability and strength of local leadership, the extent to which marginalized voices are represented in decision-making and whether and how to work with existing structures; Community management capacity to leverage and manage resources, use data for decision-making and for planning, monitoring, and accountability; Community and health system capacity to interact including the roles and relationships that community health workers, NGOs and others can play to link communities and health systems, and the use of regularly scheduled effective processes that use key questions to drive constructive dialogue; and. Revisiting community participation. 2017 Aug 31;17(1):267. doi: 10.1186/s12884-017-1449-7. Conclusion: Correspondence to An official website of the United States government. Article Many governing bodies do not exist in some councils, and where they exist, they are just symbolic as they do not fully fulfill their roles and responsibilities (8, 9). Key facilitators of community participation included supportive policy and funding environments where communities see women's health as a collective responsibility; linkages with a functioning health system e.g. (KI 2: CHMT member). The interview indicated that there is little support from government authorities at the district and village level to support the HFGCs in implementation of their roles especially in preparing and implementing the health facility plans. The analysis of the factors influencing community participation in the development and implementation of CCHP has generated five main categories, which explain why it has been difficult for participatory organs at the community level to participate fully in the planning and implementation process of health activities in these areas. However, some do and other facilities do not apply for money. Studies on community participation in planning and implementation of health programmes reported positive experiences of programme participants, although they reported few details. Lack of management capacity particularly in planning skills among HFGC members was a common concern raised in this study. In: Susan W, editor. Stakeholder committees in Bangladesh were reported to be generally acceptable, with the strongest committees recognizing they could apply their strengthened problem-solving skills to other issues beyond health, and saying that they appreciated programme staff assistance in how they motivated committees to come up with their own solutions [18]. In other studies this type of process occurred not by design, but serendipity: the community mobilization study in India, for instance, relied on the programmes community organizers to act as intermediaries between communities and health services as part of the intervention which in turn increased community willingness and ability to hold health workers accountable for services [25]. Programmes in Indonesia, India and Nepal highlighted the importance of programme personnel understanding and working to mobilize social networks in culturally-sensitive ways to bring about changes in social norms [20, 21, 24, 25]. 2022 Feb 19;22(1):359. doi: 10.1186/s12889-022-12730-y. Community involvement in health development: a review of the concept and practice. A member of a health center governing committee had this to say: I heard about CCHP when I was attending a workshop at the regional headquarters but I do not know in details about it. Harkins T, Drasbek C, Arroyo J, McQuestion M. The health benefits of social mobilization: experiences with community-based integrated Management of Childhood Illness in Chao, Peru and San Luis. Effects of a community-based data for decision-making intervention on maternal and newbornhealth care practices in Ethiopia: a dose-response study. Effects of community participation on improving uptake of skilled care for maternal and newborn health: a systematic review. Background of Study: In Pakistan, political process has been distracted due to many reasons especially lack of political participation. s\1plI3M4wC&,1u &Bt{L?c>A]g]5Akp;_@UvGcNu0)Sej~Q!oBn$>nY$1&$Dq!dULa'TTMo}Tyw~v As the programme evolved, however, the study authors report that community awareness grew: both about the nature of the challenges and how they could help by working together. The study employed a thematic approach in analyzing data. In Tanzania, one study showed how community members initially perceived womens health as the responsibility of individuals and were not inclined to work together to address barriers to service use [22, 23]. All authors approved the final version. This study revealed that the majority of the HFGC members were not aware of their roles and responsibilities. stream Yes it's true we are not budgeting for any HFGC activities due to shortage of funds but we really know this situation has negative impact to the performance of HFGC. 2021 Jan-Dec;12:21501327211029800. doi: 10.1177/21501327211029800. The guide comprised of questions on the awareness of community participation in health planning, roles and responsibilities of CHSB, HFGCs and CHMT, information sharing among governance structures, management capacity, and availability of resources. Int J Health Policy Manag. All authors have read and approved the final manuscript. Health Sector Reform in Tanzania places emphasis on the participation of lower level health facilities and community in health planning process. In: Kahssay H, Oakley P, editors. In this study, we have found that most of the members of HFGC had primary education level, which seems to be insufficient to make them competent in performing their roles without exposing them to appropriate capacity building programs through training. Our respondents said that HFGC were rarely involved in the implementation of some activities such as construction/rehabilitation of facility buildings. Business transactions may be limited among different communities or regions more if they have social and cultural differences as this may inhibit geographical mobility. Draper AK, Hewitt