Knowledge From the Afrikan World, For the World

PMC Articles

Collaborations and Networks Within Communities for Improved Utilization of Primary Healthcare Centers: On the Road to Universal Health Coverage

PMCID: PMC11180759

PMID: 38887723

Abstract

Objectives Community involvement depends on the level of linked and targeted activities for health by community members. This study examines the collaborations employed within communities to ensure sustainable access and improved use of healthcare in the community. Methods This study was conducted in rural and urban local government areas in Anambra, Kano, and Akwa-Ibom, Nigeria. About 90 in-depth interviews and 12 focus group discussions were conducted with community stakeholders and service users. The findings were transcribed and coded via thematic analysis, guided by the Expanded Health Systems framework. Results Various horizontal collaborations in communities foster increased use of PHC services; promoting community health. Major horizontal collaborations in these communities were community-led, primary health facility-led, and Individual-led collaborations. Their actions revolved around advocacy, building and renovating PHC centers, equipping facilities, and sensitization to educate community members on the need to utilize services at PHC centers. Conclusion Strategic involvements and collaborations of local actors within communities give rise to improvements in the utilization of primary healthcare centres, reportedly resulting in improved access to PHC healthcare services for community members.

Full Text

The Primary healthcare (PHC) system is an effective, efficient, and equitable approach to enhancing health and achieving Universal Health Coverage (UHC) [1]. The Astana declaration on primary healthcare reaffirmed the primal place of PHC and its key pillars including community participation, in strengthening health system for the achievement of UHC. Redirecting efforts to strengthen health systems towards a primary healthcare approach is essential for driving meaningful and effective change [2].
Community involvement is a crucial pillar in supporting primary healthcare. It entails engaging community members in promoting their own health and wellbeing, as well as that of their families and the community at large. This participation extends to collaborations on strategies that address the healthcare needs of community members [3]. Furthermore, community members also have the opportunity to exercise their right to make decisions that influence their health. This active involvement of community members not only enhances the effectiveness of primary healthcare services but also empowers individuals to take control of their own health [4].
In some contexts, high levels of community involvement in health-related activities, have led to a conceptualization of community health systems (CHS) being defined as “. . .the set of local actors, relationships, and processes engaged in producing, advocating for, and supporting health in communities and households outside of, but existing in relationship to, formal health structures” [5]. It has also been conceptualized as the ‘grey zone’ between the public health system, non-governmental organizations (NGO) and private health system [6], comprising community actors that transcend beyond Community Health Workers and include community groups, informal health providers, faith organizations, sporting groups, social networks, and non-government sectors such as housing, education, and social development that support close to community providers that contribute to healthcare in the community [7]. However, in Nigeria, whilst there are no defined CHS boundaries, the term is sometimes used interchangeably with the PHC system [8] there is a clear recognition of community involvement in health-related activities and health services, hence the need for collaboration with the formal PHC system.
Collaboration by the different stakeholders at the community level is important to ensure that the CHS works optimally, whether independently or as part of the PHC system. Collaboration is the merging of activities and knowledge, necessitating a partnership characterized by shared authority and responsibilities. It involves coordination of members to achieve shared goals; cooperation of team members by respecting each other’s opinion; shared decision making, which relies on open communication, trust, and power balance; partnerships where members work together in equity [9].
Access to healthcare and improvement in the health and health equity of the populace can be influenced by collaborations and endeavors of various organizations from national and local governments, schools, agencies, and community organizations [10, 11]. This influence comes from the impact that living environment, policies, and economic conditions have on the health of the population [12]. Partnerships and collaborations beyond the health field have been proposed as a way to ensure improved health [13].
In the global space, cross-country collaborations have been used to address public health concerns like tobacco use [14]. There have also been established collaborations within countries in diverse contexts. They exist as public service collaborations and community alliances in a particular state or interstate arrangements. In the United Kingdom and the United States, inter-sector partnerships are used among policymakers to address health concerns by using healthcare organizations and non-healthcare organizations to coordinate healthcare services and other existing social services to improve the health of the public [11, 15]. Collaborations can sometimes comprise a smaller populace in a town, local government, or a village [16]. Duties in the coalition could be voluntary or mandatory to achieve a common course [13].
