Community perspectives on roles and responsibilities for strengthening primary health care in rural Ethiopia

Abstract

Government–community partnerships are central to developing effective, sustainable models of primary health care in low-income countries; however, evidence about the nature of partnerships lacks the perspective of community members. Our objective was to characterise community perspectives regarding the respective roles and responsibilities of government and the community in efforts to strengthen primary health care in low-income settings. We conducted a qualitative study using focus groups (n=14 groups in each of seven primary health care units in Amhara and Oromia, Ethiopia, with a total of 140 participants) in the context of the Ethiopian Millennium Rural Initiative. Results indicated that community members defined important roles and responsibilities for both communities and governments. Community roles included promoting recommended health behaviours; influencing social norms regarding health; and contributing resources as feasible. Government roles included implementing oversight of health centres; providing human resources, infrastructure, equipment, medication and supplies; and demonstrating support for community health workers, who are seen as central to the rural health system. Renewed efforts in health system strengthening highlight the importance of community participation in initiatives to improve primary health care in rural settings. Community perspectives provide critical insights to defining, implementing and sustaining partnerships in these settings.

Keywords:

• community participation
• primary health care
• rural Ethiopia
• qualitative methods

Notes

1. A health post is the unit below a health centre in the primary health care unit (PHCU). Each PHCU consists of approximately 5–7 health posts that are supervised and report to one health centre. A health post is typically a 2–3 room structure staffed by two HEWs which provides preventative health services to approximately 5000–7000 people.

2. Sometimes families must pay 20–30 Birr (under $2 USD) for lab services or pay for small medical supplies (e.g. gloves) for delivery services (under $3 USD).

3. Based on the Health Extension Package, if a family is trained for over 96 hours on the 16 packages by HEWs they will graduate to become a ‘model family’. In order to become a model family, a family must pass over 75% of the 16 packages. Model families are then expected to become role models for health within their communities.