Strengthening community participation at health centers in rural Cambodia: role of local non-governmental organizations (NGOs)

Abstract

Cambodia's health policy emphasizes community participation to improve health services. This study identifies factors facilitating community participation in health center management in rural Cambodia, focusing on roles of local NGOs. We conducted a questionnaire survey of 50 local NGOs regarding their understanding of new health systems and policies and NGO collaboration with health centers. Eight local NGOs and their partner health centers were selected for further field survey. Using an assessment tool developed by the authors, structured interviews were conducted with 35 stakeholders to measure the level of community participation in the management of health centers through health committees mandated for each health center by the new health policy. Roles and approaches of the eight NGOs were examined. Levels of community participation at the health centers varied and were associated with roles of the partner NGOs. Critical roles of NGOs in facilitating community participation were found to include: nurturing a base through community organizing and capacity building, and encouraging the community to apply community experiences in health; regularly communicating with, monitoring and providing management support to health centers; and linking local actors for health. To take such roles effectively, long-term commitments to specific localities and small financial inputs were found to be advantageous characteristics for NGOs. Local NGOs, even those without health expertise and with limited resources, can effectively promote and facilitate community participation in health center management. Such roles of local NGOs are critically important for sustainable health development, and therefore, should be further recognized and supported.