Collaborations could be affected by management and financial issues, as well as cultural and accountability barriers. When reviewed, even established partnerships may not be as resilient or prepared to enhance community health as their reputation would imply [17, 18]. However, several studies have pointed out key traits of successful collaboration as mutual trust, effective communication, balanced structures/roles, and aligned goals among the members of the associated organizations and their leaders [19, 20]. Other factors that led to effective collaboration were shared hosting, team meetings, evaluation of partnership, and previous history of successful partnership [19, 20].
Increased access to healthcare services can be fostered through collaborations. Equitable access was seen in the less privileged population and people accessing mental healthcare [21, 22]. Some studies reported a reduction in access as the outcome of a failed plan of collaborations [13].
However, poor access to healthcare services, especially to PHC services is the major reason behind preventable deaths in Sub-Saharan Africa [23]. Barriers to accessing the use of PHC services are mostly systemic challenges like lack of coordination and defective healthcare workforce [24]. Heightened trust in traditional medicine can also hinder the use of primary healthcare facilities. Cultural barrier is another major hindrance [25]. Other barriers include unavailability of infrastructure, lack of functional equipment, lack of manpower, absenteeism among healthcare workers, misinformation, long waiting times, attitude of healthcare workers, and financial hindrances [26, 27].
Many of the constraining factors are traced back to poor levels of community involvement and participation in the development and implementation of strategies for improving health within their communities. Some women have to seek permission before seeking care, which is a restriction to timely care. In Northern Nigeria, women in Purdah cannot seek healthcare even when in labour, unless the husband gives his permission or accompanies her to the hospital [26].
The conceptual framework for the study was adapted from the expanded health system framework proposed by Sacks et al in 2019 [11], which recognizes “societal partnerships” between the formal PHC system building blocks and community actors including informal providers, and community organizations (Figure 1). We focused on how community participation and partnerships/collaborations improved coverage and increased access to the utilization of PHCs. The expanded health system framework recognizes the inclusion of community action, household provision of health and partnerships with other non-health sectors, and a multiplicity of stakeholders [11].
The study adopted a qualitative cross-sectional study design to explore insights into community participation and involvement in community healthcare. The method was chosen to describe the phenomena from the participants’ perspective. This study was reported according to the consolidated criteria for reporting qualitative studies. See Table 1 for details. Three states from three of the six geopolitical zones in Nigeria were selected for the study. The states selected were Kano (North-west), Akwa-Ibom (South-south), and Anambra (South-east). In each state, two local government areas (LGAs) were selected, with one predominantly rural setting and the other urban.
Participants were purposively selected based on their roles and involvement in health service provision to ensure a representative sample. They included policymakers, health programme managers, formal healthcare providers, informal healthcare providers, Civil Society Organizations (CSOs)/Non-Governmental Organizations (NGOs), community leaders, and community groups, to ensure diversity in views. The participants were recruited through a face-to-face encounter, where they agreed to partake in the study. At the end of the interview process, 102 successful interviews were recorded, comprising 90 in-depth interviews (IDIs) and 12 focus group (FGD) discussions with male and female groups of respondents, as summarized in Table 2.
Major actors within the community include formal healthcare providers, informal health providers, community organizations, community leaders, and community members. Each of these actors played different roles that contributed to enhancing the use of primary healthcare facilities in communities as summarized in Table 3.
The roles they played centered around sensitization/awareness creation, advocacy, and paying for impoverished community members to access care. They also donated lands for building of PHCs, renovated PHCs, and created structures that will promote the penetration of health programmes and interventions. These roles played by various community members to improve access to health facilities are presented under the collaborations that occurred in the community: PHC-led collaboration, Community organization-led collaboration, and Individual-led collaboration. These are depicted in Figure 2 and described below.
