2 min read
01 May

By Ermel Johnson* & Marie Renaud**

  • *West African Health Organisation
  • **International Development Research Center 

Contributors: Issiaka Sombié, Dismas Matovelo, Ejemai Eboreime, Celso Belo, Nafissatou Diop


As part of the 25th Canadian Conference on Global Health, the Innovating for Maternal and Child Health in Africa (IMCHA) team and the West African Health Organization (WAHO) organised a panel on health systems governance through grassroots community mobilization and engagement. IMCHA is a 7-year initiative funded by Global Affairs Canada, the Canadian Institutes of Health Research and Canada’s International Development Research Center, and aims to improve maternal, newborn and child health outcomes in targeted countries by strengthening health systems, using primary health care as an entry point.

In this panel, three research teams involved in the initiative shared their experiences of community mobilization and engagement. Indeed, three panellists and the hundred or so participants shared experiences of community mobilization in health system governance in different contexts. The presentations focused on:

  • Community engagement for improving women's access to quality care during pregnancy in Edo State, presented by Dr Ejemai Eboreime on behalf of the Women Health & Action Research Centre, Nigeria;
  • Community mobilization for improving maternal and newborn child health outcomes in rural Tanzania, presented by Dr Dismas Matovelo, Catholic University of Health and Allied Sciences, Tanzania;
  • Influencing health systems through community mobilization for maternal and newborn health in Nampula province, by an Alert Community to Prepared Hospital presented by Dr Celso Belo, faculty of Health Sciences, University of Lurio, Mozambique.

In these three experiences, different strategies were used according to the needs of the communities identified through baseline studies. In Nigeria, these included: a Drug Revolving fund managed by communities to fill the gap in essential drugs was set up; a Community Health Insurance fund with a monthly contribution of CAD 7 per woman of childbearing age established and managed by the community development committee to provide free access to care; and a Text4Life program involving the association of taxi drivers, mobile phone companies and the community to allow women to be referred in case of emergencies free of charge to the reference centres already on alert. In Tanzania, the community-based health workers (CHWs) identified by community members were trained and mentored to promote health care in the community. Finally, in Mozambique, community members were identified as maternal and child health champions to raise awareness and promote primary health care, as well as the use of motorcycle ambulances.

These different interventions with community participation have had a direct impact on targeted population health. The number of women attending health services for antenatal care has quadrupled in Nigeria, doubled in Tanzania and the coverage and adoption of motorcycle ambulances has increased the number of women referred to hospitals for better delivery care by a factor of five in Mozambique.

The second part of the panel allowed the audience to contribute to the debate by sharing their thoughts on two questions: How do the innovations in community mobilization and engagement influence the governance of health systems? and Which aspects of health system governance can these innovations contribute to improve? It is worth noting from the exchanges that the community can make a significant contribution to the governance of health systems under the condition that they are given responsibility. As shown in the experiences of the three projects presented, the involvement of communities in reducing barriers to access care and in providing community education have contributed to improving the use of health services and consequently the well-being of women and children. To this end, the community must be involved in all stages of health system management, from the identification of priority problems, interventions definition, implementation, and monitoring for sustainability. Nevertheless, it is also important to clearly define the role of the community, as well as its share of accountability. This will have the benefit of setting up a shared and transparent management of all actors in the health system. These prerequisites will allow an effective influence of the community in the governance of health systems, particularly in terms of leadership, decision-making, identification of local solutions, mobilization of endogenous resources and accountability. Again, for any CHWs programming to be successful and sustainable; it has to be based on community needs, ensure community leaders’ recognition, well-articulated to existing interventions in the health system, and find an empowering motivation mechanism.

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