Abstract
Recent studies in Cameroon after 20 years of implementation of the Community Directed Treatment with ivermectin (CDTI) strategy, revealed mixed results as regards community ownership. This brings into question the feasibility of Community Directed Interventions (CDI) in the country. We carried out qualitative surveys in 3 health districts of Cameroon, consisting of 11 individual interviews and 10 Focus Group Discussions (FGDs) with specific community members. The main topic discussed during individual interviews and FGDs was about community participation in health. We found an implementation gap in CDTI between the process theory in the 3 health districts. Despite this gap, community eagerness for health information and massive personal and financial adhesion to interventions that were perceived important, were indicators of CDI feasibility. The concept of CDI is culturally feasible in rural and semi-urban settlements, but many challenges hinder its actual implementation. In the view of community participation as a process rather than an intervention, these challenges include real dialogue with communities as partners, dialogue and advocacy with operational level health staff, and macroeconomic and political reforms in health, finance and other associated sectors.
Highlights
1978 was a crucial date year for Public Health, marked by the well-known Alma Ata Declaration, in which health was reaffirmed as a human right, and by, Primary Health Care (PHC) being recognized as essential for achieving the goals of “health for all by the year 2000” [1]
During the 3 first decades following Alma Ata, the dominance of the selective understanding of the PHC principles led to the fragmentation of many health systems, namely in Sub-Saharan African countries, into vertical health programs that focused on individual communicable diseases control [3,5,8]
We did a total of 11 individual interviews, with 1 canton leader, 6 community leaders and 4 “Community Directed Treatment with ivermectin (CDTI)-averse”
Summary
1978 was a crucial date year for Public Health, marked by the well-known Alma Ata Declaration, in which health was reaffirmed as a human right, and by, Primary Health Care (PHC) being recognized as essential for achieving the goals of “health for all by the year 2000” [1]. During the four decades that followed 1978, the promises were not reached, and despite the efforts of PHC rebirth in 2008 [2,3,4], the 40th anniversary of Alma Ata was marked by slow progresses in PHC, namely in low and middle income countries [5]. During the 3 first decades following Alma Ata, the dominance of the selective understanding of the PHC principles led to the fragmentation of many health systems, namely in Sub-Saharan African countries, into vertical health programs that focused on individual communicable diseases control [3,5,8]. The last ten years, dedicated to PHC engagements renewal, have been marked by a progressive switch to the comprehensive approach with better community empowerment [4,5]. One example of the effect of this switch in CP in Sub-Saharan Africa, is the experience of the African Program for Onchocerciasis (APOC) with the Community Directed Treatment with Ivermectin (CDTI)
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