Willing but unable? Extending theory to investigate community capacity to participate in Ghana’s community-based health planning and service implementation

  • Evaluation and Program Planning, Volume 72, Year 2019

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Study Justification:
This study aimed to investigate the level of community capacity to participate in the Community-Based Health Planning and Service (CHPS) program in Ghana. While community participation is a key component of primary health care programs in low- and middle-income countries, there is limited empirical evidence on the capacity of local communities to effectively participate in and support such programs. This study sought to fill this gap by assessing the community’s capacity to participate in CHPS, which can inform future program planning and implementation.
Highlights:
– The study used Chaskin’s (2001) indicators of community capacity, with modifications, to assess the level of community capacity to participate in CHPS.
– Data was collected through interviews with community informants, frontline health providers, and district health managers, as well as questionnaires administered to households.
– Findings revealed that while local leadership and community social mobilization groups showed high capacity to support CHPS, there were challenges related to growing individualism, low trust in neighbors, and apathetic behaviors that undermined the capacity for mutual support.
– The study also found that poor voluntarism and poverty further hindered the community’s capacity to provide needed resource support for CHPS.
– These findings have significant implications for building strong and capable communities for participation in community-oriented health programs.
Recommendations:
– Strengthen efforts to promote a sense of community and mutual support among community members to enhance their capacity to participate in CHPS.
– Address the issue of low trust in neighbors and apathetic behaviors through community engagement and awareness campaigns.
– Develop strategies to improve voluntarism and community ownership of CHPS, including fostering a sense of responsibility and shared ownership among community members.
– Explore ways to address the poverty-related challenges that limit the community’s capacity to provide resource support for CHPS.
Key Role Players:
– Community leaders and social mobilization groups: They play a crucial role in promoting and supporting CHPS within the community.
– Frontline health providers: They work closely with the community and can contribute to building community capacity for participation in CHPS.
– District health managers: They have a role in coordinating and supporting community-based health programs like CHPS.
Cost Items for Planning Recommendations:
– Community engagement and awareness campaigns: Budget for materials, personnel, and logistics for conducting campaigns to address low trust and apathetic behaviors.
– Capacity-building initiatives: Allocate funds for training programs and workshops to enhance community members’ understanding and skills related to CHPS participation.
– Resource support: Consider budgeting for resources that can be provided to the community to alleviate poverty-related challenges and enhance their capacity to support CHPS.
Please note that the cost items provided are general suggestions and may vary depending on the specific context and needs of the community.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study assessed the level of community capacity to participate in a specific health program in Ghana and used a theoretical framework to guide the assessment. Data was collected from multiple sources, including community informants, frontline health providers, and district health managers. The findings highlight both strengths and weaknesses in community capacity to support the program. However, the abstract does not provide details on the sample size or specific methods used for data collection and analysis. To improve the evidence, the abstract could include more information on the research design, sample size, and statistical analysis methods used.

While primary health care programmes based on community participation are widely implemented in low- and middle- income settings, empirical evidence on whether and to what extent local people have the capacity to participate, support and drive such programmes scale up is scant in these countries. This paper assessed the level of community capacity to participate in one such programme – the Community-Based Health Planning and Service (CHPS) in Ghana. The capacity assessments were drawn from Chaskin’s (2001) theorised indicators of community capacity with modifications to include: sense of community; community members commitment; community leadership commitment; problem solving mechanisms; and access to resources. These capacity measures guided the design of an interview guide used to collect data from community informants, frontline health providers (FLP) and district health managers. Key qualitative themes were built into a questionnaire administered to households selected through systematic sampling approach. Findings showed that growing individualism, low trust in neighbours and apathetic behaviours undermined the capacity of mutual support for CHPS. The capacity to support CHPS was high for local leadership and community social mobilisation groups who often dedicated time to working with FLP to promote maternal and reproductive health service use, and in advocating broader support for CHPS. Within the wider community, commitment to voluntarism was low as members perceived CHPS to be owned by, and run on government funds and resources. Poor voluntarism was compounded by poverty that crippled the capacity to provide needed resource support for CHPS. Findings have great implications for building strong capable communities for participation in community oriented health programmes.

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Based on the research described in the publication “Willing but unable? Extending theory to investigate community capacity to participate in Ghana’s community-based health planning and service implementation,” the following recommendations are made to improve access to maternal health:

1. Strengthening sense of community: Encourage community members to develop a sense of belonging and shared responsibility towards maternal health. This can be done through community engagement activities, such as town hall meetings, community forums, and awareness campaigns.

