Karuga Robinson, Kok Maryse, Luitjens Marthe, Mbindyo Patrick, Broerse Jacqueline E W, Dieleman Marjolein
LVCT Health, P.O. Box 19835, Nairobi, 00202, Kenya.
Athena Institute, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands.
BMC Public Health. 2022 Feb 19;22(1):359. doi: 10.1186/s12889-022-12730-y.
Health committees are key mechanisms for enabling participation of community members in decision-making on matters related to their health. This paper aims to establish an in-depth understanding of how community members participate in primary health care through health committees in sub-Saharan Africa (SSA).
We searched peer-reviewed English articles published between 2010 and 2019 in MEDLINE, Popline and CINAHL databases. Articles were eligible if they involved health committees in SSA. Our search yielded 279 articles and 7 duplicates were removed. We further excluded 255 articles following a review of titles and abstracts by two authors. Seventeen abstracts were eligible for full text review. After reviewing the full-text, we further excluded two articles that did not explicitly describe the role of health committees in community participation. We therefore included 15 articles in this review. Two authors extracted data on how health committees contributed to community participation in SSA using a conceptual framework for assessing community participation in health. We derived our themes from five process indicators in this framework, namely, leadership, management and planning, resource mobilization from external sources, monitoring and evaluation and women involvement.
We found that health committees work well in voicing communities' concerns about the quality of care provided by health facility staff, day-to-day management of health facilities and mobilizing financial and non-financial resources for health activities and projects. Health committees held health workers accountable by monitoring absenteeism, quality of services and expenditures in health facilities. Health committees lacked legitimacy because selection procedures were often not transparent and participatory. Committee members were left out in planning and budgeting processes by health workers, who perceived them as insufficiently educated and trained to take part in planning. Most health committees were male-dominated, thus limiting participation by women.
Health committees contribute to community participation through holding primary health workers accountable, voicing their communities' concern and mobilizing resources for health activities and projects. Decision makers, health managers and advocates need to fundamentally rethink how health committees are selected, empowered and supported to implement their roles and responsibilities.
健康委员会是促使社区成员参与与其健康相关事务决策的关键机制。本文旨在深入了解撒哈拉以南非洲地区（SSA）的社区成员如何通过健康委员会参与初级卫生保健。
我们检索了2010年至2019年期间发表在MEDLINE、Popline和CINAHL数据库中的同行评审英文文章。如果文章涉及SSA的健康委员会，则符合入选条件。我们的检索共得到279篇文章，去除了7篇重复文章。在两位作者对标题和摘要进行审查后，我们又排除了255篇文章。17篇摘要符合全文审查条件。在审查全文后，我们又排除了两篇未明确描述健康委员会在社区参与中作用的文章。因此，本综述纳入了15篇文章。两位作者使用评估社区健康参与的概念框架，提取了关于健康委员会如何促进SSA社区参与的数据。我们从该框架中的五个过程指标中得出主题，即领导力、管理与规划、外部资源动员、监测与评估以及妇女参与。
我们发现，健康委员会在表达社区对医疗机构工作人员提供的护理质量的关注、医疗机构的日常管理以及为健康活动和项目筹集财政和非财政资源方面发挥了良好作用。健康委员会通过监测医疗机构工作人员的缺勤情况、服务质量和支出，使他们对工作负责。健康委员会缺乏合法性，因为选拔程序往往不透明且缺乏参与性。在规划和预算过程中，卫生工作者将委员会成员排除在外，认为他们受教育程度和培训不足，无法参与规划。大多数健康委员会以男性为主导，从而限制了女性的参与。
健康委员会通过使初级卫生工作者负责、表达社区关注以及为健康活动和项目筹集资源，促进了社区参与。决策者、卫生管理者和倡导者需要从根本上重新思考如何选拔、授权和支持健康委员会以履行其职责。
