The architecture and effect of participation: A systematic review of community participation for communicable disease control and elimination. Implications for malaria elimination

Pacific Malaria Initiative Support Centre, Australian Centre for International and Tropical Health, School of Population Health, University of Queensland, Brisbane, Australia.
Malaria Journal (Impact Factor: 3.49). 08/2011; 10(1):225. DOI: 10.1186/1475-2875-10-225
Source: PubMed

ABSTRACT Community engagement and participation has played a critical role in successful disease control and elimination campaigns in many countries. Despite this, its benefits for malaria control and elimination are yet to be fully realized. This may be due to a limited understanding of the influences on participation in developing countries as well as inadequate investment in infrastructure and resources to support sustainable community participation. This paper reports the findings of an atypical systematic review of 60 years of literature in order to arrive at a more comprehensive awareness of the constructs of participation for communicable disease control and elimination and provide guidance for the current malaria elimination campaign.
Evidence derived from quantitative research was considered both independently and collectively with qualitative research papers and case reports. All papers included in the review were systematically coded using a pre-determined qualitative coding matrix that identified influences on community participation at the individual, household, community and government/civil society levels. Colour coding was also carried out to reflect the key primary health care period in which community participation programmes originated. These processes allowed exhaustive content analysis and synthesis of data in an attempt to realize conceptual development beyond that able to be achieved by individual empirical studies or case reports.
Of the 60 papers meeting the selection criteria, only four studies attempted to determine the effect of community participation on disease transmission. Due to inherent differences in their design, interventions and outcome measures, results could not be compared. However, these studies showed statistically significant reductions in disease incidence or prevalence using various forms of community participation. The use of locally selected volunteers provided with adequate training, supervision and resources are common and important elements of the success of the interventions in these studies. In addition, qualitative synthesis of all 60 papers elucidates the complex architecture of community participation for communicable disease control and elimination which is presented herein.
The current global malaria elimination campaign calls for a health systems strengthening approach to provide an enabling environment for programmes in developing countries. In order to realize the benefits of this approach it is vital to provide adequate investment in the 'people' component of health systems and understand the multi-level factors that influence their participation. The challenges of strengthening this component of health systems are discussed, as is the importance of ensuring that current global malaria elimination efforts do not derail renewed momentum towards the comprehensive primary health care approach. It is recommended that the application of the results of this systematic review be considered for other diseases of poverty in order to harmonize efforts at building 'competent communities' for communicable disease control and optimising health system effectiveness.

