Anchoring contextual analysis in health policy and systems research: A narrative review of contextual factors influencing health committees in low and middle income countries

George, Asha; Scott, Kerry; Garimella, Surekha; Mondal, Shinjini; Ved, Rajani; Sheikh, Kabir

doi:10.1016/j.socscimed.2015.03.049

Cited by 66 publications

(75 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Context is both shaped by actors involved as much as it constrains their activities, and refers to a "complex set of social actors intersect with socio-political structures to dynamically co-create contextual influences" [55], p.43. George et al (2015) indicate that contextual elements are dynamic and porous in nature, influencing programs as much as being influenced by programs (outcomes) because of the permeability of system boundaries [56]. Therefore, in line with other studies, we found that there are multiple ways to define contexts, hence multiple ways of constructing CMO configurations [39].…”

Section: Discussionsupporting

confidence: 85%

Promoting physical activity in socially vulnerable groups : a mixed method evaluation in multiple community-based physical activity programs

Herens¹

View full text Add to dashboard Cite

Section: Discussionsupporting

confidence: 85%

Promoting physical activity in socially vulnerable groups : a mixed method evaluation in multiple community-based physical activity programs

Herens¹

View full text Add to dashboard Cite

“…Operating in such open systems, CHCs are most likely strongly influenced by contextual factors20 and subject to human experiences. Specifically, committees cannot be managed or understood as a single entity, but as a group consisting of autonomous beings working towards a common goal.…”

Section: Discussionmentioning

confidence: 99%

“…5 13 14 Second, there is a need for methodologies studying CHCs to be reflective of their operation in open systems, and to include a strong theoretical component. [15][16][17][18][19] Third, while previous studies have identified important contextual factors for their operationalisation, 20 an explanation on how these groups work, who they work best for and why is still missing from this field. Finally, realist evaluations are increasingly being used to inform complex health interventions, [21][22][23] with an emerging application in lowincome and middle-income countries.…”

Section: Introductionmentioning

confidence: 99%

How do community health committees contribute to capacity building for maternal and child health? A realist evaluation protocol

et al. 2016

View full text Add to dashboard Cite

IntroductionThe proposed research is part of ongoing operations research within World Vision's Access: Infant and Maternal Health Programme. This study aims to identify key context features and underlying mechanisms through which community health committees build community capacity within the field of maternal and child health. This may help to improve programme implementation by providing contextually informed and explanatory findings forhowcommunity health committees work,whatworks best and forwhomdo they work for best for. Though frequently used within health programmes, little research is carried out on such committees’ contribution to capacity building—a frequent goal or proposed outcome of these groups.Methods and analysisThe scarce information that does exist often fails to explain ‘how, why, and for whom’ these committees work best. Since such groups typically operate within or as components of complex health interventions, they require a systems thinking approach and design, and thus so too does their evaluation. Using a mixed methods realist evaluation with intraprogramme case studies, this protocol details a proposed study on community health committees in rural Tanzania and Uganda to better understand underlying mechanisms through which these groups work (or do not) to build community capacity for maternal and child health. This research protocol follows the realist evaluation methodology of eliciting initial programme theories, to inform the field study design, which are detailed within. Thus far, the methodology of a realist evaluation has been well suited to the study of community health committees within these contexts. Implications for its use within these contexts are discussed within.Ethics and disseminationInstitutional Review Boards and the appropriate research clearance bodies within Ireland, Uganda and Tanzania have approved this study. Planned dissemination activities include via academic and programme channels, as well as feedback to the communities in which this work occurs.

show abstract

“…Other authors stressed the importance of the capacity of community groups to express their views or to exert pressure on health providers or on the public authorities [45, 46], a well-functioning health committee [45, 47] especially considering the limited influence of health providers [48, 49], competent decentralization [45, 50], and the role of the media in providing access to information [28] as enabling factors of social accountability.…”

Section: Discussionmentioning

confidence: 99%

Understanding the local context and its possible influences on shaping, implementing and running social accountability initiatives for maternal health services in rural Democratic Republic of the Congo: a contextual factor analysis

Mafuta

Hogema

Mambu

et al. 2016

BMC Health Serv Res

View full text Add to dashboard Cite

BackgroundSocial accountability has to be configured according to the context in which it operates. This paper aimed to identify local contextual factors in two health zones in the Democratic Republic of the Congo and discuss their possible influences on shaping, implementing and running social accountability initiatives.MethodsData on local socio-cultural characteristics, the governance context, and socio-economic conditions related to social accountability enabling factors were collected in the two health zones using semi-structured interviews and document reviews, and were analyzed using thematic analysis.ResultsThe contexts of the two health zones were similar and characterized by the existence of several community groups, similarly structured and using similar decision-making processes. They were not involved in the health sector’s activities and had no link with the health committee, even though they acknowledged its existence. They were not networked as they focused on their own activities and did not have enough capacity in terms of social mobilization or exerting pressure on public authorities or providers.Women were not perceived as marginalized as they often occupied other positions in the community besides carrying out domestic tasks and participated in community groups. However, they were still subject to the local male dominance culture, which restrains their involvement in decision-making, as they tend to be less educated, unemployed and suffer from a lack of resources or specific skills.The socio-economic context is characterized by subsistence activities and a low employment rate, which limits the community members’ incomes and increases their dependence on external support.The governance context was characterized by imperfect implementation of political decentralization. Community groups advocating community rights are identified as “political” and are not welcomed. The community groups seemed not to be interested in the health center’s information and had no access to media as it is non-existent.ConclusionsThe local contexts in the two health zones seemed not to be supportive of the operation of social accountability initiatives. However, they offer starting points for social accountability initiatives if better use is made of existing contextual factors, for instance by making community groups work together and improving their capacities in terms of knowledge and information.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1895-3) contains supplementary material, which is available to authorized users.

show abstract

Anchoring contextual analysis in health policy and systems research: A narrative review of contextual factors influencing health committees in low and middle income countries

Cited by 66 publications

References 43 publications

Promoting physical activity in socially vulnerable groups : a mixed method evaluation in multiple community-based physical activity programs

Promoting physical activity in socially vulnerable groups : a mixed method evaluation in multiple community-based physical activity programs

How do community health committees contribute to capacity building for maternal and child health? A realist evaluation protocol

Understanding the local context and its possible influences on shaping, implementing and running social accountability initiatives for maternal health services in rural Democratic Republic of the Congo: a contextual factor analysis

Contact Info

Product

Resources

About