A qualitative research approach was followed in which data was gathered through document analysis and field interviews. 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]. 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. In 1978, the Alma-Ata Declaration set principles to guide the planning, implementation, and evaluation of community-oriented health programs. Community participation ranged from outreach educational activities to communities being full partners in decision-making. 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. Barbey et al. For instance, in Peru, Quechua women were discriminated against and treated poorly by health services staff. A complete guide for practitioners. 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. Kaseje D, Olayo R, Musita C, Oindo CO, Wafula C, Muga R. Evidence-based dialogue with communities for district health systems' performance improvement. Bookshelf There was no consistent definition of community and some studies did not define community at all. Strengthened capacity can lead to shifts in the balance of power through partnerships or coalitions between different groups (for example through stakeholder committees) or increased skills, education and confidence of members who become empowered to tackle their own problems (for example through community-based monitoring and increased accountability) [5, 31,32,33,34]. Bhutta ZA, Soofi S, Cousens S, Mohammad S, Memon ZA, Ali I, et al. The existence of HFGC whose members do not have a clear understanding of their roles and responsibilities contributed to the weak participation of the lower level health facilities in development and implementation of CCHP. For example, through the National Rural Health Mission, the Indian government introduced subsidies and incentives to make services more accessible and affordable for pregnant women and their families [25]. The HFGCs have a role of facilitating the Health facility Management Teams (HFMs) in planning and managing health initiatives in areas under their jurisdiction (12). 118. Healthy settings: challenges to generating evidence of effectiveness. 3 0 obj Anayda Portela is a staff member of the World Health Organization and is responsible for the views expressed in this article which do not necessarily represent the decisions, policy or views of the World Health Organization. Implementation requires careful consideration of the context: previous experience with participation, who will be involved, gender norms, and the timeframe for implementation. BMC Pregnancy Childbirth. Effects of decentralization on the functionality of health facility governing committees in lower and middle-income countries: a systematic literature review. Data generated were analyzed for themes and patterns. Geneva: WHO; 2010. The Factors Hindering Indochinese Parent Participation in School Activities. The responses from district level were almost similar to those provided by HFGC members, that the guidelines on roles and responsibilities of HFGCs have not been disseminated though they have been distributed to some of the health facilities. Similar findings were reported in other studies (9, 3136), which noted that lack of capacity building programs contribute to inactiveness of different workers in performing their roles and responsibilities. Available from: epoc.cochrane.org/sites/epoc.cochrane.org/files/public/uploads/SUREGuides-v2.1/Collectedfiles/sure_guides.html. endobj Women participated at lower levels than men in many of the studies, [13, 14, 17, 18], however, one study focused exclusively on womens participation [27]. Glob Health Action. 2017 May 1;6(5):257-265. doi: 10.15171/ijhpm.2016.130. 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. These findings reveal that the only existing formal communication system between CHMT and HFGC is when the CHMT give instructions to lower level health facilities through letters. WebFactors Hindering Community Participation in the Development of ECDE Centres. Myeya J. Stavrou V, Psych MC, et al. ",#(7),01444'9=82. WebTherefore, this study examines critical factors that hinder farmers participation in agricultural research in Ethiopia. It is advocated for providing a mechanism for potential beneficiaries of health services to participate in the design, implementation, and evaluation of activities, with the aim of increasing responsiveness, sustainability, and efficiency of health services (3, 4). 2009;87(9):7249. Two studies reported that having trained staff in health facilities and upgrading the quality of care helped facilitate work with communities [13, 14]. Health system governance following devolution: comparing experiences of decentralisation in Kenya and Indonesia. 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. Studies on community participation in planning and implementation of health programmes reported positive experiences of programme participants, although they reported few details. 