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Table 1 Summary of publications on PPE strategies in Health System Improvement in SSA

From: Patient-public engagement strategies for health system improvement in sub-Saharan Africa: a systematic scoping review

Author (s) and Year of publication Country of origin Aims/Purpose Study Design and Sample Intervention setting Engagement Strategies Outcome (s) Main finding (s)
Adongo (2013) [46] Ghana To assess the impact of male involvement in Family Planning in Northern Ghana Qualitative descriptive design.
90 participants via 12 focus groups discussions
59 In-depth interviews
Maternal Health Services (Family Planning) Focus groups, Community educational Workshops Spousal approval for women in the use of contraceptives;
CHPS effect on male involvement in Family Planning.
Males were much involved in family planning activities in communities with functioning CHPS compared to those without functioning CHPS. Spousal approval was still relevant for women’s use of contraceptives.
Angwenyi, (2014) [44] Kenya To share community engagement experiences in an on-ongoing paediatric malaria vaccine trial conducted in three study sites of Kilifi County, Kenya. Mixed method descriptive design
25 participants via focus groups
32 participants via in-depth interviews
200 through observational surveys
Malaria Vaccine Trial Interviews, Focus groups,
Observation of Community Engagement activities
Daily engagement with community stakeholders and the Trial teams’ goals for community engagement before Malaria Vaccine trial Compared with the trial teams’ community engagement goals, regular engagement with community stakeholders had different expectations and goals. Engagement with community stakeholders was effective in reducing misconceptions about the vaccine trial, thereby contributing positively to a successful trial of the vaccine.
Baatiema et al., (2013) [28] Ghana To explore the PPE process of a community-based health planning and services programme in the Upper West Region of Ghana and evaluate the perspectives of the local stakeholders on their participation in the programme and its impact on health care delivery. Qualitative Study applying Spider-gram theory to measure extent of participation
17 participants via in-depth interviews
17 participants involved in 2 focus group interviews
Primary Health Care Interviews, Focus groups
Community Meetings
Use of community resources; CHPS integration with pre-existing community structures; aligning CHPS with community interest. Engagement with community become sustained and more effective by acknowledging and using community resources and integrating CHPS with pre-existing community structures as well as aligning health interventions with community interest.
Campbell et al., (2008) [3] South Africa To report on the perceptions of the community on a 3-year programme that seeks to promote grassroots’ responses to HIV/AIDS – mainly through rural health volunteers in KwaZulu-Natal, South Africa. Qualitative study involving 12 participants via in-depth interviews and
34 participants involved in 5 focus group discussions
HIV/AIDS Prevention Interviews
Focus Groups
Meeting with community leaders
Increased grassroot support for volunteers in HIV/AIDS home nursing care. The project significantly enhanced community confidence in health volunteers and also contributed to increased community knowledge and acceptance for home nursing care for people living with HIV/AIDS.
Chilaka, (2005) [45] Burkina Faso, Ghana, Nigeria, Tanzania & Uganda To use quantitative values to measure and compare levels of community participation in the Roll Back Malaria programme in five Sub-Saharan African countries Quantitative cross-sectional analysis of database using Spider-gram theory to assess 503 reported malaria cases across the studied countries (excluding Burkina Faso) Malaria Control Secondary data
Analysis of Roll Back Malaria Programme
Community participation present at all levels of the RBM programme,
Varying degree of community participation existed in the RBM programme.
Results highlighted that higher degrees of participation, among other factors resulted in improved incidence of malaria under the Roll Back Malaria programme
Dougherty et al., (2018) [52] Ghana To examine how a Community Benefit Health (CBH) programme influenced the outcomes of maternal health services through continuous sustenance of community-level support among the social networks of women. Mixed method study with 1746 participants involved in questionnaire survey and 183 participants via in-depth interviews & focus group discussions Maternal Health Services In-depth interviews,
Focus groups,
Educational meetings with community leaders
Maternal health behavioural response to CBH interventions; Male engagement in maternal health. Results showed improved maternal health outcomes such as antenatal/postpartum care, birth attendance and breastfeeding following enhanced engagement to change community and spousal attitudes towards maternal health issues.
