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Analytical summary - Community ownership and participation

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In Sierra Leone, the focus for people’s participation in the planning, implementation and monitoring of health care delivery is through community development committees and subcommittees, for example the health subcommittee and other community-based organizations such as the district AIDS committee, etc.


There are enormous potential benefits for enhancing the livelihoods of the rural poor through decentralization and through effective representation and accountability, which can be achieved through a parallel process of community-based activities led by civil society and other informal structures such as women’s clubs and complemented by institutional reforms.[1][2]

At district and national levels there are encouraging examples of civil society participation in the health sector. Civil society supports the implementation of the recently signed compact agreement and the Joint Programme of Work Fund, especially in the areas of advocacy and effective monitoring.

They, like the Ministry of Health and Sanitation, are concerned about the allocation of funds to the health sector. Thus, in protest against the Government’s reduction of the health budget by over 3% for 2012, they registered their concern by taking large numbers of pregnant and lactating women to Parliament and promised sustained advocacy in order for the Government to reverse the decision.[3]

Some district health management teams are expanding to include representation from district-based nongovernmental organizations and private for-profit and not-for-profit providers. Policy statements acknowledging the need for equity must be translated into strategies with real targets to address the issue and they need to be closely monitored to ensure that they are really changing both the allocation of resources and improving the access of those that most need them.

To combat malnutrition at the community level, the community-based management of acute malnutrition approach is being implemented in all chiefdoms in Sierra Leone. The aim is to establish a standardized approach, to be adopted and applied in all chiefdoms in all districts, to address nutrition issues and promote, among other things, the treatment as outpatients in community-based health facilities of severely malnourished children in a stable medical condition and with appetite. This has been made possible primarily by the availability of ready-to-use therapeutic foods for use at home.

The approach maximizes coverage and access and also facilitates case-finding and treatment before the severity of malnutrition escalates and medical complications occur. It does this through strengthening community-based active case-finding, referral to health facilities and improved continuum of care with supplementary feeding centres caring for moderate acute malnutrition. The links between the community and the health facility are supported through nongovernmental organizations working in close collaboration with local and district authorities.[4]

While patient satisfaction has not yet been measured, there are various issues considered to assess this.

The increased utilization of services following the introduction of the Free Health Care Initiative demonstrated the role that cost plays in preventing people from using health care services. Thus, the availability and affordability of services largely determine patients´ behaviour towards utilization of services.[4]

The focus of improved community participation is on:[5][6]

  • contributing to developing community health policies and strategies to promote communities' ownership and participation in the health system;
  • contributing to building institutional and individual capacities for community participation, organization and management of the health system;
  • contributing to institutionalizing monitoring of community-based health activities;
  • increasing awareness and advocating for mainstreaming community ownership and participation in national health policies and health strategic plans;
  • supporting the strengthening of coordination of, and collaboration with, civil society organizations particularly community-based organizations and nongovernmental organizations in community health development.


  1. Gibril A et al. Sierra Leone health sector review 2004. Freetown, British Council, 2004
  2. Civil society report, 2011. Verbal communication
  3. WHO Country Cooperation Strategy 2008–2013 Sierra Leone (pdf 943.71kb). Brazzaville, WHO Regional Office for Africa, 2009
  4. 4.0 4.1 Leigh B. Child survival and development mid-term review report for the programme 2008–2010. Sierra Leone, United Nations Children’s Fund, 2009
  5. National Health Sector Strategic Plan 2010–2015 (pdf 1.09Mb) Government of Sierra Leone, Ministry of Health and Sanitation, 2009
  6. Performance report. Government of Sierra Leone, Ministry of Health and Sanitation, 2010