Theorizing community health governance for strengthening primary healthcare in LMICs

Abstract

In recent years, community health governance structures have been established in many LMICs as part of decentralisation policies aimed at strengthening primary healthcare systems. So far, most studies on these local structures either focus on measuring their impact on health outcome or on identifying the factors that affect their performance. In this paper we offer an alternative contribution that draws on a sociological interpretation of community health governance to improve understanding of how the government’s policy vision and instrumentation translate to interactions that take place within local spaces at field level. We study 13 Village Health Sanitation and Nutrition Committees (VHSNCs) in Karnataka, India from 2016 to 2018 focusing on sanitation, nutrition and hygiene which remain impediments to improving primary health care amongst poor and marginalised communities. Three local governance mechanisms of horizontal coordination, demand for accountability and self-help help to explain improvements that have taken place at village level and contribute to the creation of a new theory of community health governance as evolving phenomena that requires a constant process of learning from the field to strengthen policymaking.

Multisectoral actions in primary health care: A realist synthesis of scoping review

“…For example, regional organisations (e.g., Medicare Locals/Primary Health Networks), Aboriginal Community Controlled Health Organisations, and local health committees can interact with community organisations and policymakers’ provision of health services (availability, reliability and affordable) to serve marginalised communities [ 29 , 39 ]. In addition, these organisations enhance better governance for horizontal coordination, and demand accountability to ensure the capture of political commitment and social innovation for improvements [ 42 , 44 ]. Systematic and regular engagement of multisector and agencies contributed to integration, knowledge exchange and implementation, resilience, and antifragility [ 34 , 50 ].…”

“…The CHWs brought holistic health services closer to the communities and hard-to-reach regions of Latin America (e.g., El Salvador) [ 22 , 31 ]. Village Health Sanitation and Nutrition Committees in India focused on sanitation, nutrition, and hygiene, which impede improving PHC amongst poor and marginalised communities [ 44 ]. The committee members with retired government workers had political connections, power, and influence in the decision-making [ 40 ].…”

How can community participation strengthen a health insurance system? The case of health insurer’s user associations in Colombia

“…In India, for example, health committees were activated through widespread community mobilisation, training and capacity building inputs for members, and access to some budgetary and political power. 31 32 …”

“…Participatory structures for health system governance have moved along the spectrum towards empowerment and effectiveness when many of these issues are resolved, usually with strong and institutionalised political support. In India, for example, health committees were activated through widespread community mobilisation, training and capacity building inputs for members, and access to some budgetary and political power 31 32…”

Analyzing Primary Healthcare Governance in Indonesia: Perspectives of Community Health Workers

“…As a practical implication, there is a necessity for advocacy on how the health systems approach should become the primary framework of thought in regional health planning and execution. Even though there are problems with bureaucracy and management coordinating Puskesmas [30] and there is no good governance [32], we need to look into options where village heads and higher levels of local government can manage cross-sectoral programs at the community level, such as hiring managers outside of sectoral bureaucracy [25,33]. This exploration is crucial for enhancing the efficiency and effectiveness of healthcare delivery at the grassroots level.…”