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Willing but unable? Extending theory to investigate community capacity to participate in Ghana’s community-based health planning and service implementation

Author

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  • Atinga, Roger A.
  • Agyepong, Irene Akua
  • Esena, Reuben K.

Abstract

While primary health care programmes based on community participation are widely implemented in low- and middle- income settings, empirical evidence on whether and to what extent local people have the capacity to participate, support and drive such programmes scale up is scant in these countries. This paper assessed the level of community capacity to participate in one such programme – the Community-Based Health Planning and Service (CHPS) in Ghana. The capacity assessments were drawn from Chaskin’s (2001) theorised indicators of community capacity with modifications to include: sense of community; community members commitment; community leadership commitment; problem solving mechanisms; and access to resources. These capacity measures guided the design of an interview guide used to collect data from community informants, frontline health providers (FLP) and district health managers. Key qualitative themes were built into a questionnaire administered to households selected through systematic sampling approach. Findings showed that growing individualism, low trust in neighbours and apathetic behaviours undermined the capacity of mutual support for CHPS. The capacity to support CHPS was high for local leadership and community social mobilisation groups who often dedicated time to working with FLP to promote maternal and reproductive health service use, and in advocating broader support for CHPS. Within the wider community, commitment to voluntarism was low as members perceived CHPS to be owned by, and run on government funds and resources. Poor voluntarism was compounded by poverty that crippled the capacity to provide needed resource support for CHPS. Findings have great implications for building strong capable communities for participation in community oriented health programmes.

Suggested Citation

  • Atinga, Roger A. & Agyepong, Irene Akua & Esena, Reuben K., 2019. "Willing but unable? Extending theory to investigate community capacity to participate in Ghana’s community-based health planning and service implementation," Evaluation and Program Planning, Elsevier, vol. 72(C), pages 170-178.
  • Handle: RePEc:eee:epplan:v:72:y:2019:i:c:p:170-178
    DOI: 10.1016/j.evalprogplan.2018.10.001
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    References listed on IDEAS

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    1. Hollard, Guillaume & Sene, Omar, 2016. "Social capital and access to primary health care in developing countries: Evidence from Sub-Saharan Africa," Journal of Health Economics, Elsevier, vol. 45(C), pages 1-11.
    2. Ghazala Mansuri, 2004. "Community-Based and -Driven Development: A Critical Review," The World Bank Research Observer, World Bank, vol. 19(1), pages 1-39.
    3. Draper, Alizon Katharine & Hewitt, Gillian & Rifkin, Susan, 2010. "Chasing the dragon: Developing indicators for the assessment of community participation in health programmes," Social Science & Medicine, Elsevier, vol. 71(6), pages 1102-1109, September.
    4. Brune, Nancy E. & Bossert, Thomas, 2009. "Building social capital in post-conflict communities: Evidence from Nicaragua," Social Science & Medicine, Elsevier, vol. 68(5), pages 885-893, March.
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    Cited by:

    1. Samuel Egyakwa Ankomah & Adam Fusheini & Christy Ballard & Emmanuel Kumah & Gagan Gurung & Sarah Derrett, 2021. "Patient–public engagement interventions for health system improvement in Sub‐Saharan Africa: A systematic scoping review protocol," International Journal of Health Planning and Management, Wiley Blackwell, vol. 36(2), pages 273-281, March.
    2. Gamo, Bereket Roba & Park, Duk-Byeong, 2022. "Community capacity influencing community participation: Evidence from Ethiopia," World Development Perspectives, Elsevier, vol. 27(C).

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