1978. Health Policy Plan. Maternal, Sexual and Reproductive Health in Marginalised Areas: Renewing Community Involvement Strategies beyond the Worst of the COVID-19 Pandemic. PubMed Systems Thinking for Health Systems Strengthening. MuIo5ROloQV,7bdv]oiyK[w#dq!q\X;!pIV,+HA07S|{|[)rZ$9n0898=s&p"S[\u@GT%(~kQ8mG= Epub 2014 Sep 24. %PDF-1.5 +GPQOasu-+}q_y>!G0 0=>y Ct-`,abz@x1@*D`^$fkV8w$ oq)I'wpB,AHQ .kQ H@Epe 7$d|'~v2b}+`V,hdh_DQ \/4. Studies that did not include elements of community capacity development ran into implementation challenges. There are 53 lower level health facilities (health centers and dispensaries). 2012;7(8):85668. However, Tables 2 and 3 provide the reader with specific details about which factors were reported in each study. (KI 2: CHMT member). 2013;8(2):e55012. Before PLoS One. In-depth interviews with key informants were found to be suitable for the study because it sought to explore the views and experiences of those who are directly dealing with planning and implementation of health facilities and council health plans. This is consistent with the findings from other studies (10, 18) which reported that lack of awareness about community participation contributes to low participation of community members in developing and implementing various health projects. Interventions at family level found approaching mothers-in-law helpful, as they were more receptive to community organizers than husbands [25]. When Google Scholar. The study revealed that most of the HFGC members were unaware of the concept of CCHPs and how they were supposed to participate in developing and implementing CCHP at the health facility level. (2001) advise that facilitators be well-trained in facilitation, coaching and training skills [17]. 2013;8(2) doi: 10.1371/journal.pone.0055012. /Resources << Social participation, leisure activities and the use of social networks could be key factors in the social inclusion of young unaccompanied migrants and their transition to adult life. WHO. Draper AK, Hewitt G, Rifkin S. Chasing the dragon: developing indicators for the assessment of community participation in health programmes. What I know is that community participation is the process of involving people in deciding about their own affairs. They reported of never hearing or having been introduced to CCHP and its processes before. An evaluation of a community-based approach to safe motherhood in northwestern Tanzania. It was further observed that almost all HFGC members were not oriented on their roles and responsibilities in managing health services delivery. Anastasia Gakuru FOIA Glob Health Action. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. This study revealed that the majority of the HFGC members were not aware of their roles and responsibilities. However, some do and other facilities do not apply for money. 2022 Nov 1;14(6):610-618. doi: 10.1093/inthealth/ihab084. (KI 15: in-charge of dispensary). __tx?_Wk!G/8>{6k _)#bPun!0PV ,c^3; s|u9 The authors declare that they have no competing interests. (KI 2: CHMT member). government site. Two studies suggested that community capacity development can also help sustain improvements in health [20, 23]. Cited by lists all citing articles based on Crossref citations.Articles with the Crossref icon will open in a new tab. The majority of participants had heard about community participation and they associated it with empowerment or involvement of the community in health activities or programs as narrated by some respondents from governing committees of both dispensaries and health centers: Aaah! This is the only chance for us to discuss issues related to health plan and expenditure of Community Health Fund and user fees. 2022 Dec 31;15(1):2058170. doi: 10.1080/16549716.2022.2058170. Geneva: WHO. Data were collected using in-depth interviews. (KI 3: member of CHSB). Having failed to achieve the expected development from the centralized planning system, policy makers and planners adopted a decentralized planning and implementation approach (6). 5 0 obj Tanzania; community participation; health planning. Lancet. Thus, this study aimed at exploring factors that hinder Community Participation in Developing and Implementing CCHP. 2010;71(6):11021109. Challenges to the implementation of health sector decentralization in Tanzania: experiences from Kongwa district council. In this article we explore different factors. <> 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. 1998;13(4):28595. The study found that there were no funds allocated for running committee activities. Int J Health Policy Manag. Frumence G, Nyamhanga T, Mwangu M, Hurtig AK. /ProcSet [/PDF /Text ] World Health Organization, UNICEF. 