The dynamics of community and NGO partnership: primary health care experiences in rural Mali

Solomon, Yodit; Ballif-Spanvill, Bonnie; Ward, Carol; Fuhriman, Addie; Widdision-Jones, Kacey

doi:10.1177/1025382308097696

Cited by 11 publications

(17 citation statements)

References 16 publications

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“…At the same time, other efforts have met with weaker outcomes [10]–[12]. Prior research has identified the cost, level and quality of available health services [7], [13]–[14], distance and transportation [14]–[16], and social and cultural norms [17]–[18] as site-level factors influencing the utilization of primary health care services.…”

Section: Introductionmentioning

confidence: 99%

A Systems Approach to Improving Rural Care in Ethiopia

et al. 2012

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BackgroundMultiple interventions have been launched to improve the quality, access, and utilization of primary health care in rural, low-income settings; however, the success of these interventions varies substantially, even within single studies where the measured impact of interventions differs across sites, centers, and regions. Accordingly, we sought to examine the variation in impact of a health systems strengthening intervention and understand factors that might explain the variation in impact across primary health care units.Methodology/Principal FindingsWe conducted a mixed methods positive deviance study of 20 Primary Health Care Units (PHCUs) in rural Ethiopia. Using longitudinal data from the Ethiopia Millennium Rural Initiative (EMRI), we identified PHCUs with consistently higher performance (n = 2), most improved performance (n = 3), or consistently lower performance (n = 2) in the provision of antenatal care, HIV testing in antenatal care, and skilled birth attendance rates. Using data from site visits and in-depth interviews (n = 51), we applied the constant comparative method of qualitative data analysis to identify key themes that distinguished PHCUs with different performance trajectories. Key themes that distinguished PHCUs were 1) managerial problem solving capacity, 2) relationship with the woreda (district) health office, and 3) community engagement. In higher performing PHCUs and those with the greatest improvement after the EMRI intervention, health center and health post staff were more able to solve day-to-day problems, staff had better relationships with the woreda health official, and PHCU communities' leadership, particularly religious leadership, were strongly engaged with the health improvement effort. Distance from the nearest city, quality of roads and transportation, and cultural norms did not differ substantially among PHCUs.Conclusions/SignificanceEffective health strengthening efforts may require intensive development of managerial problem solving skills, strong relationships with government offices that oversee front-line providers, and committed community leadership to succeed.

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Section: Introductionmentioning

confidence: 99%

A Systems Approach to Improving Rural Care in Ethiopia

et al. 2012

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“…Linkages were also established between communities, health system actors and non-governmental actors to facilitate community input into higher-level program planning and decision-making [29, 42, 58]. While some papers reported significant positive collaborations arising from these latter two types of linkages [42, 58], others found difficulties [25, 29–31, 59]. …”

Section: Resultsmentioning

confidence: 99%

“…Women, youth, the less educated, the elderly and ethnic minorities were found to be excluded from decision making processes dominated by men, older people wealthier families and/or those from more powerful ethnic groups [30]. In other instances, selection processes for community representatives, volunteers or workers were politicized with lack of open communication [29] and limited channels for inputs by the wider community [59, 64–66]. …”

Section: Resultsmentioning

confidence: 99%

“…Certain articles highlighted the minimization or exclusion of women from decision-making forums such as community meetings [24, 27, 59]. In another example, Harpham and Few [64] note that despite efforts to prioritize the involvement of women on ‘health boards’ in Dar es Salaam, Tanzania, women’s representation did not meet the minimum requirement.…”

Section: Resultsmentioning

confidence: 99%

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Synergies, strengths and challenges: findings on community capability from a systematic health systems research literature review

George

Scott

Mehra

et al. 2016

BMC Health Serv Res

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BackgroundCommunity capability is the combined influence of a community’s social systems and collective resources that can address community problems and broaden community opportunities. We frame it as consisting of three domains that together support community empowerment: what communities have; how communities act; and for whom communities act. We sought to further understand these domains through a secondary analysis of a previous systematic review on community participation in health systems interventions in low and middle income countries (LMICs).MethodsWe searched for journal articles published between 2000 and 2012 related to the concepts of “community”, “capability/participation”, “health systems research” and “LMIC.” We identified 64 with rich accounts of community participation involving service delivery and governance in health systems research for thematic analysis following the three domains framing community capability.ResultsWhen considering what communities have, articles reported external linkages as the most frequently gained resource, especially when partnerships resulted in more community power over the intervention. In contrast, financial assets were the least mentioned, despite their importance for sustainability. With how communities act, articles discussed challenges of ensuring inclusive participation and detailed strategies to improve inclusiveness. Very little was reported about strengthening community cohesiveness and collective efficacy despite their importance in community initiatives. When reviewing for whom communities act, the importance of strong local leadership was mentioned frequently, while conflict resolution strategies and skills were rarely discussed.Synergies were found across these elements of community capability, with tangible success in one area leading to positive changes in another. Access to information and opportunities to develop skills were crucial to community participation, critical thinking, problem solving and ownership. Although there are many quantitative scales measuring community capability, health systems research engaged with community participation has rarely made use of these tools or the concepts informing them. Overall, the amount of information related to elements of community capability reported by these articles was low and often of poor quality.ConclusionsStrengthening community capability is critical to ensuring that community participation leads to genuine empowerment. Our simpler framework to define community capability may help researchers better recognize, support and assess it.

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“…They learn to recognize their rights and gain confidence in speaking out for themselves (9). It is important for a successful health care programme to provide a culturally appropriate way to include women, to incorporate diverse local perspectives and to promote broad‐based participation, as well as to cooperate with local organizations and to involve members of the community (2, 10). The oral health training is embedded in the existing vocational training because it was considered that performing basic oral health promotional duties required specific competencies that these women acquired during their 6‐month training, among them are higher self‐esteem, as well as a changed attitude and confidence to educate fellow villagers.…”

Section: Introductionmentioning

confidence: 99%