Self‐reliance or social accountability? The raison d'être of community health committees in Nigeria

Abstract

Social justice requires that communities demand social accountability. We conducted this study to inform ongoing efforts to facilitate social accountability through community health committees in Nigeria. We theorised that committees may see themselves in two ways – as outwardly‐facing (‘social accountability’) and/or as inwardly‐facing (‘self‐reliance’). We analysed the minutes of their meetings, alongside interviews and group discussions with committee members, community members, health workers, and health managers in four states across Nigeria. The committees' raison d'être reflects a bias for self‐reliance in three ways. First, seen as a platform for the community to co‐finance health services, members tend to be the local elite who can make financial contributions. Second, in a one‐sided relationship, they function more to achieve the goals of governments (e.g. to improve the uptake of services), than of the community (e.g. rights‐based demands for government support). Third, their activities in the community reflect greater concern to ensure that their community makes the most of what the government has already provided (e.g. helping to drive the uptake of existing services) than asking for more. Optimising the committees for social accountability may require support by actors who do not have conflicts of interests in ensuring that they have the necessary information and strategies to demand social accountability.

Scope of health worker migration governance and its impact on emigration intentions among skilled health workers in Nigeria

“…However, our study suggests a low awareness of the WHO Code or its role in the governance of SHW migration in Nigeria, consistent with findings from a study exploring its relevance in eastern and southern Africa [60] Even if poor engagement with the WHO Code can be explained by state actors' disagreement with its relevance in an African context [60], the absence of civic engagement on SHW migration and its impact on population health suggests a more fundamental issue regarding how this issue is perceived in Nigeria. Previous studies have shown that social mobilisation for improving population health in Nigeria is possible [6,61,62] Since our findings offer little evidence in support of social mobilisation for improved SHW migration governance, it may reflect a lack of consensus on how SHW migration governance offers public value in Nigeria. Beyond responding to push and pull factors, scholars have described migration behaviour as an expression of liberty-the freedom to choose where, and how to live [63].…”

Adoption and scale-up of the cardiovascular Polypill: a realist institutional analysis

“…We first theorized ‘context’ and ‘mechanism’ from the literature on entrepreneurial action in the face of institutional uncertainty; and we then used empirical data to operationalize the theorization ( Abimbola et al. , 2016 ; 2019 ; 2022 ; Braithwaite et al. , 2018 ; Shaw et al.…”

“Like a broom tied together”: A qualitative exploration of social cohesion and its role in community capacity strengthening to support integrated health in Nigeria

“…Nonetheless, these committees necessitate ongoing capacity building and related support, including that delivered through social and behaviour change_(SBC) programming [ 27 ]. For example, a qualitative study that examined capacity building for WDCs to promote health in Nigeria showed that following capacity-building activities such as training, mentoring, and supportive supervision, there was increased participation and commitment by the WDCs that translated to increased support for health facilities to provide quality health services in the community [ 28 , 35 ]. Community-based structures can enable communities to participate in the governance of primary health care [ 33 ].…”