Gregson et al., (2013) [1] Zimbabwe To investigate if PPE or Community grassroots participation resulted in increasing HIV Testing and Counselling services in Zimbabwe Prospective cohort study involving 5260 participants interviewed in 2 consecutive rounds of cohort survey HIV/AIDS Prevention Interviews
Educational programmes
Uptake of HIV Testing and Counselling,
partnership with organisations for community support
Results showed increased HIV testing and Counselling uptake services for community organisations due to grassroot participation compared with non-community organisations
Kamanda et al., (2013) [47] Kenya To describe the approaches and principles of Community-Based Participatory Research through harnessing grassroots power in conducting public health research in Sub-Saharan Africa. Randomised Controlled Trial with semi-annual assessment of 3130 participants Community Public Health Research Community Advisory Boards (CAB)
Household interviews
Adaption of Community-Based Participatory Research in implementation of community health programmes and public health research
Cultural and community relevance in shaping public health research and interventions
Community engagement effectively shapes public health research design and increases community participation in subsequent implementation of community-based health interventions
Mafuta et al., (2015) [48] Congo To explore how health care providers respond to concerns of women through an existing social accountability mechanism in a local setting. Exploratory study involving two health zones with 48 participants interviewed Maternal Health Services Interviews, forming
Health Committees and CABs
Varied perception of health providers’ responsiveness, lack of support for women’s participation in maternal health despite existence of many local community health-related groups Results showed that, most women did not have voice to participate in maternal health issues. Among the factors found include; absence of procedures to express views, lack of knowledge, fear of reprisal, ethnicity, power and status.
Musesengwa and Chimbari, (2017) [29] South Africa & Zimbabwe To document the experiences of members in Community Engagement processes during a project implementation in two countries Qualitative case study approach involving 102 participants via focus groups and 66 participants via interviews Malaria and Bilharzia Geospatial disease and vector Mapping, Focus group,
Participatory Rural appraisal (PRAs) workshops, Biomedical techniques, CAB
Community experience in community engagement process, Research naïve community in public health research and implementation of health programmes. Results showed that continuously soliciting views and preferences from main stakeholders significantly contributes to the engagement process. Also, compared with research experienced communities, research naive communities can significantly contribute to research and community engagement process
Ntshanga et al., (2010) [31] South Africa To strengthen community mobilization, awareness, education and involvement to improve TB control by building community-health sector partnership through the establishment of Community Advisory Board. Cross sectional study with a total of 140 participants involved in 2 Consultative workshop Tuberculosis Control and Research Stakeholder workshops through CAB Mechanisms for community consultation and participation Results revealed low incidence of TB was due to the regular community involvement in TB control activities. CABs were found to be effective in facilitating community involvement in patient care.
Person et al., (2016) [49] Tanzania To describe, using Human-Centred Design in Community co-designed process to prevent and control Schistosomiasis. It also aimed to explore how local knowledge, creativity and experiences could be used to design community-owned structural and behavioural interventions to reduce the spread of Schistosomiasis. Cross sectional study involving 5 focus group discussions with community figureheads, 35 school-based discussions with children, 25 interviews with teachers and 16 parents Schistosomiasis School-based education and training, focus groups, interviews Sustainable PPE strategies for controlling Schistosomiasis; implementing PPE using Human-Centred design The outcome of the study revealed that community co-designed process with emphasis on Human-Centred Design principles of PPE ensures a more sustainable and effective interventions for controlling Schistosomiasis.
