"Like a broom tied together": A qualitative exploration of social cohesion and its role in community capacity strengthening to support integrated health in Nigeria.

Social cohesion, broadly understood as the degree of connectedness, solidarity, and trust across various community groups and between individuals, is critical for community capacity. This paper examines social cohesion and its role in community capacity strengthening for sustaining integrated health gains in Nigeria. This study took place in the context of a mid-course qualitative evaluation of a Community Capacity Strengthening approach that focuses on engaging Ward Development Committees (WDC) to increase community agency, coordinate and support the ward-level health ecosystem and ensure sustained community-level activities supporting behaviour change for improved health outcomes. This qualitative study was conducted in four selected wards per state in Bauchi and Sokoto states, targeting WDC members, Village Development Committee members, Community Volunteers, local government officials, traditional leaders, and Community Capacity Strengthening project staff. Thematic content analysis findings show that recognition and legitimacy were operationalized through the election of members into committees which in turn gave them a sense of identity and credibility. At the community level, WDCs leveraged the influence of social networks in the community to achieve their goal. Trust was also identified as a prerequisite to the acceptance and accomplishment of social and behaviour change programming. At the institutional level, our findings revealed strong conflict management skills and high collective efficacy of committee members for programme implementation. This study found high cohesion among committee members, promoting a sense of belonging and agency, and facilitating social and behavior change activities for improved health outcomes. However, we found clear limits to the extent to which high social cohesion can contribute to community capacity to sustain health implementation and improvements. While cohesive community organizations present a good opportunity for health programmes, there is a need for more investment of resources to address funding, logistics, and service delivery limitations.