Lessons from community participation in health programmes: a review of the post Alma-Ata experience

Rifkin, Susan B.

doi:10.1016/j.inhe.2009.02.001

Cited by 181 publications

(187 citation statements)

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“…[21] Mobilisation of impoverished rural communities to participate in improving health reflects the underlying value for social justice, and promotes their contribution to decisions that affect them. [22] c) Community Health Promotion to prevent malaria It involves environmental modification and proper water, sanitation and hygiene (WASH) practices to control disease-causing agents such as mosquitoes and it is pivotal in breaking the infection cycle. [15] Community-based health promotion emphasises integrated and comprehensive primary prevention, through direct education and involvement of the general population in specific activities [20] such as environmental management and proper WASH. A synergistic implementation of these interventions is likely to improve knowledge, attitude and practice, and yield positive changes at the individual, household and community levels, with long term health benefits.…”

Section: Factors Influencing the Prevalence Of Malaria In Cameroonmentioning

confidence: 99%

Enhancing Malaria Prevention in Cameroon Through Community Participation: An in-Depth Review

Mbako¹

2017

CAJPH

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Abstract:Despite 66 percent reduction in mortality between 2000 and 2015, malaria remains a major global public health problem, affecting mostly Sub-Saharan Africa. Cameroon remains endemic to malaria, with about 41 percent suffering at least one episode of malaria, annual overall mortality of 30 to 35 percent and 67 percent childhood mortality. Cameroon government's subsidy on artemisinin combination therapy (ACT) for uncomplicated malaria, intermittent preventive treatment for pregnant women (IPTp), free distribution of insecticide treated bed nets (ITNs) to pregnant women and under-fives have been more of a top-down approach, with the affected communities mainly at the receiving end. Challenges of failed adherence to test results, drug and insecticide resistance, substandard and self-medication, low ITN ownership and utilisation have been identified, especially in the rural areas. This study reviews malaria prevention in Cameroon and proposes community based context-specific complementary interventions strategies that will promote community participation in prevention and mitigate the effects of poverty towards achievement of the sustainable development goals targets for malaria. The study involved an in-depth review of secondary data from electronic and non-electronic documents. Electronic search was done in Global Health, PubMed, governmental and non-governmental organisation websites, journals and google scholar. Non-electronic documents from the University of Leeds and World Health Organisation (WHO), Geneva libraries were also used. A conceptual framework on integrated community-based approach on intervention to prevent neglected tropical diseases and infectious diseases of poverty was adapted and used, while different intervention strategies were analysed. A total of 96 publications were eligible for inclusion. Analysis of the factors influencing malaria prevention in Cameroon, reveals that current measures alone are insufficient. Therefore, a combination of multiple delivery strategies using an integrated community-based approach is likely to be more effective in breaking the transmission cycle than single programme interventions. Concurrent implementation of community mobilisation through social groups and Village Development Committees, education on house screening, training of mothers and caregivers and health promotion through environmental management were recommended as the best and most feasible strategies to complement current interventions in Cameroon.

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Section: Factors Influencing the Prevalence Of Malaria In Cameroonmentioning

confidence: 99%

Enhancing Malaria Prevention in Cameroon Through Community Participation: An in-Depth Review

Mbako¹

2017

CAJPH

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“…In contrast, community participation has been extensively conceptualised and analysed in the broader literature on health (Morgan, 2001;Rifkin, 1986Rifkin, , 2009Zakus & Lysack, 1998). Rifkin (1986), points to three main approaches to community participation in health programmes: medical; health services; and community development.…”

Section: Community Participation In Cbhimentioning

confidence: 99%

Why do people drop out of community-based health insurance? Findings from an exploratory household survey in Senegal

