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Analytical summary - Community ownership and participation

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The concept of community ownership and participation is key to the implementation of the primary health care renewal. Countries of the WHO African Region have advanced primary health care revitalization through the adoption of the Ouagadougou Declaration on Primary Health Care and Health Systems in Africa and its related implementation framework.

The primary health care approach empowers communities so that they can be involved in processes to help ensure that health services are people centred. This means that they should meet people’s identified health needs, encompassing physical, emotional and social concerns beyond disease categories. Services that meet people’s health needs have to be comprehensive, including health promotion, prevention, diagnosis, treatment, referral, long-term care and social health services. These services also need to be consistently available until the health problem is resolved or the risk factor has disappeared.

The Region has made significant progress in promoting and strengthening local community mobilization in health development. Many countries have set up community structures to interface with health workers, especially at the first level of the formal health system. In some countries, these community structures determine how health services are organized and operated.

Where communities are closely involved, service utilization rates are higher. However, the interface between communities and the formal health care delivery system is still weaker than desirable, because institutionalization of the primary care concept as the hub for coordination of health services at community level has not yet taken strong root. In addition, decentralization of financial and other resources for management within the primary care hubs has not yet been adequately achieved.

Community involvement in health development takes numerous forms. Some communities, working alongside the formal health system, administer medicines for the control and prevention of various diseases. An example is the community-directed treatment with ivermectin for onchocerciasis control taking place in affected African countries. In a number of countries, hospital advisory committees and village health committees play a role in promoting healthy lifestyles and managing peripheral health facilities. However, as communities discharge these duties on a mainly voluntary basis, drop-out rates tend to be very high.