Community Participation in Primary Healthcare in the South Sudan Boma Health Initiative: A Document Analysis

Abstract

Background: Community participation is central to primary health care, yet there is little evidence of how this works in conflict settings. In 2016, South Sudan's Ministry of Health launched the Boma Health Initiative to improve primary care services through community participation. Methods: We conducted a document analysis to examine how well the Boma Health Initiative policy addressed community participation in its policy formulation. We reviewed other policy documents and published literature to provide background context and supplementary data. We used a deductive thematic analysis that followed Rifkin and colleagues' community participation framework to assess the Boma Health Initiative policy. Results: The Boma Health Initiative planners included inputs from communities without details on how the needs assessment was conducted at the community level, what needs were considered, and from which community. The intended role of communities was to implement the policy under local leadership. There was no information on how the Initiative might strengthen or expand local women's leadership. Official documents did not contemplate local power relations or address gender imbalance. The policy approached households as consumers of health services. Conclusions: Although the Boma Health Initiative advocated community participation to generate awareness, increase acceptability, access to services and ownership, the policy document did not include community participation during policy cycle.

Community engagement initiatives in primary health care to achieve universal health coverage: A realist synthesis of scoping review

“…None of the studies in this review explored diversity in representation (e.g., the extent to which women are adequately represented and actively participated in decision-making within decision-making groups). Rather, studies reported the gender composition within decision-making groups [ 16 ], and all studies that mentioned gender composition reported that men dominated membership and leadership within decision-making groups [ 16 , 55 , 64 ]. A review by Karuga et al reported that the selection processes of community-level health committees in Sub-Saharan African countries were not transparent and participatory, resulting in a lack of legitimacy [ 16 ].…”