Cocoman Olive, Jackson Debra, Ruysen Harriet, Gilmore Brynne
Department of Infectious Disease Epidemiology and International Health, London School of Hygiene & Tropical Medicine, London, United Kingdom.
School of Public Health, University of the Western Cape, South Africa.
PLOS Glob Public Health. 2025 Sep 2;5(9):e0005139. doi: 10.1371/journal.pgph.0005139. eCollection 2025.
In 2024, 194 countries endorsed World Health Assembly Resolution (WHA77.2) to strengthen participation in health-related decision-making. Achieving this requires strong leadership to institutionalise community participation by embedding it into health system functions. However, efforts are often fragmented and short-term, hindering both sustainability and scalability. There is limited understanding of how well countries have institutionalised community participation in decision-making for quality maternal and newborn health services. A secondary analysis of maternal and newborn health survey data was conducted using responses from 102 Ministries of Health in low-and middle-income countries. The analysis assessed progress in adopting and implementing maternal and newborn health recommendations on community participation. A descriptive approach was used to summarise the frequency of reported community participation activities. Percentages were applied to describe the data, which was disaggregated by 2024-2025 World Bank classifications for income level, and fragile and conflict-affected settings. Country responses were categorised using Lasswell's Policy Cycle heuristic. The findings indicate substantial gaps in institutionalising community participation in maternal and newborn health. Only half of countries reported integrating participation into national plans, and just one-third into implementation. In 90% of countries, parent groups were reported to be either absent or lacking influence on policymaking. National research on community participation, essential for evidence-based decision-making, was rarely reported. Across all regions, countries had varied progress, reflecting a diverse and uneven landscape of community participation. Stronger efforts are required to institutionalise community participation across the maternal and newborn health policy cycle. Strengthening this integration will require clear metrics to track implementation, enabling more accurate assessments of progress and accountability. Identifying countries where institutionalisation is advancing can surface positive deviance cases. Studying these in-depth may reveal drivers and effective strategies for fostering community participation to guide the adaption and integration of successful approaches into national health systems.
2024年，194个国家认可了世界卫生大会第77.2号决议，以加强对卫生相关决策的参与。要实现这一目标，需要强有力的领导，通过将社区参与融入卫生系统功能，使其制度化。然而，相关努力往往零散且短期，这既阻碍了可持续性，也影响了可扩展性。对于各国在将社区参与制度化以提供优质孕产妇和新生儿保健服务决策方面的成效，人们了解有限。利用低收入和中等收入国家102个卫生部的回复，对孕产妇和新生儿健康调查数据进行了二次分析。该分析评估了在采纳和实施关于社区参与的孕产妇和新生儿健康建议方面的进展。采用描述性方法总结报告的社区参与活动的频率。使用百分比来描述数据，并按2024 - 2025年世界银行的收入水平分类以及脆弱和受冲突影响的地区进行分类。国家回复根据拉斯韦尔政策周期启发法进行分类。研究结果表明，在将社区参与制度化以保障孕产妇和新生儿健康方面存在巨大差距。只有一半的国家报告将参与纳入国家计划，仅有三分之一的国家将其纳入实施过程。在90%的国家，据报告家长团体要么不存在，要么对政策制定没有影响力。很少有国家报告开展关于社区参与的全国性研究，而这对于基于证据的决策至关重要。在所有地区，各国的进展各不相同，反映出社区参与的情况多样且不均衡。需要做出更大努力，在孕产妇和新生儿健康政策周期中使社区参与制度化。加强这种整合将需要明确的指标来跟踪实施情况，以便更准确地评估进展和问责情况。确定制度化进程正在推进的国家可以发现积极偏差案例。深入研究这些案例可能会揭示促进社区参与的驱动因素和有效策略，以指导将成功方法适应并融入国家卫生系统。
