\u201cFrom experts to locals hands\u201d healthcare service planning in sub-Saharan Africa: an insight from the integrated community case management of Ghana

Mavis Lepiinlia Sillim,Francis Dakyaga,Isaac Annobil

doi:10.1186/s12913-021-06407-2

Abstract

BackgroundAlthough community participation remains an essential component globally in healthcare service planning, evidence of how rural communities participate in the planning of rural-based healthcare programs has less been explored in Sub-Saharan Africa.ObjectiveWe explored communities’ participation in health care planning in hard-to-reach communities, within the context of Integrated Community Case Management (iCCM), a community-based health program implemented in Ghana.MethodsQualitative data were collected from eleven (11) hard-to-reach communities through Focus Group Discussions (FGDs), Key Informant Interviews (KIIs) as well as district-level studies (Nadowli-Kaleo, and WA East districts of Ghana). The Rifkin’s spider-gram, framework, for measuring and evaluating community participation in healthcare planning was adapted for the study.The resultsThe study found that community participation was superficially conducted by the CHOs. A holistic community needs assessment to create awareness, foster a common understanding of health situations, collaboration, acceptance and ownership of the program were indiscernible. Rather, it took the form of an event, expert-led-definition, devoid of coherence to build locals understanding to gain their support as beneficiaries of the program. Consequently, some of the key requirements of the program, such as resource mobilization by rural residents, Community-based monitoring of the program and the act of leadership towards sustainability of the program were not explicitly found in the beneficiaries’ communities.Conclusion and recommendationThe study concludes that there is a need to expand the concept of community involvement in iCCM to facilitate communities’ contribution to their healthcare. Also, a transdisciplinary approach is required for engineering and scaling up community-based health programs, empowering VHCs, CBHVs and CHAs to realize success.

Highlights

Since the era of the Alma Ata Declaration, community participation in health care planning has been an essential component for attaining primary health care [1]
A transdisciplinary approach is required for engineering and scaling up community-based health programs, empowering Village Health Committees (VHCs), Community-Based Health Volunteers (CBHVs) and Community Health Actors (CHAs) to realize success
Community health – health facilities, proximity and the actors involved in health service delivery Community-Based Health Planning and Services (CHPS) were the major centres providing basic healthcare services in hard-to-reach communities, though unevenly distributed

Summary

Introduction

Since the era of the Alma Ata Declaration, community participation in health care planning has been an essential component for attaining primary health care [1]. In the context of social accountability, community participation is pronounced and streamlined in the policies of governments in both low-and-middle-income countries [2, 3] This evolution is influenced by the increasing gap in health staff to patient ratio, and by the spatial disparities between urban and rural communities with access to health. In this arena, locals are perceived as more knowledgeable of their settings, capable of taking-up affairs, and utilizing healthcare services better when they are at the centre of affairs [3]. Community participation remains an essential component globally in healthcare service planning, evidence of how rural communities participate in the planning of rural-based healthcare programs has less been explored in Sub-Saharan Africa

Methods

Results

Conclusion