Download full-text


Available from: Lisa Fitzgerald, Jul 26, 2015
  • Source
    • "CHWs can improve health seeking behaviour and provide low-cost maternal and child health interventions ; cost of CHW subsystem is estimated to be $2.62 per capita, and a programme cost of $3584 per CHW Naimoli et al. (2012) Reviews broad set of interventions; role of health systems and the community CHWs can successfully deliver a range of preventive and curative services to improve health outcomes; -Number of factors influence CHW performance, including CHW, community characteristics ; service mix, contextual factors and community are involved in CHW support activities Perry and Zulliger (2012) Review of literature, expert opinion; CHWs highly effective in promoting breastfeeding; treating childhood pneumonia, diarrhoea and malaria ; reducing maternal and child mortality Abad-French et al. 2011 Systematic review of community participation in the control of Chagas disease Participation enhances control of disease but further evidence is necessary Prost et al. 2013 Systematic review of role of women's participatory groups in improving birth outcomes Women's groups are cost-effective and improve birth outcomes rapidly on a large scale Atkinson et al. 2011 Systematic review of the role of community in communicable disease control with malaria as a case study Challenges of lack of definition for 'community' and 'participation' and poor understanding of the constructs of participation and a ''peoples' component'' in control programmes Preston et al. 2010 Systematic review of evidence of community participation and improvements in rural health outcomes Lack of evidence of direct link but this did not mean lack of effect; need to improve understanding of participation in terms of time and financing and need tools to measure and understand participation Marston et al. 2013 Systematic review of evidence of effects of community participation on improving skilled care for maternal and newborn health Found very few high quality studies and none that answered question of why interventions succeed or fail; need qualitative component to study 'complex interventions' as part of RTCs Mubyazi and Hutton 2012 Review of community participation in health planning , resource allocation and service delivery from published and grey literature Barrier to evidence is lack of standard definition of 'community' and 'participation'; contribution of participation depends on many factors including system factors and socio-cultural factors; lack of data to make generalizations McCoy et al. 2011 Systematic review of health service committees Barriers to evidence is lack of standard definition of 'community' and 'participation'; lack of data for robust analysis; cannot confirm external validity; outcomes depend on process and context Molyneux et al. 2012 Review of literature on community accountability at peripheral health facilities Accountability depended on political interests, response to funding, selection, support from local and national government and relationships in committees and with other groups, health providers and managers Evans et al. 2010 Systematic review of impact of participatory approaches on UK public health units on health and social outcomes Little evidence of a direct link between participatory approaches and a 'noteworthy' impact on health and social outcomes Milton et al. 2011 Systematic review of community engagement on health and social outcomes No evidence on population health or quality of services but some positive impact on housing, crime, social capital and community empowerment "
    [Show abstract] [Hide abstract]
    ABSTRACT: As a key principle of Primary Health Care (PHC) and Health Systems Reform, community participation has a prominent place in the current global dialogue. Participation is not only promoted in the context of provision and utilization of health services. Advocates also highlight participation as a key factor in the wider context of the importance of social determinants of health and health as a human right. However, the evidence that directly links community participation to improved health status is not strong. Its absence continues to be a barrier for governments, funding agencies and health professionals to promote community participation. The purpose of this article is to review research seeking to link community participation with improved health status outcomes programmes. It updates a review undertaken by the author in 2009. The search includes published articles in the English language and examines the evidence of in the context of health care delivery including services and promotion where health professionals have defined the community’s role. The results show that in most studies community participation is defined as the intervention seeking to identify a direct causal link between participation and improved health status modeled on Randomized Control studies (RCT). The majority of studies show it is not possible to examine the link because there is no standard definition of ‘community’ and ‘participation’. Where links are found, they are situation-specific and are unpredictable and not generalizable. In the discussion, an alternative research framework is proposed arguing that community participation is better understood as a process. Once concrete interventions are identified (i.e. improved birth outcomes) then the processes producing improved health status outcomes can be examined. These processes may include and can lead to community uptake, ownership and sustainability for health improvements. However, more research is needed to ensure their validity.
    Health Policy and Planning 10/2014; 2(Supple)::ii98–ii106. DOI:10.1093/heapol/czu076 · 3.00 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: In poor countries, tragically, people die unnecessarily. Having changed our understanding about issues related to poverty, even in the fight against malaria we must keep in mind a number of issues other than simple lack of economic resources. In this article we tried to discuss the various aspects that make malaria a disease closely related to poverty and the effects of malaria on the same poverty of patients who are affected. If you want the program to "Rool Back Malaria" to succeed, you must program interventions that improve the living conditions of populations in endemic area, individually and as communities. As has become clear that the discovery of an effective vaccine will not eradicate the disease, remains a fundamental understanding of mechanisms related to poverty that cause Malaria remains one of the major killers in the world, to help communities affected and individuals to prevent, cure properly and not being afraid of this ancient disease.
    Mediterranean Journal of Hematology and Infectious Diseases 01/2012; 4(1):e2012048. DOI:10.4084/MJHID.2012.048
  • [Show abstract] [Hide abstract]
    ABSTRACT: Immunization coverage rates in Nigeria have remained very poor, in spite of numerous programs and strategies, specifically designed to improve coverage. This study was to assess the possible effects of greater community participation on immunization coverage, by comparing the immunization coverage in a rural community with a functional community health committee, with an urban community, with no distinct community structure. The study was carried out in Ondewari, a rural, riverine community, in Bayelsa State; and Yenagoa, the capital of Bayelsa State, south-south Nigeria; using a cross-sectional, comparative study design. The data were collected using a structured interviewer-administered questionnaire, administered on female head of households in both communities, with under-five children; and used to collect information on the socio-demographic characteristics of the respondents, the immunization status of children in the household below the age of 2 years, and reasons for none and incomplete immunization. A total of 288 respondents were studied in the rural community, while 270 respondents were studied in the urban center. The respondents in the urban center were significantly younger (P<0.01), better educated (P<0.001), and had fewer number of children (P<0.01). The immunization status of children in the rural community was significantly better than those in the urban community (P<0.000). Only 11.46% of the children in the rural community were not immunized, compared to 47.04% in the urban community. However, the dropout rate in the rural community was much higher; with a DPT dropout rate of 77.34%, compared to 12.39% in the urban community. Most of the reasons given in the urban community for the incomplete immunization were linked lack of motivation, and include relocation (11.34%) and the adverse rumor about childhood immunization (17.23%), while the reasons in the rural community were mostly health facility related, and included the absence of the vaccinator (20.46%) and nonavailability of vaccines (26.64%). The immunization coverage in the rural community was surprisingly better than that of the urban community, which can be attributed to better mobilization and participation in the delivery of immunization services.
    Journal of the Nigeria Medical Association 03/2012; 53(1):21-5. DOI:10.4103/0300-1652.99826
Show more