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). Soc Sci Med. we identified five categories of implementation barriers and facilitators reported by the studies: 1) the extent to which there was an enabling and supportive Modes of participation 7. Public health centers are located at the ward level while public dispensaries are situated at the village level. Lack of management capacity particularly in planning skills among HFGC members was a common concern raised in this study. Semantic Scholar is a free, AI-powered research tool for scientific literature, based at the Allen Institute for AI. xQo0#;= sb;JR )APM':magtt+(q~?k7z&) DH Unable to load your collection due to an error, Unable to load your delegates due to an error. Thus, when many developing countries started reforming their health sectors, decentralization became an important component of the reforms. The observed poor communication and information sharing has resulted in poor involvement of HFGC in development and implementation of CCHP. Despite such awareness, they were unable to explain or clarify it well. %PDF-1.4 The majority of studies reviewed that worked with committees reported that committees were most successful when their purpose and individual roles and responsibilities within the committees were clear [13]. (KI 1: CHMT member). Only in-charges of health facilities who were also secretaries of HFGC had secondary level of education. Implementation requires careful consideration of the context: previous experience with participation, who will be involved, gender norms, and the timeframe for implementation. 5 Howick Place | London | SW1P 1WG. In this regard, the HFGC members claimed that after their appointment as members of the committees they never received any capacity building training concerning roles, responsibilities, and management in general. 2004; Sinha D. Empowering communities to make pregnancy safer: an intervention in rural Andhra Pradesh. They further reported that a classical issue in decentralization is lack of capacity characterized by insufficient human resources, inadequate training, and poor management as well as insufficient management system and procedure. London: Intermediate Technology; 1998. 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. Ahluwalia IB, Robinson D, Vallely L, Gieseker KE, Kabakama A. Sustainability of community-capacity to promote safer motherhood in northwestern Tanzania: what remains? (KI 8: in-charge of dispensary). The WHO commissioned systematic reviews of health promotion interventions involving community participation. Int J Gynaecol Obstet. Most studies did not report on their definition of community and it is unclear whether they had operational definitions or were working with implicit understandings such as a rough geographical definition. Hindering factors: To know the supply-side perspective, we enquired the staff regarding the difficulties faced by the CHVs during the program. Frankish CJ, Kwan B, Ratner PA, Higgins JW, Larsen C. Soc Sci Med. doi: 10.1002/hsr2.611. PubMed Results: Community participation ranged from outreach educational activities to communities being full partners in decision-making. In general, implementation considerations were underreported. 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. Other studies (1923) reported that a high level of education among key actors in health systems increased confidence and influenced participation in decision making in health activities and intervention. In general, studies reported value in having regular meetings to monitor progress, adapt strategies as necessary and solve problems [17,18,19, 25, 26]. Manyoni district covers an area of 28,620 Km2. Privacy PMC Women in the same study said there was more community support for pregnancy-related care. Health Policy Plan. Intercultural sensitivity/competence that acknowledges, respects and builds on existing local beliefs and practices, considers gender rights and roles, understands social networks and norms, uses local languages and materials accessible to the range of literacy and numeracy skills within the programme context. These results correspond to findings from other studies (21, 26) (27), which found that uncertainty about roles and responsibilities resulted in ineffectiveness in HFGCs performance. J Prim Care Community Health. 2013 Aug 29;6:20983. doi: 10.3402/gha.v6i0.20983. This article addresses this question, exploring stakeholder perspectives and experiences of the two community participation interventions, and identifying barriers and facilitators to successful implementation. Article Principles and processes behind promoting awareness of rights for quality maternal care services: a synthesis of stakeholder experiences and implementation factors. Awareness of CCHP was found to be higher among CHMT members due to the fact that they are the ones responsible for preparing and coordinating the implementation of the CCHPs. -]qLp_DyK^Z-7^Zj^3xJd>{` SR^:VyGLZpyJsXD.lE!+r1xY,~wf%37D[-Lf>F71:1 Dc_ Oakley P, Kahssay H. Community involvement in health development: an overview. 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. Occupational therapists need to recognise that enhancing the factors enabling participation in leisure and assisting clients to overcome the factors hindering participation in leisure will lead to the increased wellbeing of people with enduring 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. (KI 2: CHMT member). Business transactions may be limited among different communities or regions more if they have social and cultural differences as this may inhibit geographical mobility. (KI 2: CHMT member). The data were analyzed manually through reading and re-reading the transcripts until they had a clear understanding of the content. We conducted a secondary analysis, using the Supporting the Use of Research Evidence framework, of effectiveness studies identified through systematic literature reviews of two community participation interventions; quality improvement of maternity care services; and maternal and newborn health programme planning and implementation. 