2013;8(2) doi: 10.1371/journal.pone.0055012. World Health Organization, UNICEF. Q J Econ. However, this study identified several factors which hinder community participation in the development of CCHP. Studies also reported reduced absenteeism [25, 26], reduced drug stock-outs [19, 26], reduced waiting time [26], better examination procedures [26], improved facility infrastructure and equipment [19, 25, 27] and reduced use of untrained providers [25] as well as generally improved quality of care [17, 18]. This, in turn, created opportunities for programme participants to advocate for more accessible services for women [27]. via stakeholder committees; intercultural sensitivity; and a focus on interventions to strengthen community capacity to support health. The site is secure. By clicking accept or continuing to use the site, you agree to the terms outlined in our. Register to receive personalised research and resources by email. (KI 2: CHMT member). (KI 8: in-charge of dispensary). 2013;8(2):e55012. Evidence From Iramba and Iringa Districts in Tanzania. Results: Community participation ranged from outreach educational activities to communities being full partners in decision-making. In general, implementation considerations were underreported. De Savigny D, Adam T, WHO. 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. 3099067 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. The systematic reviews themselves are not the topic of this paper. Given the limited resources and time, two wards were purposively selected for this study. In: Kahssay H, Oakley P, editors. Article As regards the implementation of the planned activities in the CCHP, the study found that the lower level health facilities staff are not aware of the annual facility budget, district budget, annual planned activities and even the action plans for implementing various activities in the CCHP. These include: lack of awareness among HFGC members; lack of awareness on the roles and responsibilities of HFGC; poor means of communication and information sharing between CHMT and HFGC, lack of management capacity of members of HFGC, and lack of financial resources for HFGC activities in their respective areas. Data generated were analyzed for themes and patterns. Objective: To conduct a 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. 43 No. 118. Women in the same study said there was more community support for pregnancy-related care. Bangladesh IJOG. George AS, Mehra V, Scott K, Sriram V. Community participation in health systems research: a systematic review assessing the state of research, the nature of interventions involved and the features of engagement with communities. PubMed Central (2011) observed that leadership transitions were a challenge to implementation; trust and relationship building had to begin again with each new leader [14]. This situation complicates further efforts to design effective interventions (10). Political environment 4. The existence of a school community is very important in order to promote effective education, it aims to mobilize and improve the quality of education in accordance with the needs of the community. All interviewed HFGC members reported that for many years, the lower level health facilities (health centers and dispensaries) are operating without budgets and they were not conversant with the annual activities and budgets, which have been developed, approved, and implemented by CHMT on their behalf. MeSH Strategies to increase rural maternal utilization of skilled health personnel for childbirth delivery in low- and middle-income countries: a narrative review. 2015;10(10):125. Ahluwalia IB, Robinson D, Vallely L, Gieseker KE, Kabakama A. Sustainability of community-capacity to promote safer motherhood in northwestern Tanzania: what remains? Under section 86A of Act No 7, 1982, Prime Ministers Office Regional Administration and Local Government, Summary of an assessment of comprehensive council health plans 2010/11 and third quarter (January March 2011), The interview is a conversation with a purpose, School of Health & Social Services, Massey University, Understanding mechanisms for integrating community priorities in health planning, resource allocation and service delivery: results from a literature review: EQUINET Discussion Paper No. 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). Strengthened abilities of community members and groups to plan and implement programme-related activities acquired through experience and training can be applied beyond the programme, enhancing community participation in broader civil society in the immediate and longer term [22, 23, 25, 26]. The majority of the respondents reported that they had never heard of CCHP. CHMT respondents also confirmed the findings that members of the HFGC were not trained or oriented with their duties and responsibilities: Honestly, we have not trained or oriented any of the HFGC members in our district on their roles and responsibilities. Cite this article. In Uganda, the programme encouraged communities to be more involved with the state of health service provision and strengthened their capacity to hold their local health providers to account for performance [26]. It was learnt that lack of autonomy at the lower level health facilities in controlling budget and their annual plans has partly contributed to the failure of HFGC to manage properly the collection of user fees and CHF. However, the supportive supervision checklist used by CHMT to supervise health facilities does not provide room for discussing issues relating to CCHP. Health Policy Plan. >> The aim of this study was to investigate An interview guide with questions focused on achieving the study objectives was developed to guide the interviews. J Prim Care Community Health. (KI 2: chairperson of health center governing committee). 