G, Rifkin S. Chasing the dragon: developing indicators for the assessment of community participation in health programmes. PubMed A village is a largest subdivision of a ward. 2014:2014. One of the respondents said: Maybe the CHMT fears that once we are capable to undertake our functions they will lose control of the resources which are supposed to be managed by ourselves. Yet, incomplete and inconsistent data at health facilities made it difficult to plan effectively, and also made it hard for programmes to assess the effects of changes they had made [17, 19, 28]. Since I became a member of HFGC I never saw or heard that our committee is consulted or involved in any stage of preparing what you called CCHP. For example, working in a setting in which there is a very low level of trust among members of the community is likely to require a great deal more time and effort spent on building trust before meaningful engagement in joint programme planning can take place. 2015 Mar 29;15:75. doi: 10.1186/s12884-015-0501-8. Glob Health Action. A gender roles analysis study in China advocated a gender rights focus as a way to help raise community awareness about inequities in womens access to services and other opportunities, making the case for womens participation in bottom up planning processes in resource-poor settings where womens status is low to better inform decision-makers about womens needs and views [27]. Lessons from community participation in health programmes: a review of the post Alma-Ata experience. This involved establishment of Council Health Service Boards (CHSBs), Health Facilities Governing Committees (HFGCs), and the introduction of a new formula of fiscal allocation to councils to enhance, among other things, good governance and community ownership in the public health care system at local levels (7, 8). Across studies there was limited discussion about why the programmes chose the approaches they implemented and the extent to which these approaches seemed to work, or needed to be adjusted during the programme. Some programmes were designed with this aim in mind; for example, the youth participation programme in Nepal and the Gender and Health Equity Network in China helped groups of socially marginalised people learn how to influence decision-making on health policy making and practice [20, 21, 27]. The aim of this study was to investigate Data were collected using in-depth interviews. Examining the links between community participation and health outcomes: a review of the literature. They included forming stakeholder committees [13,14,15,16,17,18,19,20,21], mobilizing communities to take action [14, 22,23,24,25], community based monitoring of health outcomes or services [17,18,19, 25, 26], community outreach activities to increase awareness of health issues [13, 16, 27] and facilitating stakeholder dialogues [19, 28]. Lack of training has also been reported to have an effect on the performance of HFGC members. Most authors did not report on how programme team members developed their own capacity to design, facilitate and support these processes and how relationships and personalities influenced effectiveness during implementation. HHS Vulnerability Disclosure, Help Some participants showed concern that lack of financial resources for paying allowances to HFGC members when they perform their duties has led them to become dormant or ineffective in participating in the implementation of various activities. Thus, when many developing countries started reforming their health sectors, decentralization became an important component of the reforms. via stakeholder committees; intercultural sensitivity; and a focus on interventions to strengthen community capacity to support health. some of the factors facilitating community participation included community mobilisation of local resources to support chps (communities made significant in kind and cash contributions to support the program), chps integration with pre-existing community structures (existing unit committees, health volunteers and traditional birth Having failed to achieve the expected development from the centralized planning system, policy makers and planners adopted a decentralized planning and implementation approach (6). In China, a rural health insurance scheme was introduced which allowed local officials to decide on which services would be covered. When asked to explain their roles and responsibilities in the development of health plans, one respondent said: For my knowledge I know we are supposed to participate in development and implementation of health plans but we have not performed this role because we have not yet been trained on issues related to health plans. There is a need for the national and district health authorities to address these problems so as to provide an enabling environment that will ensure better involvement of community and lower level health facilities in the development and implementation of various health plans for better health outputs. quality of basic education in primary schools. Factors affecting effective community participation in maternal and newborn health programme planning, implementation and quality of care interventions. The CHSBs and CHMTs are also responsible for incorporating these plans into CCHP before submitting them to the Full Council and the Regional Secretariat for further review and approval (11). One CHMT member said: CCHP is an annual activity plan for health sector developed by involving various stakeholders who also participate in its implementation. Limitations within health systems were highlighted in many studies. Mathur S, Mehta M, Malhotra A. Marston C, Renedo A, McGowan CR, Portela A. PubMed Central The site is secure. The authors declare that they have no competing interests. https://doi.org/10.1186/s12884-017-1443-0, DOI: https://doi.org/10.1186/s12884-017-1443-0. Karuga R, Kok M, Luitjens M, Mbindyo P, Broerse JEW, Dieleman M. BMC Public Health.
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