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Institute of Health and Society, Department of Community Medicine and Global Health, Faculty of Medicine, University of Oslo, P.O. Box 1072 Blindern, 0316, Oslo, Norway.
BMC Pregnancy Childbirth. 2017 Aug 31;17(1):268. doi: 10.1186/s12884-017-1443-0.
Community participation in in health programme planning, implementation and quality improvement was recently recommended in guidelines to improve use of skilled care during pregnancy, childbirth and the postnatal period for women and newborns. How to implement community participation effectively remains unclear. In this article we explore different factors.
We conducted a secondary analysis, using the Supporting the Use of Research Evidence framework, of effectiveness studies identified through systematic literature reviews of two community participation interventions; quality improvement of maternity care services; and maternal and newborn health programme planning and implementation.
Community participation ranged from outreach educational activities to communities being full partners in decision-making. In general, implementation considerations were underreported. Key facilitators of community participation included supportive policy and funding environments where communities see women's health as a collective responsibility; linkages with a functioning health system e.g. via stakeholder committees; intercultural sensitivity; and a focus on interventions to strengthen community capacity to support health. Levels of participation and participatory approaches often changed over the life of programmes as community and health services capacity to interact developed.
Implementation requires careful consideration of the context: previous experience with participation, who will be involved, gender norms, and the timeframe for implementation. Relevant stakeholders must be actively involved, particularly those often excluded from decision making. Current limited evidence suggests that the vision of community participation as a process and the presence of a focus to strengthen community capacity to participate and to improve health may be a key factor for long term success.
最近的指南建议社区参与卫生规划的制定、实施和质量改进，以改善妇女和新生儿在妊娠、分娩和产后期间对熟练护理的利用。如何有效地实施社区参与仍然不清楚。在本文中，我们探讨了不同的因素。
我们使用支持使用研究证据框架，对通过系统文献综述确定的两项社区参与干预措施的有效性研究进行了二次分析；改善产妇保健服务质量；以及孕产妇和新生儿健康规划的制定和实施。
社区参与的范围从针对社区的外联教育活动到社区成为决策的完全合作伙伴。一般来说，实施考虑因素报告不足。社区参与的主要促进因素包括支持性政策和资金环境，使社区将妇女健康视为集体责任；与运作良好的卫生系统建立联系，例如通过利益攸关方委员会；文化敏感性；并注重加强社区支持健康能力的干预措施。参与程度和参与方法通常随着方案的发展而改变，因为社区和卫生服务部门的互动能力得到了发展。
实施需要仔细考虑背景：参与的前期经验、谁将参与、性别规范以及实施的时间框架。必须让相关利益攸关方积极参与，特别是那些通常被排除在决策之外的利益攸关方。目前有限的证据表明，社区参与作为一个过程的愿景以及加强社区参与和改善健康的能力的重点，可能是长期成功的关键因素。
