Page 128 - GHES-3-2

Global Health Economics and
Sustainability
Community participation in primary health care

reporting standards and embodies the spirit of evidence- 72% of the WDCs use health facility data obtained
based decision-making, a cornerstone of effective from supervisory visits and performance indicators for
healthcare implementation. In a similar study exploring decision-making, which presents a valuable opportunity
the nature and roles of health facility committees in Kenya, for evidence-based actions and priority setting. However,
Goodman et al. (2011) discovered that about 80% of the the extent to which these decisions can contribute to
committees met at least once in a quarter, and in all cases, effective healthcare services at the health facilities and
meeting notes were available (Goodman et al., 2011). This for the communities served depends on various factors
study showed a similar finding to the current study. and contexts. It is well known that the effectiveness of
WDCs in influencing health services depends on multiple
4.8. WDCs: Guardians of primary health care interacting factors at the levels of the committees,
Our study also found that almost all WDCs (98%) communities, health facilities (including personnel), and
engaged in routine health facility supervision as part of the wider health system (McCoy et al., 2012). In addition,
their activities. Most WDCs (94%) monitored health decisions made by these committees are likely to result
facility performance indicators during such supervisory in significant changes and outcomes only if they are
visits. These findings suggest that WDCs undertake some supported by authorities at the local or state government
deliberate efforts to ensure they are fully aware of what levels (Njelita et al., 2023).
the health facilities are doing and use data for evidence- In the present study, most of the committees (91%)
based decision-making on behalf of the communities they stated they had independent means of generating funds
represent. Although it was not part of our study objective for their routine activities. However, only a few (16%)
to determine the technical capabilities of WDC members, disclosed that they maintained bank accounts in the
our findings suggest that many members wholly or partly committee’s name. This finding aligns with findings
possessed some technical skills necessary for data-driven from previous studies (Ogbuabor & Onwujekwe, 2018),
decision-making. Monitoring performance indicators which identified financial management as a key challenge
also requires a certain level of technical capacity from the for many such committees, highlighting an area for
supervising team. These findings are consistent with the improvement. Siachisa et al. (2023) found financial
established mandates of WDCs (Abosede et al., 2012). resources and irregularities as constraints to the effective
In a qualitative synthesis on participation in primary functioning of WDCs in Zambia (Siachisa et al., 2021). In
health care through community-level health committees contrast, the current study found that the majority of the
in Sub-Saharan Africa, Karuga et al. (2022) found similar WDCs reported having sources of funds. Ezinwa (2017),
results regarding the role of community-level health in a study on the roles and challenges of WDCs, found that
committees in supervising and monitoring health facilities, a key challenge faced by WDCs in Ogun State, Nigeria,
as well as holding health workers accountable (Karuga et al., was financial constraint (Ezinwa, 2017). As stated earlier,
2022; Siachisa et al., 2021). An important quality outcome WDCs are highly context-specific and influenced by social,
of these roles performed by WDCs is the improvement of political, and economic factors, and all WDCs should be
healthcare services at the health facilities, which, in turn, viewed as such (McCoy et al., 2012).
leads to improved community outcomes. However, a study Notably, our study highlights the roles played and
by Njelita et al. (2023) assessing the awareness and roles efforts championed by the WDCs in Kebbi State. For
of community members in health facilities found that instance, the efforts of the WDCs and their engagement
most community members do not know about the roles with various stakeholders led to the establishment and
and responsibilities of WDCs. This finding is significant operation of community-led DRF schemes, with about
because the roles performed by WDCs must match the level 33% of these schemes established in Kebbi State where
of awareness among community members; it underscores no functional government-driven DRF scheme existed; in
the narrative that not only do WDCs need to have good addition, through the routine engagement with PHCs via
performance records, but the community members also supervision and monitoring, about 61% of PHCs started
need to be informed and mobilized to actively participate displaying their operational hours publicly as a way of
in attaining the health goals of their communities. providing information to clients.
The roles of WDCs do not only stop at engaging health Beyond the sphere of WDCs, the study unveils
facilities but also mobilizing communities to seek care the significance of additional community structures
in health facilities. McCoy et al. (2012) noted that wider in bolstering healthcare access. We found that 90%
community mobilization is imperative for improved of communities covered by WDCs had TBAs. These
functioning of health facilities. Our findings show that community-based healthcare providers filled critical gaps,

Volume 3 Issue 2 (2025) 120 https://doi.org/10.36922/ghes.4945