5 Howick Place | London | SW1P 1WG. Challenges of citizen participation in regional health authorities. CAS Despite the various efforts aiming at ensuring that communities participate in deciding about their affairs including health issues, operationalization of such efforts is poorly done. Bethesda, MD 20894, Web Policies London: Intermediate Technology; 1995. pp. In short, we do not implement any activities outlined in the CCHP. The interviews were carried out in May 2013 and each interview lasted between 60 and 90 min and was held in the offices of the respondents or special rooms provided by the district medical officer (DMO) or in-charge of a health facility. Oakley P. Understanding participation. Community engagement to reduce inequalities in health: a systematic review, meta-analysis and economic analysis. Respondents cited supportive supervision as the major means of information sharing between the district level and facility level. Studies reporting qualitative data were included. These findings are consistent with other findings (8, 26), which revealed that lack of meeting allowances has a significant effect on committee functioning. 2006;27:32340. % Other cited benefits included policies and actions that reflected and addressed womens needs [27]. Workshop Paper 11, Institutional and economic perspectives on government capacity to assume new roles in the health sector: a review of experience, in University of Birmingham series The Role of Government in Adjusting Economies Paper 4, UK, November 1995, Making it work! Cultural adaptation of birthing services in rural Ayacucho, Peru. The findings across the two interventions were very similar so in this analysis we discuss them together. However, largely, such plans are prepared at the council level by Council Health Management Team (CHMT). 2022 Mar 14;19(6):3431. doi: 10.3390/ijerph19063431. One public health center was selected from each ward and two dispensaries were selected from the first ward whereas three public dispensaries were selected from the second ward. Lancet. << How to implement community participation effectively remains unclear. WHO recommendation on community mobilization through facilitated participatory learning and action cycles with womens groups for maternal and newborn health. (KI 15: in-charge of dispensary). doi: 10.7759/cureus.24643. Schapera notes that in, Available in print form, East Africana Collection, Dr. Wilbert Chagula library Members of HFGC reported that after their appointment as members of the committees, they never received any capacity building training concerning management in general and planning in particular. Table 1 shows characteristics of included studies. 1 0 obj Although the Government of Tanzania has made great efforts to reform the health care system by developing comprehensive policies and guidelines, there are still challenges in terms of accountability, community voice, information reporting, and feedback. eCollection 2022 May. Participatory monitoring and evaluation approaches that influence decision-making: lessons from a maternal and newborn study in Eastern Uganda. An official website of the United States government. s\1plI3M4wC&,1u &Bt{L?c>A]g]5Akp;_@UvGcNu0)Sej~Q!oBn$>nY$1&$Dq!dULa'TTMo}Tyw~v These concepts were further analyzed based on the research objectives to categorize their similarities and differences as well as identifying the main emerging themes. PMC This is the only chance for us to discuss issues related to health plan and expenditure of Community Health Fund and user fees. The observed poor communication and information sharing has resulted in poor involvement of HFGC in development and implementation of CCHP. Factors affecting effective community participation in maternal and newborn health programme planning, implementation and quality of care interventions. The authors declare that they have no competing interests. LKv Improvement of perinatal and newborn care in rural Pakistan through community-based strategies: a cluster-randomised effectiveness trial. The authors declare that they have no competing interests. WebTherefore, this study examines critical factors that hinder farmers participation in agricultural research in Ethiopia. via stakeholder committees; intercultural sensitivity; and a focus on interventions to strengthen community capacity to support health. The designs of the original studies, along with the complexity of the integrated multi-component interventions and the different approaches to community participation, make it difficult to link specific implementation strategies to specific outcomes [7, 8]. how community participation. Anastasia Gakuru When Results: Four approaches to capacity building in health: consequences for measurement and accountability. (KI 1: CHMT member). Results from a four nation study, Health, Nutrition and Population Department, Human Development Network, World Bank, Health care access of the very poor in Kenya. PubMed -. A qualitative research uses a naturalist approach, which tries to understand phenomena in context-specific settings; it gives details and insights of participants experiences of the world (16). We identified five categories of implementation barriers and facilitators reported by the studies: 1) the extent to which there was an enabling and supportive environment or not; 2) the nature of community capacity; 3) health system factors; 4) features of the interface between community and health services; and, 5) intercultural competence and sensitivity of the programmes. -, Zakus JD, Lysack CL. Frumence G, Nyamhanga T, Mwangu M, Hurtig AK. This site needs JavaScript to work properly. A qualitative approach was conducted in this study with key informants from Health Facility Governing Committees (HFGC), Council Health Service Board (CHSB), and Council Health Management Team (CHMT). A study in India [25] using community mobilization and monitoring noted: Community leaders reported that as a result of direct interaction with government officials on problems faced by health providers and the women themselves, there was more openness among officials to resolving issues and a greater willingness to accept feedback from the community p14 [25]. 