Unlocking community capabilities
The unlocking community capabilities theme systematically examines how communities can be active participants in the planning, delivery, monitoring and evaluation of their health system, by identifying and mobilising individual and collective capabilities in different social, political, and institutional environments.
Defining community capabilities
Communities are groups of people having common interests, resources, beliefs, needs, occupations or other social conditions that characterise the identity of members and affect their cohesiveness. FHS focuses on communities that live in a particular geographic area, but also examines other social characteristics of communities. The term ‘community capability’ encompasses key concepts of empowerment, mobilisation, social capital and capacity building.
- Developing reproducible ways of measuring community capabilities to understand the social relations and resources within and across communities, including the status, social relations and entitlements of disadvantaged populations.
- Developing reproducible ways of changing community capabilities as a process and outcome of health systems interventions by improving linkages, strengthening monitoring, securing resources, improving resilience, and changing social norms.
- Having robust measures of change in community capabilities and developing research methodologies to understand pathways for change in community capabilities and how they relate to changes in health systems.
Defining an appropriate model of health systems ethics relevant to long-term engagements with communities, especially in low-resource settings.
Recent FHS publications on 'unlocking community capabilities'
Community clinics (CCs) were established by the Government of Bangladesh with an aim to extend primary health services to the grassroots population in rural areas. Currently there are 13,500 CCs throughout the country and each covers 6,000 population under its jurisdiction and are meant to provide maternal, child health, family planning and other primary health care services. However, challenges still remain in ensuring accountability, quality and equity in healthcare service at the local level. Voice and accountability mechanism are almost non-existent. There are gaps in logistics, quality assurance procedures and the facilities suffer from high staff absenteeism, unskilled staff and inefficient use of supplies. Stakeholders are not fully aware of clinics' purposes and there is weak communication and lack of involvement of local government institutions.
At the time of the 2014–2015 Ebola Virus Disease (EVD) outbreak, Liberia was still recovering from years of civil war and unrest. The country’s infrastructure was very poor, especially in rural regions, where people could not easily travel because of the lack of adequate roads. Liberia’s health system was also weakened by the civil war, leaving health facilities struggling to respond to the EVD outbreak effectively.
Community clinics, a flagship programme of the Government of Bangladesh, are health facilities set up to deliver primary health care, family planning and nutrition services to rural people at the grassroots level. Currently there are 13,500 community clinics (CC) in Bangladesh, aimed to cover every 6000 rural population. Despite the widespread establishment of the community clinics, challenges such as shortage of supply, provider absenteeism, lack of properly defined roles and responsibilities of human resources, poor behaviour towards patients, weak accountability and governance, and absence of active participation from community in healthcare delivery restrict efficient use of these facilities and available resources.
To complement the monitoring mechanism of community clinics, the Future Health Systems (FHS) Bangladesh team at icddr,b aimed to implement a community scorecard (CSC) to ensure community participation and provider accountability in the local health system. This FHS Research Brief presents the learnings from the three cycles of community scorecard implementation in the intervention community clinics.
This issue brief describes the factors that facilitate the CSC implementation process, based on the lessons learnt from a CSC project on maternal and newborn health service delivery and utilization in six sub-counties of Kibuku district in Uganda. District and sub-county stakeholders led the implementation of the CSC, with support from Makerere University School of Public Health (MakSPH). Four rounds of scoring were undertaken between November 2017 and September 2018.
Beginning in June 2017, the Makerere University School of Public Health (MakSPH), in collaboration with Future Health Systems, has been implementing a CSC project focusing on maternal and newborn health service delivery and utilization in six sub-counties in Kibuku district, Uganda. As one of its exit strategies, the project carried out a qualitative study that explored ways of involving political leaders in the CSC process to ensure its sustainability.
Musoke D, Ssemugabo C, Ndejjo R, Ekirapa-Kiracho E and George AS (2018) Reflecting strategic and conforming gendered experiences of community health workers (CHWs) using photovoice in rural Wakiso district, Uganda, Human Resources for Health, 16:41, DOI: 10.1186/s12960-018-0306-8
Community health workers (CHWs) are an important human resource in Uganda as they are the first contact of the population with the health system. Understanding gendered roles of CHWs is important in establishing how they influence their performance and relationships in communities. This paper explores the differential roles of male and female CHWs in rural Wakiso district, Uganda, using photovoice, an innovative community-based participatory research approach.
FHS partner Makerere University School of Public Health is undertaking a Community Score Cards study, which is contributing to research on how leaders can work with the community and health workers to improve maternal and newborn health in Kibuku District. The use of the Community Score Card tool – a two-way and ongoing participatory tool for assessment, planning, monitoring and evaluation - aims to improve the performance of facilities and accountability by the different stakeholders who are responsible for improving the performance of facilities. This film provides an overview of the work and the use of community scorecards.
This film, produced by FHS partner Makerere University School of Publich Health (MakSPH), highlights the challenges that women with disabilities face when seeking maternal health services in the Eastern Uganda district of Kibuku. To address some of these challenges, FHS partner MakSPH, in partnership with Research in Gender and Ethics (RinGs), is using the Community Scorecard methodology - a participatory tool for assessment, planning, monitoring and evaluation of services – with mothers living with disabilities, allowing their voices to be heard.