What evidence is there to show that community participation and accountability in health service delivery leads to improved access to quality health services and increased government ownership/ responsibility? Do you know of any studies linking community accountability to improved health outcomes? What evidence is there that community engagement in health service delivery contributes towards stabilisation and peace building/state building efforts?
There is evidence to show that community participation and accountability in health service delivery and health care leads to improved health outcomes within that community. This review gives definitions of the key concepts and a history of community participation and accountability in section 2.
The experience of pilot programmes suggests that community mobilisation can bring about cost-effective and substantial reductions in mortality and improvements in the health of newborn infants, children, and mothers. This is reviewed in detail in section 3 including studies showing evidence of this link. Section 4 provides some evidence of an improvement in quality due to community participation, especially in providing better services in terms of community need. Action through civil society is a critical influence on health care quality and access and on the social determinants of health.
Government ownership has been shown to be important; the state can play a role in ensuring its citizens' right to health, while respecting participatory and empowering processes. If marginalised groups organise, they can influence power relations and pressure the state into action. Such popular pressure can play an essential role in ensuring the implementation of adequate government policies to address health inequities. This is what is required to assert the right to health. This is presented in detail in section 5.
Section 6 looks at community engagement in health service delivery and how this contributes towards stabilisation and peace building/state building efforts. In conflict-affected areas worldwide, development projects have the potential to promote reconciliation and build peace. Participatory development projects that involve the input and governance from and implementation by the community maximise that potential.
Holley, C. Helpdesk Report: Community Engagement in Health Service Delivery. Human Development Resource Centre, UK (2011) 23 pp.