Mobilising Community Participation to Strengthen Primary Healthcare Delivery
Authors and Contributing author:
Ofovwe Aig-Imoukhuede, Nonye Egekwu, Ojukwu Mark Ojukwu, Folaranmi Adeoye, and Myiriah Kogi
Community participation is a cornerstone of effective primary healthcare delivery. By actively involving communities in health planning and implementation, we can create more responsive and sustainable healthcare systems that truly meet the needs of the people. The Alma-Ata Declaration, adopted in 1978 at the International Conference on Primary Health Care (PHC) in Alma-Ata (now Almaty, Kazakhstan), was a landmark global health policy that emphasized Primary Health Care as the key to achieving "Health for All" by the year 2000. Key highlights of the declaration are;
Recognises health as a fundamental human right,
Defined Primary Health Care (PHC) as essential, community-based, and universally accessible healthcare,
Stressed the importance of intersectoral collaboration, including education, agriculture, and social services, in achieving health goals,
Called for government action, international cooperation, and community participation in strengthening PHC.
The 1978 declaration underscored that health care should be accessible, affordable, and involve the community in planning and implementation.
Specifically, VII.5 of the declaration states that “primary health care requires and promotes maximum community and individual self-reliance and participation in the planning, organization, operation and control of primary health care, making fullest use of local, national and other available resources; and to this end develops through appropriate education the ability of communities to participate”, this ultimately aims to create more effective, sustainable, and culturally appropriate health care delivery systems.
The World Health Organisation (WHO) defines community participation “as a process by which people are enabled to become actively and genuinely involved in defining the issues of concern to them, in making decisions about factors that affect their lives, in formulating and implementing policies, in planning, developing and delivering services and in taking action to achieve change”.1 In Nigeria, the Nigerian National Health Policy2 and the Sustainable Community Engagement Strategy3 highlight the importance of community participation in PHC delivery. These documents outline strategies that support communities in health planning, management, and monitoring.
Over the years, the Nigerian government has continued to design impactful community programs aimed at strengthening primary healthcare delivery in the country. Examples of these include;
The Community Health Workers (CHWs) Program (1978 – present): This initiative was introduced to bridge the gap in healthcare provision, particularly in rural and underserved areas. Community Health Workers (CHWs) were trained to provide basic health services, conduct health education, immunizations, and help manage common diseases, including malaria, diarrhea, and respiratory infections . Community engagement with CHWs has resulted in a 50% increase in family planning service uptake and expanded access to other primary health care services including maternal and child health services, and chronic disease management.
Community Health Influencers, Promoters, and Services (CHIPS) Program (2018 - Present): The CHIPS Program focuses on enhancing community health participation by training community health influencers and promoters to deliver health education, promote healthy behaviors, and assist communities to access essential health services. CHIPS workers, often members of the local communities, are deployed to engage with the communities, conduct health outreaches, facilitate health campaigns, and promote family planning, immunisations, and maternal health. CHIPS agents have effectively promoted healthy behaviors and facilitated access to essential health services, leading to improved health indicators.
COVID-19 Community Response and Health Education (2020 - 2022): In Nigeria’s response to the COVID-19 pandemic, community participation played a vital role in the public health response. Community health workers (CHWs) were mobilized to provide health education, assist in contact tracing, and distribute COVID-19 preventive materials. Local community leaders, religious groups, and influencers helped spread vital information regarding the COVID-19 pandemic, including safety measures like mask-wearing, social distancing, and hand hygiene.
Strengthening Community Engagement and Accountability for PHC (SCEAP) Project (2021 - present): implemented by BudgIT Foundation with support from the Bill and Melinda Gates Foundation (BMGF), this project aims to improve primary healthcare delivery through community-led advocacy and monitoring, and empowering community actors to promote transparency and improve healthcare facilities and service .
The collaborative partnership between the community-based organisations, stakeholders, village heads/representatives, WDCs, women leaders, facility in-charges, and community members has proven instrumental in addressing healthcare challenges and enhancing service delivery. There is also an increase in service utilization at the PHCs which is evident in increased patient turnouts that have been observed since the start of SCEAP, with a 55% increase in the number of participants visiting the PHCs weekly and a 30% increase in the monthly visits to the facilities. Additionally, there has been a 70% increase in outpatient consultation and antenatal care services in most facilities.
Ward Development Committees (WDCs) and Village Development Committees (VDCs) (2001) were created as community structures to support planning and monitoring of health care services. These community structures have facilitated community involvement in healthcare decision-making leading to more tailored and accepted health interventions, and enhanced monitoring of health services which has contributed to improved accountability and service delivery.
Basic Healthcare Provision Fund (BHCPF) (2019 – present): This is a funding mechanism designed to provide financial support to primary healthcare centers across Nigeria. It aims to improve the quality and accessibility of PHC services by ensuring adequate funding for essential health services, including immunization, maternal and child health, and disease surveillance.
The establishment of the BHCPF has enhanced accountability in fund utilisation, thereby improving the management and delivery of PHC services. The BHCPF has also improved access to basic healthcare services, especially for vulnerable groups such as women of childbearing age and children under five years of age. A study found that that most patients (98.2%) were satisfied with service delivery, which influenced patient utilisation of PHC facilities.
The Aig-Imoukhuede Foundation recognizes the critical roles that community structures like the CHIPS and WDCs play to ensure effective delivery of PHC to communities. As a result, we are taking clear steps to support government interventions and improve community participation for PHCs through our Adopt-a-Health Facility Programme (ADHFP), which aims to strengthen PHC systems, improve service delivery, and enhance community engagement.
These steps include:
Providing periodic structured training programmes to WDC members to strengthen their leadership and governance capacities.
Support existing funding structures for multi-stakeholder review and engagement meetings between WDCs, local government health authorities, and community stakeholders.
Strengthen feedback mechanisms between communities, WDCs and PHC workers.
Advocate for more private sector involvement in strengthening community structures to improve PHC.
By strengthening community-based structures like the WDCs to improve primary healthcare service delivery, we envisage:
WDCs will be better equipped to co-design, track progress, and monitor the implementation of program work plans, mobilise resources for community initiatives, and oversee the activities of community health workers. This will improve transparency, oversight and can lead to better outcomes at PHCs.
These activities will engender a culture of continuous improvement because community concerns and health priorities can be addressed promptly and improve service delivery and patient experience.
Trust between communities and healthcare workers will be improved and this can lead to an increase in service utilisation.
Funding and resource availability for healthcare programs is expanded as community members can advocate and raise funds for Primary health programs.
Visit our website (www.aig-imoukhuedefoundation.org) or the PSHAN website (www.pshan.org) to learn more about how you too can make a difference in your communities.