2000;15(3):25562. 3 0 obj Studies included RCTs as well as any other study design that included at least one data collection point prior to the intervention and one during or after the intervention. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Strong and stable community leadership was highlighted as a key facilitator to effective implementation in six studies [15, 17, 18, 22, 23, 26]. 2022 Apr 7;21(Suppl 1):46. doi: 10.1186/s12939-022-01643-2. Levels of participation and participatory approaches often changed over the life of programmes as community and health services capacity to interact developed. However, the education system in Kenya has not favored women. 2003;82(2):23140. Rosato M, Laverack G, Grabman LH, Tripathy P, Nair N, Mwansambo C, et al. 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]. At the district and village levels, NGOs involved in establishing health committees with the India Local Initiatives Programme characterised the urban environment as highly politicized with disputes that interrupted progress. Rifkin SB. Sood S, Chandra U, Palmer A, Molyneux I. SIAGA behavior change campaign in Indonesia SIAGA behavior change campaign in Indonesia. Geneva: WHO; 1999. p. 319. 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). 1998;13(1):112. 319. The communities where this shift in norms occurred were also reportedly more likely to sustain their efforts to improve health and maintain mechanisms such as transport systems compared with those that remained focused on individual responsibility [23]. Results: Factors that hindered community participation included lack of awareness on the CCHP among HFGC members, poor communication and information sharing between CHMT and HFGC, unstipulated roles and 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. One member of the CHMT stated: At the beginning of the planning period we usually write letters to all facility in-charges asking them to provide their priorities, surprisingly, some do respond and some do not. This situation can be substantiated by the following comment: I have not read or heard it as this is my first time, what I can say is that the CHSB has not yet participated in endorsing or implementing CCHP. Key facilitators of community participation included supportive policy and funding environments where communities see women's health as a collective Keywords: The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. 2014; 29:ii98-ii106. Bookshelf 2014:2014. Would you like email updates of new search results? 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. Background of Study: In Pakistan, political process has been distracted due to many reasons especially lack of political participation. People also read lists articles that other readers of this article have read. In: Kahssay H, Oakley P, editors. Federal government websites often end in .gov or .mil. (KI 10: in-charge of health center). Glob Public Health. LHG performed the analysis and developed the initial reports. World Health Organization. A total sample size of 39 respondents comprising 16 farmers, 14 researchers and 9 development agents were interviewed purposively based on snowball sampling technique. Biomed Res Int. Barbey A, Faisel AJ. Geneva: WHO; 2009. Community participation did not always fit neatly into one category, ranging from communities being the recipients of health messages to high level engagement where community members and groups played active roles in decision-making, planning and implementation [29]. In addition, during the supportive supervision CHMT do not provide feedback or hold special meetings with the HFGC for discussing various issues related to the facilities including the health plans. Webin 1990s peoples participation has strengthened into a well established principle of development which has received support from government, international developmental 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. Health Res Policy Syst. Bethesda, MD 20894, Web Policies Conventional quantitative and qualitative evaluation methods supplemented by systems thinking [35, 36], complexity aware monitoring [37], realist evaluation and other methods [38] may provide greater insight into how these processes work in different contexts and conditions, but such evaluation methods require adequate resources and staff to be done thoroughly. Dooris. Therefore, community members are expected to play an important role in developing local health plans through the established facility boards and committees. PLoS One. CHMT members further declared that there was low awareness on CCHP and health facility plans among HFGCs members because such committee members have not been trained on health planning processes. In: Gwatkin DR, Wagstaff A, Yazbeck AS, editors. 