2. Enhancing community leadership commitment: Foster strong leadership within the community to drive and support maternal health initiatives. Empower local leaders to take ownership of the programs and encourage their active involvement in promoting maternal and reproductive health services.

3. Improving problem-solving mechanisms: Establish effective mechanisms for identifying and addressing challenges related to maternal health. This can involve setting up community-based committees or task forces dedicated to addressing maternal health issues and finding innovative solutions.

4. Increasing access to resources: Work towards improving access to resources needed for maternal health services. This may involve advocating for increased government funding, seeking partnerships with NGOs or private sector organizations, and mobilizing community resources to support maternal health programs.

5. Promoting community social mobilization: Encourage community members to actively participate in promoting maternal health services. This can be achieved through community-led campaigns, peer education programs, and the involvement of local social mobilization groups.

6. Addressing poverty and resource constraints: Recognize the impact of poverty on community capacity to support maternal health programs. Implement strategies to alleviate poverty and provide necessary resources, such as financial assistance, transportation support, and access to essential supplies.

By implementing these recommendations, communities can be empowered to actively participate in maternal health programs, leading to improved access and better health outcomes for mothers and their children.
AI Innovations Description
The recommendation to improve access to maternal health based on the described research is to focus on building community capacity and addressing key barriers. This can be achieved through the following strategies:

1. Strengthening sense of community: Encourage community members to develop a sense of belonging and shared responsibility towards maternal health. This can be done through community engagement activities, such as town hall meetings, community forums, and awareness campaigns.

2. Enhancing community leadership commitment: Foster strong leadership within the community to drive and support maternal health initiatives. Empower local leaders to take ownership of the programs and encourage their active involvement in promoting maternal and reproductive health services.

3. Improving problem-solving mechanisms: Establish effective mechanisms for identifying and addressing challenges related to maternal health. This can involve setting up community-based committees or task forces dedicated to addressing maternal health issues and finding innovative solutions.

4. Increasing access to resources: Work towards improving access to resources needed for maternal health services. This may involve advocating for increased government funding, seeking partnerships with NGOs or private sector organizations, and mobilizing community resources to support maternal health programs.

5. Promoting community social mobilization: Encourage community members to actively participate in promoting maternal health services. This can be achieved through community-led campaigns, peer education programs, and the involvement of local social mobilization groups.

6. Addressing poverty and resource constraints: Recognize the impact of poverty on community capacity to support maternal health programs. Implement strategies to alleviate poverty and provide necessary resources, such as financial assistance, transportation support, and access to essential supplies.

By implementing these recommendations, communities can be empowered to actively participate in maternal health programs, leading to improved access and better health outcomes for mothers and their children.
AI Innovations Methodology
To simulate the impact of the main recommendations on improving access to maternal health based on the abstract, a mixed-methods approach could be used. Here is a brief description of the methodology:

1. Study Design: Conduct a pre-post intervention study design to assess the impact of implementing the recommendations on community capacity and access to maternal health services.

2. Selection of Study Sites: Choose a representative sample of communities in Ghana where the Community-Based Health Planning and Service (CHPS) program is implemented.

3. Data Collection:

a. Baseline Assessment: Administer a survey questionnaire to community informants, frontline health providers, and district health managers to assess the level of community capacity using the modified indicators (sense of community, community members commitment, community leadership commitment, problem-solving mechanisms, and access to resources).

b. Intervention Implementation: Implement the recommendations outlined in the abstract, such as community engagement activities, strengthening community leadership, establishing problem-solving mechanisms, improving resource access, promoting community social mobilization, and addressing poverty and resource constraints.

c. Post-Intervention Assessment: Repeat the survey questionnaire to measure changes in community capacity after implementing the recommendations.

4. Data Analysis:

a. Quantitative Analysis: Analyze the survey data using appropriate statistical methods to compare the baseline and post-intervention results. This analysis will provide insights into the impact of the recommendations on community capacity.

b. Qualitative Analysis: Conduct thematic analysis of qualitative data collected from interviews and open-ended survey questions to gain a deeper understanding of the factors influencing community capacity and access to maternal health services.

5. Results and Conclusion: Summarize the findings from the quantitative and qualitative analyses to evaluate the impact of the recommendations on improving access to maternal health. Draw conclusions based on the results and provide recommendations for further interventions or improvements.

By using this methodology, researchers can assess the effectiveness of the recommendations in enhancing community capacity and ultimately improving access to maternal health services in Ghana.


Statistics:
Citations: 9
Identifiers:
DOI: 10.1016/j.evalprogplan.2018.10.001
ISSN: 01497189
Research Areas:
Community Interventions, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Social Determinants
Study Countries:
Ghana
Study Approach:
Qualitative
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