Beyond positive a priori bias: reframing community engagement in LMICs

2019 ◽  
Vol 35 (3) ◽  
pp. 598-609 ◽  
Author(s):  
Seye Abimbola
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Community Engagement ◽  
A Priori ◽  
Causal Link ◽  
Government Support ◽  
Service Users ◽  
Holy Grail ◽  
Primary Health ◽  
Health Care Governance

Abstract Showing the causal link between community engagement and improved health outcomes is a ‘holy grail’ of health policy. This article argues that this ‘holy grail’ has remained elusive because community engagement in primary health care is under-theorized, having been based on positive a priori assumptions, e.g. that people necessarily want to be engaged in governing their health system. By adopting a theory-driven approach and an agnostic premise, we show that understanding why, how and when community engagement may emerge or function spontaneously is important for informing efforts to support community engagement in primary health care primary health care governance. We draw on empirical research on community engagement in Nigeria and on the literature to identify the ‘why’ (coalition of service users can emerge in response to under-governance); the ‘how’ (five modes: through meetings; reaching out within their community; lobbying governments; augmenting government support; and taking control of service delivery) and the ‘when’ (as geographical, socio-economic and institutional context align, such that the benefits of action outweigh costs). Understanding the broad patterns of mechanisms and of contextual factors that apply across communities is, after all, our ‘holy grail’—and this understanding should inform efforts to tailor support for community engagement in governance in different settings.

scholarly journals Perceptions of Ghanaian traditional health practitioners, primary health care workers, service users and caregivers regarding collaboration for mental health care

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Solomon Nyame ◽  
Edward Adiibokah ◽  
Yasmin Mohammed ◽  
Victor C. Doku ◽  
Caleb Othieno ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Human Rights ◽  
Primary Health Care ◽  
Service Users ◽  
Traditional Health ◽  
Healthcare Needs ◽  
Primary Health ◽  
Traditional Health Practitioners ◽  
Health Practitioners

Abstract Background In low- and middle-income countries, the paucity of conventional health services means that many people with mental health problems rely on traditional health practitioners (THPs). This paper examines the possibility of forging partnerships at the Primary Health Care (PHC) level in two geopolitical regions of Ghana, to maximize the benefits to both health systems. Methods The study was a qualitative cross-sectional survey. Eight (8) focus group discussions (FGDs) were conducted between February and April 2014. The views of THPs, PHC providers, service users (i.e. patients) and their caregivers, on the perceived benefits, barriers and facilitators of forging partnerships were examined. A thematic framework approach was employed for analysis. Results The study revealed that underlying the widespread approval of forging partnerships, there were mutual undertones of suspicion. While PHC providers were mainly concerned that THPs may incur harms to service users (e.g., through delays in care pathways and human rights abuses), service users and their caregivers highlighted the failure of conventional medical care to meet their healthcare needs. There are practical challenges to these collaborations, including the lack of options to adequately deal with human rights issues such as some patients being chained and exposed to the vagaries of the weather at THPs. There is also the issue of the frequent shortage of psychotropic medication at PHCs. Conclusion Addressing these barriers could enhance partnerships. There is also a need to educate all providers, which should include sessions clarifying the potential value of such partnerships.

scholarly journals Organisation of primary health care systems in low- and middle-income countries: review of evidence on what works and why in the Asia-Pacific region

2019 ◽  
Vol 4 (Suppl 8) ◽  
pp. e001487 ◽  
Author(s):  
Rebecca Dodd ◽  
Anna Palagyi ◽  
Stephen Jan ◽  
Marwa Abdel-All ◽  
Devaki Nambiar ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Community Engagement ◽  
Asia Pacific ◽  
Pacific Region ◽  
Asia Pacific Region ◽  
Middle Income ◽  
Middle Income Countries ◽  
What Works ◽  
Primary Health

IntroductionThis paper synthesises evidence on the organisation of primary health care (PHC) service delivery in low-income and middle-income countries (LMICs) in the Asia Pacific and identifies evidence of effective approaches and pathways of impact in this region.MethodsWe developed a conceptual framework describing key inputs and outcomes of PHC as the basis of a systematic review. We searched exclusively for intervention studies from LMICs of the Asia-Pacific region in an effort to identify ‘what works’ to improve the coverage, quality, efficiency, equity and responsiveness of PHC. We conducted a narrative synthesis to identify key characteristics of successful interventions.ResultsFrom an initial list of 3001 articles, we selected 153 for full-text review and included 111. We found evidence on the impact of non-physician health workers (NPHWs) on coverage and quality of care, though better integration with other PHC services is needed. Community-based services are most effective when well integrated through functional referral systems and supportive supervision arrangements, and have a reliable supply of medicines. Many studies point to the importance of community engagement in improving service demand. Few studies adopted a ‘systems’ lens or adequately considered long-term costs or implementation challenges.ConclusionBased on our findings, we suggest five areas where more practical knowledge and guidance is needed to support PHC systems strengthening: (1) NPHW workforce development; (2) integrating non-communicable disease prevention and control into the basic package of care; (3) building managerial capacity; (4) institutionalising community engagement; (5) modernising PHC information systems.

