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Dada S, Cocoman O, Portela A, De Brún A, Bhattacharyya S, Tunçalp Ö, Jackson D, Gilmore B. What's in a name? Unpacking 'Community Blank' terminology in reproductive, maternal, newborn and child health: a scoping review. BMJ Glob Health 2023; 8:bmjgh-2022-009423. [PMID: 36750272 PMCID: PMC9906186 DOI: 10.1136/bmjgh-2022-009423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 01/09/2023] [Indexed: 02/09/2023] Open
Abstract
INTRODUCTION Engaging the community as actors within reproductive, maternal, newborn and child health (RMNCH) programmes (referred to as 'community blank') has seen increased implementation in recent years. While evidence suggests these approaches are effective, terminology (such as 'community engagement,' 'community participation,' 'community mobilisation,' and 'social accountability') is often used interchangeably across published literature, contributing to a lack of conceptual clarity in practice. The purpose of this review was to describe and clarify varying uses of these terms in the literature by documenting what authors and implementers report they are doing when they use these terms. METHODS Seven academic databases (PubMed/MEDLINE, Embase, CINAHL, PsycINFO, Scopus, Web of Science, Global Health), two grey literature databases (OAIster, OpenGrey) and relevant organisation websites were searched for documents that described 'community blank' terms in RMNCH interventions. Eligibility criteria included being published between 1975 and 1 October 2021 and reports or studies detailing the activities used in 'community blank.' RESULTS: A total of 9779 unique documents were retrieved and screened, with 173 included for analysis. Twenty-four distinct 'community blank' terms were used across the documents, falling into 11 broader terms. Use of these terms was distributed across time and all six WHO regions, with 'community mobilisation', 'community engagement' and 'community participation' being the most frequently used terms. While 48 unique activities were described, only 25 activities were mentioned more than twice and 19 of these were attributed to at least three different 'community blank' terms. CONCLUSION Across the literature, there is inconsistency in the usage of 'community blank' terms for RMNCH. There is an observed interchangeable use of terms and a lack of descriptions of these terms provided in the literature. There is a need for RMNCH researchers and practitioners to clarify the descriptions reported and improve the documentation of 'community blank' implementation. This can contribute to a better sharing of learning within and across communities and to bringing evidence-based practices to scale. Efforts to improve reporting can be supported with the use of standardised monitoring and evaluation processes and indicators. Therefore, it is recommended that future research endeavours clarify the operational definitions of 'community blank' and improve the documentation of its implementation.
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Affiliation(s)
- Sara Dada
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland .,UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Olive Cocoman
- London School of Hygiene & Tropical Medicine, London, UK
| | - Anayda Portela
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland
| | - Aoife De Brún
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland,UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | | | - Özge Tunçalp
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneve, Switzerland
| | - Debra Jackson
- London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Brynne Gilmore
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland,UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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Arnott G, Otema C, Obalim G, Odallo B, Nakubulwa T, Okello SBT. Human rights-based accountability for sexual and reproductive health and rights in humanitarian settings: Findings from a pilot study in northern Uganda. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000836. [PMID: 36962804 PMCID: PMC10021271 DOI: 10.1371/journal.pgph.0000836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 07/22/2022] [Indexed: 11/18/2022]
Abstract
Ensuring accountability for the realization of sexual and reproductive health and rights is a human rights obligation and central tenet of strategies to improve health systems and outcomes in humanitarian settings. This pilot study explored the feasibility and acceptability of deploying human rights strategies, specifically through a participatory community-led complaints mechanism, to hold humanitarian health systems to account for the sexual and reproductive health and rights of refugee and host community women and girls in northern Uganda. Over a fifteen-month period we conducted a multi-methods exploratory study with refugee and host community rights-holders and duty-bearers using longitudinal in-depth interviews, focus groups, and secondary data document review. Deductive and inductive coding techniques were used to analyze data iteratively for content and themes. 107 sexual and reproductive health and rights related complaints and feedback were collected through the community complaints mechanism. Complaints concerned experiences of disrespect and abuse by health care workers; lack of adolescent access to sexual and reproductive health services and information; sexual and gender-based violence; and lack of access to acceptable and quality health goods and services. Participants reported an increased understanding and claiming of human rights through the intervention, acceptability of rights-based accountability strategies among humanitarian health system actors, and improved access to remedies when sexual and reproductive health rights are not respected. Findings demonstrate integrating rights-based social accountability mechanisms at the level of humanitarian response as a promising approach for strengthening and holding humanitarian health systems accountable for the sexual and reproductive health and rights of women and girls affected by humanitarian situations.
