Unlocking community capabilities
The unlocking community capabilities theme systematically examines how communities can be active participants in the planning, delivery, monitoring and evaluation of their health system, by identifying and mobilising individual and collective capabilities in different social, political, and institutional environments.
Defining community capabilities
Communities are groups of people having common interests, resources, beliefs, needs, occupations or other social conditions that characterise the identity of members and affect their cohesiveness. FHS focuses on communities that live in a particular geographic area, but also examines other social characteristics of communities. The term ‘community capability’ encompasses key concepts of empowerment, mobilisation, social capital and capacity building.
- Developing reproducible ways of measuring community capabilities to understand the social relations and resources within and across communities, including the status, social relations and entitlements of disadvantaged populations.
- Developing reproducible ways of changing community capabilities as a process and outcome of health systems interventions by improving linkages, strengthening monitoring, securing resources, improving resilience, and changing social norms.
- Having robust measures of change in community capabilities and developing research methodologies to understand pathways for change in community capabilities and how they relate to changes in health systems.
Defining an appropriate model of health systems ethics relevant to long-term engagements with communities, especially in low-resource settings.
Recent FHS publications on 'unlocking community capabilities'
Kiracho, E.E., Namuhani, N., Apolot, R.R. et al. (2020) Influence of community scorecards on maternal and newborn health service delivery and utilization, Int J Equity Health 19, 145, https://doi.org/10.1186/s12939-020-01184-6
The community score card (CSC) is a participatory monitoring and evaluation tool that has been employed to strengthen the mutual accountability of health system and community actors. In this paper we describe the influence of the CSC on selected maternal and newborn service delivery and utilization indicators.
Hanifi, S.M.A., Hossain, A., Chowdhury, A.H. et al. (2020) Do community scorecards improve utilisation of health services in community clinics: experience from a rural area of Bangladesh, Int J Equity Health 19, 149, https://doi.org/10.1186/s12939-020-01266-5
The government of Bangladesh initiated community clinics (CC) to extend the reach of public health services and these facilities were planned to be run through community participation. However, utilisation of CC services is still very low. Evidence indicates community score card is an effective tool to increase utilisation of services from health facility through regular interface meeting between service providers and beneficiary. We investigated whether community scorecards (CSC) improve utilisation of health services provided by CCs in rural area of Bangladesh.
Mahmood, S.S., Rasheed, S., Chowdhury, A.H. et al. (2020) Feasibility, acceptability and initial outcome of implementing community scorecard to monitor community level public health facilities: experience from rural Bangladesh, Int J Equity Health 19, 155, https://doi.org/10.1186/s12939-020-01265-6
Engaging communities in health facility management and monitoring is an effective strategy to increase health system responsiveness. Many developing countries have used community scorecard (CSC) to encourage community participation in health. However, the use of CSC in health in Bangladesh has been limited. In 2017, icddr,b initiated a CSC process to improve health service delivery at the community clinics (CC) providing primary healthcare in rural Bangladesh. The current study presents learnings around feasibility, acceptability, initial outcome and challenges of implementing CSC at community clinics.
Apolot, R.R., Tetui, M., Nyachwo, E.B. et al. (2020) Maternal health challenges experienced by adolescents; could community score cards address them? A case study of Kibuku District– Uganda, Int J Equity Health 19, 191, https://doi.org/10.1186/s12939-020-01267-4
Approximately 34.8% of the Ugandan population is adolescents. The national teenage pregnancy rate is 25% and in Kibuku district, 17.6% of adolescents aged 12–19 years have begun child bearing. Adolescents mothers are vulnerable to many maternal health challenges including; stigma, unfriendly services and early marriages. The community score card (CSC) is a social accountability tool that can be used to point out challenges faced by the community in service delivery and utilization and ultimately address them. In this paper we aimed to document the challenges faced by adolescents during pregnancy, delivery and postnatal period and the extent to which the community score card could address these challenges.
Ghosh U, Sen B, and Bose S (2019) Photo voice as a participatory approach to influence climate related health policy in the Sundarbans, The Lancet Planetary Health, Volume 3, Special Issue, S22, DOI: 10.1016/S2542-5196(19)30165-2
The IPCC Fifth Assessment Report highlights community-based strategies to drive effective and ecologically sustainable local adaptation strategies. A climate change hot spot, Sundarbans, India, needs collective action between communities and for local level health and non-health decision makers to find sustainable solutions to combat the impacts of climate change on child health.
Alonge O, Sonkarlay S, Gwaikolo W, Fahim C, Cooper JL and Peters DH (2019) Understanding the role of community resilience in addressing the Ebola virus disease epidemic in Liberia: a qualitative study (community resilience in Liberia), Global Health Action, 12:1, DOI: 10.1080/16549716.2019.1662682
There is an increasing recognition that community resilience plays a significant role in addressing health shocks like the Ebola virus disease (EVD) epidemic. However, the factors that constitute community resilience, and how these operate dynamically with other health system factors are less understood. This paper seeks to understand key factors that constitute community resilience and their role in responding to the EVD outbreak in Liberia.
Between June 2017 and December 2018, Makerere University School of Public Health (MakSPH), in collaboration with Future Health Systems, implemented a Community Scorecard project focusing on maternal and newborn health service delivery and utilization in six sub-counties in Kibuku district in Eastern Uganda. This short film highlights some successes from this pilot.
Between 2017 and 2018, the Makerere University School of Public Health (MakSPH), in collaboration with the Future Health Systems Research Consortium, implemented a CSC project focusing on maternal and newborn health service delivery and utilization in six sub-counties in Kibuku District, in Eastern Uganda. The implementation was led by stakeholders in the district and comprised of sub county chiefs, Local council chair persons, Health Unit Management Committee chairpersons, Village health team members, community development officers, sub county level councilors and volunteers. This short film is based on the challenges of implementing the project and also explains how these challenges were handled.
FHS partner Makerere University School of Public Health undertook a Community Score Cards study, which contributed to research on how leaders can work with the community and health workers to improve maternal and newborn health in Kibuku District. The use of the Community Score Card tool – a two-way and ongoing participatory tool for assessment, planning, monitoring and evaluation - aims to improve the performance of facilities and accountability by the different stakeholders who are responsible for improving the performance of facilities. This film provides an overview of how to undertake a maternal and newborn community scorecard.