scholarly journals Community engagement in general practice: a qualitative study

2019 ◽  
Vol 11 (2) ◽  
pp. 146 ◽  
Author(s):  
N. Rowe ◽  
R. Keenan ◽  
L. Lack ◽  
N. Malloy ◽  
R. Strasser ◽  
...  
Keyword(s):  
Health Care ◽  
General Practice ◽  
Primary Health Care ◽  
Qualitative Study ◽  
Conceptual Framework ◽  
Community Engagement ◽  
Perceived Benefits ◽  
Primary Health ◽  
General Practices ◽  
Systematic Framework

ABSTRACT BACKGROUNDCommunity engagement is believed to be an important component of quality primary health care. We aimed to capture specific examples of community engagement by general practices, and to understand the barriers that prevent engagement. METHODSWe conducted 20 distinct interviews with 31 key informants from general practice and the wider community. The interviews were semi-structured around key relevant topics and were analysed thematically. RESULTSKey themes identified from the interview transcripts included an understanding of ‘community’, examples of community engagement and the perceived benefits and barriers to community-engaged general practice. We particularly explored aspects of community engagement with Māori. CONCLUSIONSGeneral practices in the study do not think in terms of communities, and they do not have a systematic framework for engagement. Although local champions have generated some great initiatives, most practices seemed to lack a conceptual framework for engagement: who to engage with, how to engage with them, and how to evaluate the results of the engagement.

scholarly journals Substance abuse and HIV risk behaviours amongst primary health care service users in Cape Town

2006 ◽  
Vol 8 (4) ◽  
Author(s):  
Catherine L Ward ◽  
Jennifer R Mertens ◽  
Alan J Flisher ◽  
Graham F Bresick ◽  
Stacy A Sterling ◽  
...  
Keyword(s):  
Health Care ◽  
Substance Abuse ◽  
Primary Health Care ◽  
Hiv Risk ◽  
Care Service ◽  
Health Care Service ◽  
Primary Health Care Service ◽  
Service Users ◽  
Risk Behaviours ◽  
Primary Health

Importance of community engagement in primary health care: the case of Afghan refugees

2015 ◽  
Vol 21 (3) ◽  
pp. 262 ◽  
Author(s):  
I-Hao Cheng ◽  
Sayed Wahidi ◽  
Shiva Vasi ◽  
Sophia Samuel
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Community Engagement ◽  
Health Care Services ◽  
Local Community ◽  
Health Workers ◽  
Care Services ◽  
Primary Health ◽  
Primary Health Care Services ◽  
The Impact

Refugees can experience problems accessing and utilising Australian primary health care services, resulting in suboptimal health outcomes. Little is known about the impact of their pre-migration health care experiences. This paper demonstrates how the Afghan pre-migration experiences of primary health care can affect engagement with Australian primary care services. It considers the implications for Australian primary health care policy, planning and delivery. This paper is based on the international experiences, insights and expert opinions of the authors, and is underpinned by literature on Afghan health-seeking behaviour. Importantly, Afghanistan and Australia have different primary health care strategies. In Afghanistan, health care is predominantly provided through a community-based outreach approach, namely through community health workers residing in the local community. In contrast, the Australian health care system requires client attendance at formal health service facilities. This difference contributes to service access and utilisation problems. Community engagement is essential to bridge the gap between the Afghan community and Australian primary health care services. This can be achieved through the health sector working to strengthen partnerships between Afghan individuals, communities and health services. Enhanced community engagement has the potential to improve the delivery of primary health care to the Afghan community in Australia.

scholarly journals Lessons from Disability Counting in Ecuador, with a Contribution from Primary Health Care

2021 ◽  
Vol 18 (10) ◽  
pp. 5103
Author(s):  
Debrouwere Inge ◽  
Álvarez Vera Pedro Celestino ◽  
Pavón Benítez Ximena del Carmen ◽  
Rosero Arboleda Celia Katherine ◽  
Prinzie Peter ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
A Priori ◽  
Service Planning ◽  
Counting Method ◽  
Cross Sectional ◽  
Persons With Disabilities ◽  
Primary Health ◽  
Disability Prevalence ◽  
Cross Sectional Studies

Disability data are essential for policy. Yet, the predominant use of disability prevalence for service planning reflects dichotomous counting, increasingly less compatible with current disability thinking. Difficulties relate to variations in rates, the lack of matching with needs, and the use of prevalence to compare disability situations. From the perspective of Primary Health Care (PHC), we explore methods for disability counting regarding the usefulness of prevalences in identifying persons with disabilities and meeting their needs with local service implementation. First, we analyze the methods and results of six national cross-sectional studies in Ecuador. Then, we present a case about an exploratory needs-driven method for disability counting in a local PHC setting. The analysis of variations in rates focuses the attention on reasons for and risks of a priori exclusion of persons with disabilities from services. Longitudinal disability counting as a collateral result of meeting needs in the PHC setting yields local disability data worthy of further exploration. Thinking about disability counting from a PHC scope in a developing country prompted reflection on the comparison of prevalences to evaluate disability situations. Findings invite further exploration of the needs-driven counting method, its contributions to planning local services, and complementarity with cross-sectional disability counting.

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