Centre for International Health and Development, University College London, 30 Guilford Street, London, WC1N 1EH, UK.
Health Policy Plan. 2012 Sep;27(6):449-66. doi: 10.1093/heapol/czr077. Epub 2011 Dec 8.
Community participation in health (CPH) has been advocated as a health-improving strategy for many decades. However, CPH comes in many different forms, one of which is the use of health facility committees (HFCs) on which there is community representation. This paper presents the findings of a systematic literature review of: (a) the evidence of HFCs' effectiveness, and (b) the factors that influence the performance and effectiveness of HFCs. Four electronic databases and the websites of eight key organizations were searched. Out of 341 potentially relevant publications, only four provided reasonable evidence of the effectiveness of HFCs. A further 37 papers were selected and used to draw out data on the factors that influence the functioning of HFCs. A conceptual model was developed to describe the key factors. It consists of, firstly, the features of the HFC, community and facility, and their interactions; secondly, process factors relating to the way HFCs are established and supported; and finally, a set of contextual factors. The review found some evidence that HFCs can be effective in terms of improving the quality and coverage of health care, as well as impacting on health outcomes. However, the external validity of these studies is inevitably limited. Given the different potential roles/functions of HFCs and the complex and multiple set of factors influencing their functioning, there is no 'one size fits all' approach to CPH via HFCs, nor to the evaluation of HFCs. However, there are plenty of experiences and lessons in the literature which decision makers and managers can use to optimize HFCs.
社区参与卫生（CPH）作为一种改善健康的策略已经得到了数十年的倡导。然而，CPH 有多种不同的形式，其中之一是使用有社区代表的卫生机构委员会（HFC）。本文介绍了对以下两个方面的系统文献综述的结果：（a）HFC 有效性的证据，以及（b）影响 HFC 绩效和有效性的因素。四个电子数据库和八个关键组织的网站被搜索。在 341 篇可能相关的出版物中，只有四篇提供了 HFC 有效性的合理证据。进一步选择了 37 篇论文，以提取影响 HFC 运作的因素的数据。开发了一个概念模型来描述关键因素。它包括 HFC、社区和设施的特征及其相互作用；其次，与 HFC 建立和支持方式相关的过程因素；最后，一组背景因素。该综述发现了一些证据表明，HFC 可以在提高医疗保健的质量和覆盖范围以及对健康结果产生影响方面发挥作用。然而，这些研究的外部有效性不可避免地受到限制。鉴于 HFC 的不同潜在角色/功能以及影响其运作的复杂和多样的因素集，通过 HFC 进行 CPH 或对 HFC 的评估没有“一刀切”的方法。然而，文献中有很多经验和教训，决策者和管理者可以利用这些经验和教训来优化 HFC。