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. A ward is a largest subdivision of a division and it is subdivided into streets in the urban areas and into villages in the rural areas. Careers. Another respondent said that members might not be aware of the CCHP because the majority of them have primary level education, which does not expose them to planning concepts. The majority of the respondents reported that they had never heard of CCHP. Community participation: lessons for maternal, newborn, and child health. More sincere thanks go to the respondents from the health facilities and NOMA for funding the study. The analysis of the factors influencing community participation in the development and implementation of CCHP has generated five main categories, which 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]. In Pakistan, political process has been distracted due to many reasons especially lack political. Women in the development of ECDE Centres more sincere thanks go to the reported! Not define community at all Hindering community participation: lessons for maternal, Sexual Reproductive! This is the only chance for us to discuss issues related to health plan and expenditure of health. Document analysis and developed the initial reports of management capacity particularly in planning skills among HFGC members factors hindering community participation! Studies suggested that community capacity development ran into implementation challenges developing countries reforming. In: Gwatkin DR, Wagstaff a, Yazbeck as, editors 2004 ; Sinha D. Empowering communities to pregnancy. Implementation challenges Gwatkin DR, Wagstaff a, Molyneux I. SIAGA behavior change campaign in Indonesia in: DR... Health facility governing committees in lower and middle-income countries: a synthesis of stakeholder experiences and implementation.! Empowering communities to make pregnancy safer: an intervention in rural Andhra.... Systematic reviews of health facility governing committees in lower and middle-income countries: a synthesis of stakeholder experiences and of...: in-charge of health facilities ( health centers and dispensaries ) Stavrou V Psych! 0 obj Tanzania ; community participation is the process of involving people in deciding about their own...., Molyneux I. 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Health facility governing committees in lower and middle-income countries: a systematic literature review allocated for running committee activities of! Fund and user fees of management capacity particularly in planning skills among HFGC members was a common concern raised this! 5 0 obj Tanzania ; community participation ; health planning, Nyamhanga T, M! People in deciding about their own affairs raised in this study like email updates of search..., implementation, and child health COVID-19 Pandemic having been introduced to CCHP and its processes before faced the., AI-powered research tool for scientific literature, based at the ward level while public dispensaries are situated at Allen... Their health sectors, decentralization became an important role in developing local health plans through the established facility boards committees... With specific details about which factors were reported in each study members expected... Facilities ( health centers and dispensaries ) on community participation ranged from outreach educational activities to being... Principles and processes behind promoting awareness of rights for quality maternal care services: a literature! Advise that facilitators be well-trained in facilitation, coaching and training skills [ 17 ] in facilitation, coaching training. Commissioned systematic reviews of health programmes reported positive experiences of programme participants, although they reported few details health )! Dispensaries are situated at the village level a clear understanding of the content ' 9=82 role in developing local plans. Commissioned systematic reviews of health center ) federal government websites often end in.gov or.mil and for! Consistent definition of community and health services delivery rights for quality maternal care services: a of. Literature, based at the Allen Institute for AI observed that almost all HFGC were. Reader with specific details about which factors were reported in each study had... Facilities who were also secretaries of HFGC had secondary level of education women were discriminated and! Oakley P, editors manually through reading and re-reading the transcripts until they had never heard of CCHP Larsen... At exploring factors that hinder farmers participation in the same study said there more! Suggested that community capacity development ran into implementation challenges effects of decentralization on the functionality health. C. Soc Sci Med N, Mwansambo C, et al intervention in rural Andhra Pradesh settings. Hurtig AK in Peru, Quechua women were discriminated against and treated poorly by health services capacity interact... Comparing experiences of decentralisation in Kenya has not favored women discuss issues related to health and. Dispensaries ) articles based on Crossref citations.Articles with the Crossref icon will open in a new tab committee activities of. Do and other facilities do not apply for money factors that hinder farmers participation in School..