Primeau Marie-Douce, Jobin-Gelinas Marie, Maleko Mayabanza Cécile, Mayaza Maguy, Blouin Geneviève
Université de Montréal - Unité de Santé Internationale, Montréal, Québec, Canada.
Santé Monde, Kinshasa, Democratic Republic of the Congo.
Int J Health Plann Manage. 2025 Jan;40(1):108-129. doi: 10.1002/hpm.3854. Epub 2024 Oct 1.
Patient engagement is seen as a fundamental strategy for achieving quality patient-centred care, especially in community-based primary healthcare. Despite growing interest in patient engagement in Sub-Saharan Africa, few patient engagement initiatives have been identified, and those often are limited to lower levels of engagement, in participation in health research or in health system improvement. With the aim of giving a voice to under-represented community groups in healthcare governance, the Access to Health services in Kinshasa (ASSK) project supported the implementation of primary health services user committees in the Democratic Republic of the Congo, designed to enable the representation of two user groups with specific unmet sexual and reproductive health (SRH) needs: women and adolescents.
Using a mixed-method case study design combining quantitative secondary data (from the national health management information system-DHIS2) and qualitative data from two research World Café (WC1: Women user committees (WUC) n = 55; WC2: Adolescents user committee (AUC) n = 63), this paper looks at the implementation facilitators and barriers, and at the results of this initiative.
Women and adolescent members of the user committees highlighted that their participation resulted in increased knowledge of SRH and their related rights, as well as in their 'soft skills' such as communication and leadership. In addition, participants reported greater transparency and accountability on the part of the community primary health centres (e.g. by displaying fees for procedures to counter over-billing). Ultimately, WUC and AUC were associated with improved health practices in the community such as increased use of SRH services (increase of 613% for Makala and 160% for Maluku II), including adolescent family planning (increase of 320% for Makala and 12% for Maluku II) and assisted childbirth for women15-49 years old (increase of 283% for Makala and 23% for Maluku II)).
Patient user committees for specific marginalised or under-represented groups appear to be an effective way of improving the quality of primary health care services. Further research is needed to better understand how to maximise its potential.
患者参与被视为实现以患者为中心的优质医疗服务的一项基本策略，尤其是在社区基层医疗保健领域。尽管撒哈拉以南非洲地区对患者参与的兴趣与日俱增，但已确定的患者参与举措却寥寥无几，而且这些举措往往局限于较低水平的参与，如参与健康研究或卫生系统改进。为了让在医疗治理中代表性不足的社区群体能够发声，金沙萨的医疗服务获取项目（ASSK）在刚果民主共和国支持实施了基层医疗服务用户委员会，旨在让有未满足的特定性健康和生殖健康（SRH）需求的两类用户群体能够得到代表：妇女和青少年。
本文采用混合方法案例研究设计，结合定量二手数据（来自国家卫生管理信息系统-DHIS2）和来自两次研究世界咖啡馆的定性数据（WC1：女性用户委员会（WUC），n = 55；WC2：青少年用户委员会（AUC），n = 63），探讨该举措的实施促进因素和障碍以及结果。
用户委员会的女性和青少年成员强调，他们的参与使他们对性健康和生殖健康及其相关权利的了解有所增加，同时也提升了他们的“软技能”，如沟通和领导能力。此外，参与者报告称社区基层医疗中心的透明度和问责制有所提高（例如通过公示诊疗费用以防止乱收费）。最终，女性用户委员会和青少年用户委员会与社区健康行为的改善相关联，如性健康和生殖健康服务的使用增加（马卡拉地区增加了613%，马鲁古二区增加了160%），包括青少年计划生育（马卡拉地区增加了320%，马鲁古二区增加了12%）以及15 - 49岁女性的助产服务（马卡拉地区增加了283%，马鲁古二区增加了23%）。
针对特定边缘化或代表性不足群体的患者用户委员会似乎是提高基层医疗服务质量的有效途径。需要进一步开展研究以更好地了解如何最大限度地发挥其潜力。