The findings show that actors in all study areas were keen on ensuring that health works for all. Collaboration and participation were seen among community individuals and organizations to ensure improvement in the use of PHC facilities. Community members at the level of religious bodies, primary healthcare facilities, and informal providers collaborate and strategize to enhance the use of PHC facilities. Community committees and philanthropists in the organization also contribute to the enhancement. This collaborates with a Mexico study which reported that patients barely had access to advanced treatment, before the involvement of the community in the activities of the PHCs in rural Mexico [28]. It also aligns with studies done in Cross River state and Ibadan, Nigeria. They reported how the involvement of community members worked towards ensuring that quality care is available for all. They sensitized, created awareness, and mobilized resources to ensure the use of available healthcare services [29, 30]. On the contrary, Gholipour et al., 2023 reported community involvement as theory rather than practice in Iran. This could stem from not setting it up as an independent service unit [31].
Collaborations with local actors took different approaches. Training and retraining of informal providers contributed invariably. It enhanced the minds of these providers and opened their minds to the possibility of better healthcare service delivery for community members. This worked as much as involving them in healthcare services. A study conducted in Uganda reported that TBAs tried to bridge the gaps of power dynamics in homes because of the trust that some men have in them. This arose when women sought care in the informal sector because their husbands did not permit formal healthcare services [32]. This study reported that men are free when interacting with TBAs concerning their wives’ problems during pregnancy and childbirth. This creates an avenue for these TBAs to step in and give them reasons why their wives need to access care informal healthcare centres [32].
Sensitizing community members on the need to enroll and utilize the PHC facilities was another collaboration measure. This collaborates an Indian study that buttressed community involvement in healthcare delivery through the use of participatory learning action. It emphasized the need for the mechanism to be included through professionalism and teamwork attitude to bring about the necessary transformation in the health system [33]. A Belgium study maintained that increasing health literacy of a communities can optimize the use of healthcare services [34].
An equipped hospital with keen staff is an avenue to increase the people’s trust and ensure their reliability on the system, to enable utilization. Brals revealed that an upgraded healthcare facility tends to increase the utilization of healthcare services [35]. A study in Indonesia reported that one of the major factors to improve quality of care is by having high-quality medical staff, which in turn increases the use of health facilities. These staff should keep getting trained to enhance efficiency [36]. A study in sub-Saharan Africa reported that health workers were kept on their toes by monitoring absenteeism, the quality of healthcare delivered, and the expenditures in the system. Health workers in some sub-Saharan Africa need enlightenment on the need for community involvement in healthcare [4]. A similar study in South Africa reported that committees monitored health workers’ absenteeism and quality of healthcare delivery. However, these committees were considered illegitimate because they lacked transparency, and participation in selecting group members were male-dominated. These committee members were barely involved in the planning process, owing to health workers considering them uneducated and uninformed [37].
Enabling the proximity of health centers to the people occurred through collaborations. Most of these communities contributed to building the health centre by donating land, soliciting support, and combining resources to build and restructure hospitals. Cost minimization for community members who cannot afford healthcare was eminent too. Resources were mobilized and secured and used to ensure that those that need healthcare but cannot afford it, could access it. Collaborations and strategies also had community members making transport arrangements to enable access. This aligns with a Cross River study. They reported that community members were involved in building health centres and engaged in many developmental activities to better the lives of those in the community. The finding agrees with Adie et al., 2014 that activities are effective with proper mobilization [29].
The involvement of religious leaders was an approach that enhanced the use of PHC facilities because some communities consider their opinion final and the words of God. Their collaboration with formal providers contributed to a change of heart of certain men and women in the community. Akinloye’s study reported that religious leaders are seen as change ambassadors in Nigeria. He pointed out that this is the avenue for motivating and training them to advocate, educate and train their members on the need to utilize the primary healthcare centres in the community. A move that could do justice more in the development and the sustenance of PHC centres than the media [38].
Evidence from this research showed that these collaborations and varying involvements resulted in improved use of primary healthcare facilities. The result is an improvement in the health of community members. Maternal deaths and under-five mortalities were at bare. The finding from this study corroborates a study done in Korea which showed increased community involvement and capacity to enhance the community health status [39]. This also aligns with an Australian study that confirmed that involvements and engagements with community members were attributed to healthcare quality, access, utilization, and responsiveness, which in turn results in improved health outcomes in Australia [40].

