Abstract
The renewed commitment to primary health care (PHC) presents an opportunity to strengthen health systems in West and Central Africa (WCA). Though evidence-based cost-effective interventions that are predicted to prevent up to one-third of maternal, newborn, and child health complications and deaths with universal coverage have been identified, more than 50% of people living in rural areas or from poor families still do not have access to these interventions in resource-constrained settings. We conducted a multicountry systematic analysis of bottlenecks and proposed solutions to strengthen community health systems through a series of collaborative workshops in 22 countries in WCA. Countries were categorized by their under-5 mortality rate (U5MR) to assess specificities related to reported challenges. We also reviewed existing data on selected health system tracer interventions to analyze country profiles. The bottlenecks identified as severe or very severe were related to health financing (19 countries, 86%), essential medical technology and products (16 countries, 73%), integrated health service delivery (14 countries, 64%), and community ownership and partnerships (self-reported by 14 countries, 64%). Only the integrated service delivery was self-reported as a severe challenge by countries with high U5MR. The issue of human resources for community health was one of the least reported challenges. In WCA, strengthening community health systems as part of PHC revitalization efforts should focus on increasing health financing and innovative investments, strengthening the logistics management system, and fostering community ownership and partnerships. Countries with high U5MR should also reinforce integrated service delivery approaches through innovation. Government actions galvanized by global and regional ongoing initiatives should be sustained to ensure that no one is left behind.
Highlights
The renewed commitment to primary health care (PHC) presents an opportunity to strengthen health systems in West and Central Africa (WCA)
PHC was articulated as a cornerstone toward achieving universal health coverage (UHC) and the United Nations (UN) Sustainable Development Goals (SDGs)
The big challenge areas, are within walking distance of health faciliremains how to ties, community health workers (CHWs) conput health systems nected to well-trained PHC teams can extend the strengthening into reach of high-quality care to people who need it practice at the the most, right where they are
Summary
The renewed commitment to primary health care (PHC) presents an opportunity to strengthen health systems in West and Central Africa (WCA). Results: The bottlenecks identified as severe or very severe were related to health financing (19 countries, 86%), essential medical technology and products (16 countries, 73%), integrated health service delivery (14 countries, 64%), and community ownership and partnerships (self-reported by 14 countries, 64%). The integrated service delivery was self-reported as a severe challenge by countries with high U5MR. The big challenge areas, are within walking distance of health faciliremains how to ties, community health workers (CHWs) conput health systems nected to well-trained PHC teams can extend the strengthening into reach of high-quality care to people who need it practice at the the most, right where they are. Studies conducted community level to in low- and middle-income countries have shown that focusing on provision of health services at the achieve high, community level leads to more efficient equitable, and and equitable use of health resources and better effective coverage health outcomes and is a consistent compoof care
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