Community participation in public health interventions is critical to achieving sustained improvement in health outcomes within the community. It ensures that people and communities, not diseases, are at the centre of health systems, and empowers people to take charge of their own health rather than being passive recipients of services.
In many low and middle-income countries, like those in Africa, there is increasing evidence that community participation can positively impact health systems, despite many barriers.
Community participation as an integral principle of Primary Health Care (PHC), came to the fore with the 1978 Alma Ata Declaration. This principle emphasizes the underlying value of social justice in improving health, especially in deprived areas, through the involvement of the community in planning and implementation of activities toward building a healthy society.
In recent years, community participation has emerged as a priority in global health. With the rapid increase of chronic disease burden worldwide, intersectoral approaches encompassing community participation and engagement have been identified as key for implementing strategies in health promotion and the prevention and control of chronic diseases.
In Africa, this is of particular importance, as the World Health Organization (WHO) has predicted that the continent will experience a 27 percent increase in deaths from non-communicable diseases over the next 10 years. Therefore, there is a need to prioritize community participation.
Community participation in healthcare in Africa – challenges
In Africa, community participation takes many forms. An example is the establishment of health committees, which are often linked to specific facilities. Health committees typically comprise local government councillors, heads of health facilities, and community members in the areas served by the health facilities. Village health committees can be effective mechanisms to ensure local leadership and participation in healthcare delivery.
A predominant mechanism for community participation is the use of Community Health Workers (CHWs). Employing CHWs is often the most realistic method of attaining community participation. CHWs provide the first level of contact between community members and the healthcare system. To ensure trust, CHWs come from and are chosen by the community they live in.
They can be trained in a short time to perform specific tasks and carry out a vast range of activities. CHWs can play a critical role in making appropriate health promotion and service delivery strategies that reflect the political, environmental, social, and cultural dynamics and realities of the community.
They can support community participation by sensitising and educating the community on the benefits of health programs, supporting women’s groups and other community-based organisations (CBOs) to participate in health activities, and providing an opportunity for communities to engage more directly with the health system.
However, in Africa, the role of CHWs has not been fully maximised due to several challenges. A major challenge is the lack of clarity on their roles and functions.
Where the roles of CHWs are not formalised, confusion exists regarding different roles, such as governance, co-management, resource generation, community outreach, advocacy, etc. Another major challenge is limited capacity and skills, which limit the functioning and roles of CHWs. There is often a significant dearth in skills such as budgeting, lobbying, governance and policymaking.
Other challenges include limited or non-existent political support for community participation, limited financial and technical resources, poor attitude of health professionals towards participation, and apathy and disinterest in communities, amongst others.
Read also: Strengthening public health policies for better healthcare in Africa
Strategies to strengthen community participation in healthcare in Africa
Engaging in and supporting the empowerment of the community for community health decision-making and action is a critical element in health promotion and disease prevention. The impact of public health programs that target individual behaviour change is often transient and diluted unless efforts are also undertaken to tackle factors that constrain participatory development. In view of these, Bloom Public Health proposes the following strategies as effective ways to strengthen community participation in healthcare in Africa:
1. Establishing clearly defined roles and functions of community health workers: The roles and obligations of CHWs should be clearly outlined and known to all. Community members may also help to design the CHW’s role to tailor it to their needs. While the national program may set up an essential health package, the community may prioritise certain aspects. Clearly defined roles are also crucial to guide the training of CHWs.
2. Training and skills development: Clear and realistic goals for CHWs with appropriate skill-based training and continuing education are essential for efficient execution of their responsibilities. Ongoing training reinforces initial training and builds organizational development skills and health literacy to solve the root causes of poor health. Networking among peer CHWs and shared learning is also beneficial.
3. Increased political support and financial resources: An enabling political environment is critical for sustainable community participation in the health system. This requires sound national policies and buy-in at district, facility, and community levels. Also, increased government funding and financial support from the non-profits sector is necessary for optimal performance of Community Health Committees and CHWs.
Community participation is a crucial factor that enables effective health system functioning and the sustainability of public health interventions. Concerted efforts are therefore needed to create an enabling environment that maximises community participation within Africa’s health systems.