Sections

"[{\"pmc\": \"PMC11180759\", \"pmid\": \"38887723\", \"reference_ids\": [\"B1\", \"B2\"], \"section\": \"Introduction\", \"text\": \"The Primary healthcare (PHC) system is an effective, efficient, and equitable approach to enhancing health and achieving Universal Health Coverage (UHC) [1]. The Astana declaration on primary healthcare reaffirmed the primal place of PHC and its key pillars including community participation, in strengthening health system for the achievement of UHC. Redirecting efforts to strengthen health systems towards a primary healthcare approach is essential for driving meaningful and effective change [2].\"}, {\"pmc\": \"PMC11180759\", \"pmid\": \"38887723\", \"reference_ids\": [\"B3\", \"B4\"], \"section\": \"Introduction\", \"text\": \"Community involvement is a crucial pillar in supporting primary healthcare. It entails engaging community members in promoting their own health and wellbeing, as well as that of their families and the community at large. This participation extends to collaborations on strategies that address the healthcare needs of community members [3]. Furthermore, community members also have the opportunity to exercise their right to make decisions that influence their health. This active involvement of community members not only enhances the effectiveness of primary healthcare services but also empowers individuals to take control of their own health [4].\"}, {\"pmc\": \"PMC11180759\", \"pmid\": \"38887723\", \"reference_ids\": [\"B5\", \"B6\", \"B7\", \"B8\"], \"section\": \"Introduction\", \"text\": \"In some contexts, high levels of community involvement in health-related activities, have led to a conceptualization of community health systems (CHS) being defined as \\u201c. . .the set of local actors, relationships, and processes engaged in producing, advocating for, and supporting health in communities and households outside of, but existing in relationship to, formal health structures\\u201d [5]. It has also been conceptualized as the \\u2018grey zone\\u2019 between the public health system, non-governmental organizations (NGO) and private health system [6], comprising community actors that transcend beyond Community Health Workers and include community groups, informal health providers, faith organizations, sporting groups, social networks, and non-government sectors such as housing, education, and social development that support close to community providers that contribute to healthcare in the community [7]. However, in Nigeria, whilst there are no defined CHS boundaries, the term is sometimes used interchangeably with the PHC system [8] there is a clear recognition of community involvement in health-related activities and health services, hence the need for collaboration with the formal PHC system.\"}, {\"pmc\": \"PMC11180759\", \"pmid\": \"38887723\", \"reference_ids\": [\"B9\"], \"section\": \"Introduction\", \"text\": \"Collaboration by the different stakeholders at the community level is important to ensure that the CHS works optimally, whether independently or as part of the PHC system. Collaboration is the merging of activities and knowledge, necessitating a partnership characterized by shared authority and responsibilities. It involves coordination of members to achieve shared goals; cooperation of team members by respecting each other\\u2019s opinion; shared decision making, which relies on open communication, trust, and power balance; partnerships where members work together in equity [9].\"}, {\"pmc\": \"PMC11180759\", \"pmid\": \"38887723\", \"reference_ids\": [\"B10\", \"B11\", \"B12\", \"B13\"], \"section\": \"Introduction\", \"text\": \"Access to healthcare and improvement in the health and health equity of the populace can be influenced by collaborations and endeavors of various organizations from national and local governments, schools, agencies, and community organizations [10, 11]. This influence comes from the impact that living environment, policies, and economic conditions have on the health of the population [12]. Partnerships and collaborations beyond the health field have been proposed as a way to ensure improved health [13].\"}, {\"pmc\": \"PMC11180759\", \"pmid\": \"38887723\", \"reference_ids\": [\"B14\", \"B11\", \"B15\", \"B16\", \"B13\"], \"section\": \"Introduction\", \"text\": \"In the global space, cross-country collaborations have been used to address public health concerns like tobacco use [14]. There have also been established collaborations within countries in diverse contexts. They exist as public service collaborations and community alliances in a particular state or interstate arrangements. In the United Kingdom and the United States, inter-sector partnerships are used among policymakers to address health concerns by using healthcare organizations and non-healthcare organizations to coordinate healthcare services and other existing social services to improve the health of the public [11, 15]. Collaborations can sometimes comprise a smaller populace in a town, local government, or a village [16]. Duties in the coalition could be voluntary or mandatory to achieve a common course [13].