Mladovsky¹

2014

Social Science & Medicine

116

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AcknowledgementsThe author would like to thank Bart Criel, Pascal Ndiaye, Alfed Ndiaye, Werner Soors and all national stakeholders in Senegal for their contributions to the research project, the team of fieldwork assistants and supervisors, staff of the three CBHI schemes who gave up their time to facilitate the research, all the interviewees who also gave their time, the Institute of Tropical Medicine, Antwerp and the Stewart Halley Trust for providing funding for the research, and the two anonymous reviewers who provided valuable comments and insights. AbstractAlthough a high level of drop-out from community-based health insurance (CBHI) is frequently reported, it has rarely been analysed in depth. This study explores whether never having actively participated in CBHI is a determinant of drop-out. A conceptual framework of passive and active community participation in CBHI is developed to inform quantitative data analysis. Fieldwork comprising a household survey was conducted in Senegal in 2009. Levels of active participation among 382 members and ex-members of CBHI across three case study schemes are compared using logistic regression. Results suggest that, controlling for a range of socioeconomic variables, the more active the mode of participation in the CBHI scheme, the stronger the statistically significant positive correlation with remaining enrolled. Training is the most highly correlated, followed by voting, participating in a general assembly, awareness raising / information dissemination and informal discussions / spontaneously helping. Possible intermediary outcomes of active participation such as perceived trustworthiness of the scheme management / president; accountability and being informed of mechanisms of controlling abuse/fraud are also significantly positively correlated with remaining in the scheme. Perception of poor quality of health services is identified as the most important determinant of drop-out. Financial factors do not seem to determine drop-out. The results suggest that schemes may be able to reduce drop-out and increase quality of care by creating more opportunities for more active participation. Caution is needed though, since if CBHI schemes uncritically fund and promote participation activities, individuals who are already more empowered or who already have higher levels of social capital may be more likely to access these resources, thereby indirectly further increasing social inequalities in health coverage.

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“…also reveal constraints, specifically in terms of representativeness, since participation schemes fail to take into account the social diversity of communities, especially excluded groups, (Frankish et al, 2002;Tritter and McCallum, 2006); the potential for influence and the power imbalance between the sponsors of the deliberative process and the participants (Serapioni and Duxbury, 2012) and the lack of any assessment focussing on the effectiveness of participation in healthcare issues (Rowe and Frewer, 2004;Lehoux et al, 2009). There is also a serious risk of idealising such practices, likening them to magic formulas for solving the problems of the health system (Zakus and Lysack, 1998;Rifkin, 2009) and a resistance on the part of healthcare professionals and managers to implementing the outcomes of public participation in healthcare deliberative processes (Martin, 2008). With regard to the latter point, citizen involvement is more widely used as a "technology of legitimation" (Harrison and Mort, 1998).…”

Section: Civil Society's Involvement In Healthcare Systems: Potentialmentioning

confidence: 99%

Citizen participation and discontent in three Southern European health systems

Serapioni

Matos

2014

Social Science & Medicine

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a b s t r a c tParticipation has featured in political agendas in recent decades and the domain of healthcare has not been indifferent to its appeal. Although emerging later than in other European regions, the involvement of civil society in healthcare decision-making procedures has proved one of the biggest challenges facing Southern European health systems. The health systems of the countries considered in this analysis e Italy, Portugal and Spain e underwent reforms that brought citizen participation to the forefront of the health system. Through national laws or health plans, each of these countries has recognised the need to promote participation in order to 'give a voice' to citizens in the health sector. Accordingly, a range of significant activities have been implemented in the region, although they have been developed unequally within national territories, at different paces and involving the mobilisation of different actors. This article focuses on the most relevant experiences of citizen participation designed and implemented in the three selected countries, describing their key features and potential, as well as the main critical issues and contradictions that have emerged over time. Particular emphasis is given to the impact of the current financial crisis on Southern European national health systems, especially in terms of participatory methods, the way in which citizen participation is progressing and civil society's reaction to these important changes.

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Lessons from community participation in health programmes: a review of the post Alma-Ata experience

Cited by 181 publications

References 11 publications

Enhancing Malaria Prevention in Cameroon Through Community Participation: An in-Depth Review

Enhancing Malaria Prevention in Cameroon Through Community Participation: An in-Depth Review

Why do people drop out of community-based health insurance? Findings from an exploratory household survey in Senegal

Citizen participation and discontent in three Southern European health systems

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