Abstract
BackgroundCommunity participation is increasingly seen as a pre-requisite for successful health service uptake. It is notoriously difficult to assess participation and little has been done to advance tools for the assessment of community participation. In this paper we illustrate an approach that combines a ‘social psychology of participation’ (theory) with ‘spider-grams’ (method) to assess participation and apply it to a Community-based Health Planning and Services (CHPS) programme in rural Ghana.MethodsWe draw on data from 17 individual in-depth interviews, two focus group discussions and a community conversation with a mix of service users, providers and community health committee members. It was during the community conversation that stakeholders collectively evaluated community participation in the CHPS programme and drew up a spider-gram.ResultsThematic analysis of our data shows that participation was sustained through the recognition and use of community resources, CHPS integration with pre-existing community structures, and alignment of CHPS services with community interests. However, male dominance and didactic community leadership and management styles undermined real opportunities for broad-based community empowerment, particularly of women, young people and marginalised men.ConclusionWe conclude that combining the ‘spider-gram’ tool and the ‘social psychology of participation’ framework provide health professionals with a useful starting point for assessing community participation and developing recommendations for more participatory and empowering health care programmes.
Highlights
Community participation is increasingly seen as a pre-requisite for successful health service uptake
Results we present the views and perspectives of our informants, representing three groups of programme stakeholders: 1) community health committee members, who were given significant responsibility over the operations and implementation of the Community-based Health Planning and Services (CHPS) programme, and consisted of two male community opinion leaders as well as two female ‘magazias’, elderly female leaders who act in the interest of other women
They were largely poor and unaware of the work that was done to set up the health facility, and did not participate in the decision making about how it was run, as discussed below, they were occasionally called on to help in specific circumstances where labour or small donations were needed; 3) Service providers participating in the study were by our other informants referred to as health experts and health personnel from the Wa Municipal Health Services
Summary
Community participation is increasingly seen as a pre-requisite for successful health service uptake. Global health systems continue to be championed by biomedical scientists and health experts whose technocratic solutions to ill health provide community members with few opportunities to appropriate these solutions to local realities [1]. This tendency was challenged by the 1978 Alma Ata Declaration which established community participation as a core principle of primary health care [2]. Despite the revolutionary significance of the Alma Ata Declaration in viewing Alongside these efforts, much work has been done to conceptualise the pathways through which community participation might increase access to health services, improve health outcomes and promote health enhancing behaviours [7,8,9]. There is a lack of evaluations that have examined local stakeholders’ own perspectives of their participation
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