Institute of Development Studies, University of Dar es Salaam, Dar es Salaam, Tanzania.
Glob Health Action. 2013 Nov 25;6:22669. doi: 10.3402/gha.v6i0.22669.
Community participation in priority setting in health systems has gained importance all over the world, particularly in resource-poor settings where governments have often failed to provide adequate public-sector services for their citizens. Incorporation of public views into priority setting is perceived as a means to restore trust, improve accountability, and secure cost-effective priorities within healthcare. However, few studies have reported empirical experiences of involving communities in priority setting in developing countries. The aim of this article is to provide the experience of implementing community participation and the challenges of promoting it in the context of resource-poor settings, weak organizations, and fragile democratic institutions.
Key informant interviews were conducted with the Council Health Management Team (CHMT), community representatives, namely women, youth, elderly, disabled, and people living with HIV/AIDS, and other stakeholders who participated in the preparation of the district annual budget and health plans. Additionally, minutes from the Action Research Team and planning and priority-setting meeting reports were analyzed.
A number of benefits were reported: better identification of community needs and priorities, increased knowledge of the community representatives about priority setting, increased transparency and accountability, promoted trust among health systems and communities, and perceived improved quality and accessibility of health services. However, lack of funds to support the work of the selected community representatives, limited time for deliberations, short notice for the meetings, and lack of feedback on the approved priorities constrained the performance of the community representatives. Furthermore, the findings show the importance of external facilitation and support in enabling health professionals and community representatives to arrive at effective working arrangement.
Community participation in priority setting in developing countries, characterized by weak democratic institutions and low public awareness, requires effective mobilization of both communities and health systems. In addition, this study confirms that community participation is an important element in strengthening health systems.
社区参与卫生系统的重点制定在全世界范围内变得越来越重要，尤其是在资源匮乏的环境中，政府往往未能为其公民提供足够的公共部门服务。将公众意见纳入重点制定被视为恢复信任、提高问责制和确保医疗保健中具有成本效益的重点的一种手段。然而，很少有研究报告在发展中国家涉及社区参与重点制定的经验。本文的目的是提供在资源匮乏、组织薄弱和民主机构脆弱的背景下，实施社区参与和促进社区参与的经验，并探讨所面临的挑战。
对理事会卫生管理团队（CHMT）、社区代表（即妇女、青年、老年人、残疾人和艾滋病毒/艾滋病患者）以及其他参与编制区年度预算和卫生计划的利益攸关方进行了关键知情人访谈。此外，还分析了行动研究小组的会议记录和规划及重点制定会议报告。
报告了一些益处：更好地确定了社区的需求和重点，提高了社区代表对重点制定的认识，增加了透明度和问责制，促进了卫生系统和社区之间的信任，以及感知到改善了卫生服务的质量和可及性。然而，缺乏资金来支持选定的社区代表的工作、审议时间有限、会议通知时间短以及对批准的重点缺乏反馈，限制了社区代表的表现。此外，调查结果表明，外部促进和支持对于使卫生专业人员和社区代表能够达成有效的工作安排非常重要。
在民主制度薄弱和公众意识较低的发展中国家，社区参与重点制定需要有效地动员社区和卫生系统。此外，本研究证实，社区参与是加强卫生系统的一个重要因素。
