Applying community health systems lenses to identify determinants of access to surgery among mobile & migrant populations with hydrocele in Zambia: A mixed methods assessment

Abstract

Hydrocele which is caused by long term lymphatic filariasis infection can be treated through the provision of surgery. Access to surgeries remains low particularly for hard to reach populations. This study applied community health system lenses to identify determinants to the adoption, implementation and integration of hydrocele surgeries among migrants &mobile populations in Luangwa District, Zambia. A concurrent mixed methods design consisting of cross-sectional survey with hydrocele patients (n = 438) and in-depth interviews with different community actors (n = 38) was conducted in October 2021. Data analysis was based on the relational and programmatic lenses of Community Health Systems. Under the Programmatic lens, insufficient resources resulted in most health facilities being incapable of providing the minimum package of care for lymphatic filariasis. The absence of cross border collaborative structures limits the continuity of care for patients moving across the three countries. Other programmatic barriers include language barriers, inappropriate appointment systems, direct and indirect costs. In the relational lens, despite the key role that community leaders play their engagement in service delivery was low. Community actors including patients were rarely included in planning, implementation or evaluation of hydrocele services. Some patients utilized their power within to act as champions for the surgery but local groups such as fishing associations remained underutilized. Community health systems provide a potential avenue through which access amongst mobile and migrant populations can be enhanced through strategies such engagement of patient groups, knowledge sharing across borders and use of community monitoring initiatives.

Specifying implementation strategies used in delivering services for HIV, gender-based violence and sexual and reproductive health to adolescent girls and young women in community health systems in Zambia

“…In this study, examples of adaptations included delivery of integrated and adolescent-friendly HIV, GBV, and SRH services. Further, relational strategies could enhance implementation processes by providing an opportunity to accommodate diverse actors, interests, and expressions of power that characterize the CHS (19,20,25,31). Relational approaches can support adoption and sustainability of strategies by promoting shared communication and understanding of implementation problems and increased cohesion (38, 41).…”

“…Other studies have also shown that use of community-based actors and structures in delivering and disseminating services can enhance adoption and acceptability of services by promoting their relevance and legitimacy (42)(43)(44). Further, community-engaged dissemination and implementation processes can also improve penetration and sustainability by facilitating or enabling co-production and co-learning among various implementing partners (19,20,25,31). This study demonstrated co-production through instances such as community involvement in developing by-laws and support groups for people living with HIV.…”

“…Evidence suggests that LMICs that have invested in CHS have recorded some positive public health gains (17,18). CHS have attracted increased interest because of their potential to leverage diverse community resources and advance population well-being (4,14,(19)(20)(21). The gains are partly due to the ability of CHS to widen participation and collective action and promote trust in health services (20,22).…”