Page 122 - GHES-3-2

Global Health Economics and
Sustainability
Community participation in primary health care

& Dooris, 2009). It encompasses a comprehensive range center (PHC) in each of the 8,812 wards across the
of services vital for preventing, diagnosing, treating, and country (Abosede & Sholeye, 2014; Abosede et al., 2012).
managing diseases and illnesses (Ata, 1978). However, WDCs were instituted to bolster these PHCs and enhance
providing effective primary health care in countries community engagement in healthcare governance, backed
like Nigeria, situated in Sub-Saharan Africa, is the beset by the National Health Promotion Policy (Federal Ministry
with multifaceted challenges. These include resource of Health, 2005). The kick-off of the WDC initiative in
limitations, inadequate financial allocations, and a Kebbi State started in earnest in 2017 and is still becoming
persisting shortage of skilled healthcare personnel (Durey stronger today. These committees represent a concerted
et al., 2016; Gholipour et al., 2023; Goodman et al., 2011). effort drawn from the PHC’s catchment population,

A promising avenue for strengthening primary tasked with providing oversight on accountability and
healthcare services has emerged amid these formidable supporting healthcare activities (George et al., 2015).
challenges: Community involvement and participation Previously, the lion’s share of PHC responsibilities rested
(Cyril et al., 2015; Reeve et al., 2015). This approach with government healthcare workers, resulting in elevated
recognizes the potential of harnessing local resources, infant and maternal mortality rates, dilapidated healthcare
knowledge, and community-driven solutions to augment infrastructure, and inadequate pharmaceuticals and
healthcare delivery. At the heart of this community-centered consumables (Abosede & Sholeye, 2014; Federal Ministry
endeavor are ward development committees (WDCs), of Health, 2005).
representing governance structures and accountability Recognizing these systemic challenges, the state took
mechanisms rooted in the ward-level context. These decisive steps to integrate WDCs into the fabric of local
committees have evolved into integral components of healthcare governance, emphasizing local ownership
primary healthcare management within Nigeria (Baghirov and accountability. Collaborative partnerships between
et al., 2019; Gholipour et al., 2018; Haldane et al., 2019). entities such as the United States Agency for International
The World Health Organization (WHO) defines Development programs, WHO, and the United Nations
community participation as “a process by which people International Children’s Emergency Fund provided crucial
are enabled to become actively and genuinely involved in technical support and capacity-building initiatives aimed
defining the issues of concern to them, in making decisions at reinforcing the role of WDCs in PHC affairs (McCoy
about factors that affect their lives, in formulating and et al., 2012). Yet, despite the existence of WDCs and other
implementing policies, in planning, developing and community support structures, the primary healthcare
delivering services, and in taking action to achieve sector in Kebbi State continues to grapple with challenges,
change.” Community participation in primary health care prompting the imperative to explore how these community-
has been enshrined in the Alma-Ata Declaration in 1978, based structures can be optimized to ameliorate primary
where it is clearly indicated that effective primary health healthcare services (Karuga et al., 2022; Njelita et al., 2023).
care “requires and promotes maximum community and The significance of WDCs in primary health care lies
individual self-reliance and participation in the planning, in their ability to bridge the gap between communities
organization, operation, and control of primary health and healthcare facilities, fostering collaboration and
care” (Ata, 1978). accountability in healthcare delivery. These committees
Local community committees are common and have serve as a grassroots mechanism for engaging communities
been widely studied in terms of their operations or impact in health governance, promoting local ownership, and
on health services at peripheral health facilities, such as ensuring that primary healthcare services align with
primary health centers, health posts, or dispensaries, in community needs and priorities. By facilitating regular
a number of African and other developing countries, interactions between health facility staff and community
including Nigeria, Uganda, Niger, Kenya, Benin Mexico, representatives, WDCs play a pivotal role in identifying
Peru, and Nepal among others (Gholipour et al., 2023; healthcare challenges, mobilizing resources, and driving
Goodman et al., 2011). Several other studies have shown initiatives such as social mobilization and emergency
the potential value of collaboration between communities response systems.
and health professionals in health facilities for promoting This study extends the existing body of knowledge by
primary health care (George et al., 2015; Mntambo, 2017). evaluating the functionality and depth of participation of

The National Primary Health Care Under One Roof, a WDCs, highlighting their roles in Kebbi State, Nigeria.
key policy directive by the National Primary Health Care The findings emphasize how WDCs contribute to
Development Agency (NPHCDA) in Nigeria, mandated the operationalizing PHC services by enhancing community
establishment of at least one functional primary healthcare involvement in decision-making, supervision, and financial

Volume 3 Issue 2 (2025) 114 https://doi.org/10.36922/ghes.4945