Page 126 - GHES-3-2

Global Health Economics and
Sustainability
Community participation in primary health care

ability to maximize this function. Building data literacy the depth of impact they can have in shaping the primary
among WDC members, as recommended in Section 3.1, healthcare landscape. The findings have important
can enhance their decision-making capabilities. implications for implementation science and healthcare
frameworks, contributing to the ongoing discourse on
3.9. WDCs and community-driven healthcare effective healthcare delivery and community participation.
initiatives
4.1. Universal establishment of WDCs
3.9.1. ETSs
A standout observation from this study is the universal
WDCs identified the lack of reliable transport as a significant establishment of WDCs in all wards of Kebbi State. The
barrier to accessing healthcare services, particularly during establishment of WDCs in every ward aligns with the
emergencies. To address this, they organized a community- principles of equitable access to health care, emphasizing
driven approach where households contributed funds for that no community should be left behind, a fundamental
vehicle maintenance and fuel. Local leaders supported aspect of contemporary healthcare frameworks. This
these efforts in some communities by donating motorcycles finding signifies a commendable adherence to the
or vans. As a result, 67% of communities reported having requirement by the NPHCDA to have WDCs established
operational ETSs, with 80% of pregnant women facing to support community efforts in primary health care at
complications being transported to PHCs within the first the local level. This further presents an opportunity to
hour of notification. However, the system faced challenges, foster a holistic collaboration between health facilities and
including fuel shortages and irregular contributions, which communities to drive core principles of primary health
disrupted operations in 23% of these communities. care, including access and equity. In line with this finding,
3.9.2. Community-Led DRF McCoy, Hall, and Ridge (2012) noted that, like WDCs,
health facility committee’s roles and functionality, as well
WDCs, in collaboration with PHC staff, initiated DRF as factors influencing them, are invariably influenced by
schemes to address the challenge of drug availability. contextual factors, the obvious of which is the influence
Through this initiative, community members contributed of the larger health system including the regulatory and
nominal amounts to purchase essential drugs, which policy provisions which shape the approach towards
were then sold at cost-recovery prices, with the proceeds community participation and the roles, mandates, and
reinvested to replenish stock. This approach proved authority of health facility committees (McCoy et al.,
effective, as 33% of WDCs established DRF schemes in 2012). In the case of Kebbi State and Nigeria as a whole, the
wards where no government-supported DRF existed, National Health Promotion policy has certainly provided
resulting in a 50% increase in the availability of key drugs. the framework for the establishment of WDCs across all
However, the initiative faced challenges, particularly in wards. This policy framework has evidently facilitated the
tracking funds due to a lack of bank accounts and limited establishment of these committees, allowing them to serve
financial management training among WDC members. as enablers for wider social accountability functions.

3.9.3. Social mobilization for immunization 4.2. WDCs in Kebbi State: Cornerstones of
campaigns community-driven health care
WDCs engaged community influencers and volunteers Our findings provide invaluable insights into the essential
to promote immunization days, enhancing their efforts role played by WDCs in shaping the primary healthcare
with door-to-door visits and announcements during landscape. These WDCs serve as dynamic nuclei within
religious gatherings. This strategy proved effective, their respective wards, fostering the integration of
with communities actively engaged in WDC-led healthcare systems and driving sustainable change at the
social mobilization reporting a 40% increase in child community level.
immunization rates compared to baseline levels. However, The universal establishment of WDCs was remarkable,
cultural resistance in certain areas initially resulted in low and the study revealed that all wards in Kebbi State
turnout, necessitating sustained engagement to overcome have successfully established functioning WDCs. This
these barriers and improve participation. universal presence signifies a commitment to community

4. Discussion engagement and grassroots participation in health
care. Establishing WDCs in every ward aligns with the
This study, conducted in Kebbi State, illuminates the principles of equitable access to health care, emphasizing
status of WDCs, their functionality, and their level of that no community should be left behind—a fundamental
involvement with catchment health facilities, signifying aspect of contemporary healthcare frameworks.

Volume 3 Issue 2 (2025) 118 https://doi.org/10.36922/ghes.4945