2002;10(6):48591. Google Scholar. endobj 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. 1998;13(4):28595. Would you like email updates of new search results? %PDF-1.4 Our findings are limited by the following: a relatively small number of studies met the inclusion criteria for the original WHO reviews of effectiveness; there is little detail in these studies about stakeholder perspectives and the context and conditions in which programmes were implemented. volume17, Articlenumber:268 (2017) Community participation is regarded as an important tool for successful health sector development and it has been talked about since the mid-1950s (1, 2). 2005;36(3):20320. One respondent had the following to say: The doctor in charge informed me that I was one of the members of the HFGC but as far as I could remember, I never applied or contested for this post. The study was guided by the following objectives namely: to determine the effect of poverty, literacy levels of parents and teacher community relationship on community, Community participation has been adopted world wide as a means for improving the Other important measures include improving supportive supervision from the CHMT to facility level, ensuring proper dissemination of official documents related to HFGC and CCHP, allocation of financial resources to facilitate HFGC activities, and ensuring that newly elected HFGCs members are well prepared through orientation programs for members to understand their roles and responsibilities. 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. Report of the International Conference on Primary Health Care, Alma-Ata, USSR, Implementing decentralization policies an introduction, Guidelines for the establishment and Operations of Council Health Service Boards and Health Facility Governing Committees, Joint external evaluation of health sector in Tanzania, Tanzania health system assessment 2010 report. Community participation interventions in Bangladesh, India, Peru, China, and Indonesia were implemented in the context of new government schemes and approaches to upgrade services and make them more accessible and affordable [16,17,18, 24, 25, 27]. WebFactors Hindering Community Participation in the Development of ECDE Centres. Geneva: WHO; 2009. The evidence show further that after the intervention of improving the sharing of information between trained health staff and community members, there was improvement of community members in making decisions about their health needs as well as monitoring the way service providers deliver services (24). Stud Fam Plan. Conclusion: Building social accountability to improve reproductive, maternal, newborn and child health in Nigeria. Factors that hindered community participation included lack of awareness on the CCHP among HFGC members, poor communication and information sharing This study intended to find out factors that hinder community participation in developing and implementing Comprehensive Council Health Plan (CCHP). During the interviews respondents also indicated that there was no uniformity in the process of appointing community members into HFGC and the process appears to vary from one health facility to another. Please enable it to take advantage of the complete set of features! This study found that lack of financial resources to support the implementation of HFGC activities in the CCHP not only hinders the participation of the HFGC in developing and implementing CCHP but also hinders the effective functioning of these committees, including lack of timetables for conducting meetings as required in the guidelines. Howard-Grabman, L., Miltenburg, A.S., Marston, C. et al. We extracted data from 16 studies that could shed light on factors influencing implementation using an adapted SURE (Supporting the Use of Research Evidence) framework [12]. 2004. International Center for Research on Woman. The authors are grateful to the Muhimbili University, Singida Regional Secretariat, Manyoni District Administration for their tireless support during field work and data collection. National Progressive Primary Health Care Network. The comments from CHMT on collection of user fees and CHF were not different from those of HFGC members, as reported by of the CHMT members: Yes the facilities submit to us the collection of user fees and CHF because lower level facilities have not yet started to operationalize bank account; they are supposed to write the request of expenditure of their money after getting the permission of HFGC. /F2 9 0 R 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. However, neither CHMT nor facility heads requested feedback for the implementation of the provided instructions. Sustainability of Donor-Funded Health-Related Programs Beyond the Funding Lifecycle in Africa: A Systematic Review. 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Building in health: a cluster-randomised effectiveness trial groups for maternal and newborn care in rural Pakistan through community-based:! Declare that they have no competing interests authors declare that they have no competing interests and expenditure community! 10 ) howard-grabman, L., Miltenburg, A.S., Marston, C. et.. Cited benefits included Policies and actions that reflected and addressed womens needs [ 27 ] topic this! Of this paper the terms outlined in our: a systematic review, meta-analysis and economic analysis it... Critical factors that hinder farmers participation in maternal and newborn study in Eastern Uganda between... Several factors which hinder community participation ranged from outreach educational activities to communities being partners. Et al low- and middle-income countries: a systematic review, meta-analysis and economic analysis effective community participation the! 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