Unlocking community capabilities across health systems in low- and middle-income countries: lessons learned from research and reflective practice
George AS, Scott K, Sarriot E, Kanjilal B and Peters DH (2016) Unlocking community capabilities across health systems in low- and middle-income countries: lessons learned from research and reflective practice, BMC Health Services Research, 16:1859, DOI: 10.1186/s12913-016-1859-7
The right and responsibility of communities to participate in health service delivery was enshrined in the 1978 Alma Ata declaration and continues to feature centrally in health systems debates today. Communities are a vital part of people-centred health systems and their engagement is critical to realizing the diverse health targets prioritised by the Sustainable Development Goals and the commitments made to Universal Health Coverage. Community members’ intimate knowledge of local needs and adaptive capacities are essential in constructively harnessing global transformations related to epidemiological and demographic transitions, urbanization, migration, technological innovation and climate change. Effective community partnerships and governance processes that underpin community capability also strengthen local resilience, enabling communities to better manage shocks, sustain gains, and advocate for their needs through linkages to authorities and services. This is particularly important given how power relations mark broader contexts of resource scarcity and concentration, struggles related to social liberties and other types of ongoing conflicts.
As part of its thematic work on ‘Unlocking Community Capabilities’, the Future Health Systems research consortium examines how communities can be active participants in the planning, delivery, monitoring, and evaluation of their health systems, by identifying individual and collective capabilities in diverse social, political, and institutional environments to improve people’s health. This article introduces the supplement, which builds on prior work undertaken by the consortium and introduces important concepts through a literature review of key community capability domains in health systems research. The supplement then considers the measurement and effects of community capability on maternal health in Bangladesh, India and Uganda, child nutrition in India, and care preferences of the elderly in China. Authors also reflect on participatory initiatives building community capability to address maternal health in Uganda  and to support health promotion in Bangladesh. Papers also highlight methodological innovations enabling women to dialogue with local decision makers about child health through photovoice, and the use of causal loop diagrams to explore scenarios about how trust in vaccination influences health systems and community resilience. A final paper reflects on political philosophy arguments which frame how health systems research can focus on the most vulnerable in low and middle income countries.