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Affiliation(s)
- Grady Arnott
- Center for Reproductive Rights, Global Legal Program, New York, New York, United States of America
| | - Charles Otema
- CARE International in Uganda, Health Equity and Rights Team, Bugolobi, Kampala, Uganda
| | - Godfrey Obalim
- CARE International in Uganda, Health Equity and Rights Team, Bugolobi, Kampala, Uganda
| | - Beatrice Odallo
- Center for Reproductive Rights, Global Legal Program, Nairobi, Kenya
| | - Teddy Nakubulwa
- CARE International in Uganda, Gender Justice Program, Bugolobi, Kampala, Uganda
| | - Sam B T Okello
- CARE International in Uganda, Gender Justice Program, Bugolobi, Kampala, Uganda
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Kiracho EE, Aanyu C, Apolot RR, Kiwanuka SN, Paina L. Designing for Scale and taking scale to account: lessons from a community score card project in Uganda. Int J Equity Health 2021; 20:31. [PMID: 33430877 PMCID: PMC7802338 DOI: 10.1186/s12939-020-01367-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 12/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Planning for the implementation of community scorecards (CSC) is an important, though seldom documented process. Makerere University School of Public Health (MakSPH) and Future Health Systems Consortium set out to develop and test a sustainable and scalable CSC model. This paper documents the process of planning and adapting the design of the CSC, incorporating key domains of the scalable model such as embeddedness, legitimacy, feasibility and ownership, challenges encountered in this process and how they were mitigated. METHODS The CSC intervention comprised of five rounds of scoring in five sub counties and one town council of Kibuku district. Data was drawn from ten focus group discussions, seven key informant interviews with local and sub national leaders, and one reflection meeting with the project team from MakSPH. More data was abstracted from notes of six quarterly stakeholder meetings and six quarterly project meetings. Data was analyzed using a thematic approach, drawing constructs outlined in the project's theory of change. RESULTS Embeddedness, legitimacy and ownership were promoted through aligning the model with existing processes and systems as well as the meaningful and strategic involvement of stakeholders and leaders at local and sub national level. The challenges encountered included limited technical capacity of stakeholders facilitating the CSC, poor functionality of existing community engagement platforms, and difficulty in promoting community participation without financial incentives. However, these challenges were mitigated through adjustments to the intervention design based on the feedback received. CONCLUSION Governments seeking to scale up CSCs and to take scale to account should keenly adapt existing models to the local implementation context with strategic and meaningful involvement of key legitimate local and sub national leaders in decision making during the design and implementation process. However, they should watch out for elite capture and develop mitigating strategies. Social accountability practitioners should document their planning and adaptive design efforts to share good practices and lessons learned. Enhancing local capacity to implement CSCs should be ensured through use of existing local structures and provision of technical support by external or local partners familiar with the skill until the local partners are competent.
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Affiliation(s)
- Elizabeth Ekirapa Kiracho
- Department of Health Policy Planning and Management, Makerere University School of Public Health, P.O. Box 7072, Kampala, Uganda
| | - Christine Aanyu
- Department of Health Policy Planning and Management, Makerere University School of Public Health, P.O. Box 7072, Kampala, Uganda
| | - Rebecca Racheal Apolot
- Department of Health Policy Planning and Management, Makerere University School of Public Health, P.O. Box 7072, Kampala, Uganda
| | - Suzanne Namusoke Kiwanuka
- Department of Health Policy Planning and Management, Makerere University School of Public Health, P.O. Box 7072, Kampala, Uganda
| | - Ligia Paina
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, 21205 Baltimore, MD United States of America
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