Community participation in the collaborative governance of primary health care facilities, Uasin Gishu County, Kenya

Abstract

Introduction Community participation in the governance of health services is an important component in engaging stakeholders (patients, public and partners) in decision-making and related activities in health care. Community participation is assumed to contribute to quality improvement and goal attainment but remains elusive. We examined the implementation of community participation, through collaborative governance in primary health care facilities in Uasin Gishu County, Western Kenya, under the policy of devolved governance of 2013. Methods Utilizing a multiple case study methodology, five primary health care facilities were purposively selected. Study participants were individuals involved in the collaborative governance of primary health care facilities (from health service providers and community members), including in decision-making, management, oversight, service provision and problem solving. Data were collected through document review, key informant interviews and observations undertaken from 2017 to 2018. Audio recording, notetaking and a reflective journal aided data collection. Data were transcribed, cleaned, coded and analysed iteratively into emerging themes using a governance attributes framework. Findings A total of 60 participants representing individual service providers and community members participated in interviews and observations. The minutes of all meetings of five primary health care facilities were reviewed for three years (2014–2016) and eight health facility committee meetings were observed. Findings indicate that in some cases, structures for collaborative community engagement exist but functioning is ineffective for a number of reasons. Health facility committee meetings were most frequent when there were project funds, with discussions focusing mainly on construction projects as opposed to the day-to-day functioning of the facility. Committee members with the strongest influence and power had political connections or were retired government workers. There were no formal mechanisms for stakeholder forums and how these worked were unclear. Drug stock outs, funding delays and unclear operational guidelines affected collaborative governance performance. Conclusion Implementing collaborative governance effectively requires that the scope of focus for collaboration include both specific projects and the routine functioning of the primary health care facility by the health facility committee. In the study area, structures are required to manage effective stakeholder engagement.

Community engagement initiatives in primary health care to achieve universal health coverage: A realist synthesis of scoping review

“…Building relationships based on mutual trust and meaningful exchange of ideas and information were reported to be of particular importance for marginalised groups [ 12 , 54 , 56 , 86 ]. Studies also highlighted that the encounter between PHC providers and community requires cultural competence–the ability of providers to translate information in a way that gives due consideration to health literacy level and encourages community understanding [ 44 , 54 ].…”

“…Building relationships based on mutual trust and meaningful exchange of ideas and information were reported to be of particular importance for marginalised groups [ 12 , 54 , 56 , 86 ]. Studies also highlighted that the encounter between PHC providers and community requires cultural competence–the ability of providers to translate information in a way that gives due consideration to health literacy level and encourages community understanding [ 44 , 54 ]. Several reviews included in our study reiterated that for CE activities to be meaningful and lead to positive change for communities, they need to be based on transparency, trust-building and information-sharing between communities and service providers, as this will enable people to feel comfortable seeking PHC services while providing PHCs with the opportunity to align services to community’s need.…”

The Governance of Pandemics in Primary Health Care: The Governance Strategies Adopted by Health Facility Governing Committees in Times of COVID Pandemic in Tanzania

“…The governance of the primary health care facilities is significantly needed now than ever because of the decisions that HFGCs have to make to combat COVID 19. Since primary health facilities can not be depending on decisions made by the top officially upper levels [41], HFGCs are advantageous to make contextual-based and timely decisions and institute relevant governance strategies that can minimize the COVID 19 effects at the subnational level. Strengthened governance institutions such as HFGCs promise for effective governance of COVID 19 and other pandemics in LMICs.…”

How context influences the functionality of community‐level health governance structures: A case study of community health committees in Kenya

“…33,34 One study in Tanzania showed that community members did not know about community-level committees, which hindered their functionality. 35 There is literature on facility-based HFMCs in Kenya, 22,36,37 but literature on community health structures for overseeing community health services in limited. 38 This research aimed to contribute to the body of knowledge on community participation by examining how contextual factors influence the functionality of CHCs in diverse ecological settings in Kenya.…”