Page 125 - GHES-3-2

Global Health Economics and
Sustainability
Community participation in primary health care

to display operational hours and service costs (72%) bank accounts (only 16% of WDCs maintained one) and
compared to those less engaged in supervision (48%). limited financial literacy among committee members
Table 1 below shows the subgroup comparison of the posed significant challenges. These financial constraints
structural indicators and key functional outcomes. hindered the sustainability and scaling of DRF schemes.
Capacity-building in financial management, as suggested
The non-participating sites differed from the in the Section 3.1 section, is a priority to overcome these
participating ones in key structural and operational challenges.
aspects, including lower rates of WDC establishment, less
frequent community engagement activities, and limited 3.6. Transparency and accountability
financial management capacity, which may have hindered The ability of WDC to influence transparency at PHCs,
their involvement in the study. such as ensuring the public display of operational hours
(61%) and available services (65%), reflects their active role
3.3. Mechanisms of WDC contributions to health in governance and oversight, with 94% monitoring PHC
improvements
performance indicators. These achievements underscore
The mechanisms through which WDCs contribute to the committees’ potential to foster accountability. However,
health improvements are closely tied to the foundational initial resistance from health providers, who often viewed
structures and functions that define their operations. WDC supervision as interference, highlighted the
Section 3.1 outlines critical aspects of WDC functionality, challenges of integrating external oversight into facility
including governance, financial management, and management. Strengthening the collaboration between
community engagement. These factors serve as the basis WDCs and health providers through dialogue and training
for identifying and addressing challenges in implementing is essential to addressing this issue.
specific health improvement mechanisms.
3.7. ETSs
3.4. Social mobilization
ETSs established in 67% of communities were largely
Social mobilization campaigns, driven by 96% of WDCs, facilitated by WDC-led resource mobilization. These
represent a significant achievement in leveraging community systems fill critical gaps in healthcare access for
engagement to improve health outcomes. This effort stems emergencies, particularly for maternal and child health.
from the structured monthly meetings (97%) and consistent However, irregular contributions for maintenance and fuel
documentation practices highlighted in Section 3.1. These shortages frequently disrupted operations. Strengthening
meetings provided platforms for planning and coordinating financial mechanisms and community ownership, linked
campaigns. However, implementing social mobilization to the financial management structures outlined in Section
faced challenges such as cultural resistance in certain 3.1, is key to ensuring the sustainability of these systems.
communities and insufficient volunteer participation.
Addressing these barriers is crucial to expanding the reach 3.8. Evidence-based decision-making
and effectiveness of WDC-led mobilization efforts. A significant proportion of WDCs (94%) used PHC
performance indicators for decision-making, reflecting
3.5. Resource mobilization and financial management their technical capacity and structured governance
The establishment of community-led DRF schemes by practices. This evidence-based approach has been pivotal
33% of WDCs directly results from their capacity to in prioritizing health interventions. However, challenges
independently generate funds (91%), as described in such as limited access to reliable data and inadequate
Section 3.1. Despite these successes, the lack of functional technical training for WDC members constrained their

Table 1. Subgroup comparison
Structural indicator Subgroup Key functional outcome Percentage p-value
Meeting frequency Monthly meetings Successful social mobilization 85 <0.05
Less frequent meetings Successful social mobilization 63
Financial management Committees with bank accounts Successful DRF scheme implementation 45 <0.05
Committees without accounts Successful DRF scheme implementation 28
PHC supervision Active supervisors Display of operational hours 72 <0.05
Less active supervisors Display of operational hours 48
Abbreviations: DRF: Drug Revolving Fund; PHC: Primary healthcare center.

Volume 3 Issue 2 (2025) 117 https://doi.org/10.36922/ghes.4945