Riehman et al., (2013) [41] Kenya To examine the impact of Community-Based Organisations on community and individual level health outcomes; focusing on perceptions, awareness, knowledge, sexual risk behaviours of HIV/AIDS. Quasi-experimental cluster design with multi-method data collection involving 4378 adult respondents HIV/AIDS prevention Advocacy workshops, Community meetings, educational workshops Higher levels of Community-Based Engagements,
PPE strategies for Community-Based Organisations including sexual risk behaviours, awareness programmes, and social transformation (gender ideology and social capital).
Study revealed communities with more Community-Based Organisations engage more and therefore tend to have less incidence of HIV/AIDS compared with those with less Community-Based Organisations.
Sakeah et al., (2014) [50] Ghana To examine the role played by community leaders and residents during the implementation of skilled delivery programme and its effect on improving maternal health care in a Ghanaian community. Intrinsic case study design with a qualitative methodology involving 29 health professional and community stakeholders interviewed Maternal Health Services Homes visits through CHV, CHW and interviews, Traditional authority involvement Community members role in promoting skilled delivery in CHPS zones; mutual collaboration and engagement between health professionals and community members Study revealed community members are key to promoting skilled delivery and reducing maternal mortalities and pregnancy related complications. Relationship between community Health Volunteers and Traditional Birth Attendants were found to be key in providing health education on skilled and safe delivery.
Tancred et al., (2017) [53] Tanzania To examine the complexity of community-level quality improvement in health by building capacities of community members to use quality improvement behavioural change towards enhancing maternal and newborn health in Tanzania. Mixed method involving 83 participants interviewed or involved in focus groups,
and quantitative data from secondary sources
Maternal and Newborn Health Services Educational meetings with Health Volunteers, focus groups & interviews Performance implementation scores to rank communities;
Changing health seeking behaviours and uptake of community level maternal and newborn health services, regular education around quality improvement in maternal health care.
The study results revealed facilitators of PPE as ones which were most prevalent in high-performing communities, whilst the barriers were those which were lacking in these high-performing communities. The identified facilitators and barriers are key to influencing behavioural change to improve maternal and newborn health
Tindana et al., (2011) [43] Ghana To describe the community engagement practices frequently used during implementation of health projects or research through the Navrongo Health Research Centre of Ghana, and to identify the underlying cultural norms that informed those community entry practices Qualitative case study design involving 116 participants in focus groups and 20 involved in in-depth interview Public Health Research Interviews, focus groups and meetings with traditional rulers Social mappings; Traditional community engagement mechanisms; Community confidence in health professionals, and gender inequities. The study found that using existing traditional structures in a community reduces social disruptions during implementation of community-based health interventions.
Yeboah and Jagri, (2016) [51] Ghana To identify the factors that constrain or facilitate community engagement activities during the implementation of the community-based Health Planning and Services (CHPS) programme in the central region of Ghana. Qualitative case study design involving 103 participants via questionnaire survey,
8 participants via interviews,
1participant via informal discussion.
Primary Health Services/Maternal Health Health committees, interviews, Community health durbar Community support during post implementation phase in a community-based health intervention; Assessing local community’s commitment in participation on spider-gram theory; Establishing framework to define community role, expectations and responsibility prior to implementing community-based health interventions. The study found that having clearly defined shared leadership and partnership role between health authorities and communities prior to implementing community-based health intervention is key to reducing post-implementation tensions and conflict that can disrupt achieving the core goals of the programme.
Meiring et al., (2019) [42] Malawi To describe community and stakeholder engagement practices prior and during a typhoid conjugate vaccine trial; drawing lessons from the challenges and its impact on the health outcomes. Qualitative research design within a Randomised Controlled Trial with 380 participants involved in Focus groups, interviews, other engagement meetings Typhoid Vaccine Trial Focus Group Discussions, School-based meetings, Community Advisory Group meeting and Media engagements Involving wide range of stakeholders; starting community engagement early and throughout implementation phase; adequate allocation of resources to support community engagement; use of broad range of complimentary engagement activities. The study results found there was improved awareness and high turnout for the vaccine trial following an enhanced engagement with local government and community leadership as well as employing multiple channels of communication.