\"}, {\"pmc\": \"PMC11180759\", \"pmid\": \"38887723\", \"reference_ids\": [\"B17\", \"B18\", \"B19\", \"B20\", \"B19\", \"B20\"], \"section\": \"Introduction\", \"text\": \"Collaborations could be affected by management and financial issues, as well as cultural and accountability barriers. When reviewed, even established partnerships may not be as resilient or prepared to enhance community health as their reputation would imply [17, 18]. However, several studies have pointed out key traits of successful collaboration as mutual trust, effective communication, balanced structures/roles, and aligned goals among the members of the associated organizations and their leaders [19, 20]. Other factors that led to effective collaboration were shared hosting, team meetings, evaluation of partnership, and previous history of successful partnership [19, 20].\"}, {\"pmc\": \"PMC11180759\", \"pmid\": \"38887723\", \"reference_ids\": [\"B21\", \"B22\", \"B13\"], \"section\": \"Introduction\", \"text\": \"Increased access to healthcare services can be fostered through collaborations. Equitable access was seen in the less privileged population and people accessing mental healthcare [21, 22]. Some studies reported a reduction in access as the outcome of a failed plan of collaborations [13].\"}, {\"pmc\": \"PMC11180759\", \"pmid\": \"38887723\", \"reference_ids\": [\"B23\", \"B24\", \"B25\", \"B26\", \"B27\"], \"section\": \"Introduction\", \"text\": \"However, poor access to healthcare services, especially to PHC services is the major reason behind preventable deaths in Sub-Saharan Africa [23]. Barriers to accessing the use of PHC services are mostly systemic challenges like lack of coordination and defective healthcare workforce [24]. Heightened trust in traditional medicine can also hinder the use of primary healthcare facilities. Cultural barrier is another major hindrance [25]. Other barriers include unavailability of infrastructure, lack of functional equipment, lack of manpower, absenteeism among healthcare workers, misinformation, long waiting times, attitude of healthcare workers, and financial hindrances [26, 27].\"}, {\"pmc\": \"PMC11180759\", \"pmid\": \"38887723\", \"reference_ids\": [\"B26\"], \"section\": \"Introduction\", \"text\": \"Many of the constraining factors are traced back to poor levels of community involvement and participation in the development and implementation of strategies for improving health within their communities. Some women have to seek permission before seeking care, which is a restriction to timely care. In Northern Nigeria, women in Purdah cannot seek healthcare even when in labour, unless the husband gives his permission or accompanies her to the hospital [26].\"}, {\"pmc\": \"PMC11180759\", \"pmid\": \"38887723\", \"reference_ids\": [\"B11\", \"F1\", \"B11\"], \"section\": \"Conceptual Framework\", \"text\": \"The conceptual framework for the study was adapted from the expanded health system framework proposed by Sacks et al in 2019 [11], which recognizes \\u201csocietal partnerships\\u201d between the formal PHC system building blocks and community actors including informal providers, and community organizations (Figure 1). We focused on how community participation and partnerships/collaborations improved coverage and increased access to the utilization of PHCs. The expanded health system framework recognizes the inclusion of community action, household provision of health and partnerships with other non-health sectors, and a multiplicity of stakeholders [11].\"}, {\"pmc\": \"PMC11180759\", \"pmid\": \"38887723\", \"reference_ids\": [\"T1\"], \"section\": \"Study Design and Setting\", \"text\": \"The study adopted a qualitative cross-sectional study design to explore insights into community participation and involvement in community healthcare. The method was chosen to describe the phenomena from the participants\\u2019 perspective. This study was reported according to the consolidated criteria for reporting qualitative studies. See Table 1 for details. Three states from three of the six geopolitical zones in Nigeria were selected for the study. The states selected were Kano (North-west), Akwa-Ibom (South-south), and Anambra (South-east). In each state, two local government areas (LGAs) were selected, with one predominantly rural setting and the other urban.\"}, {\"pmc\": \"PMC11180759\", \"pmid\": \"38887723\", \"reference_ids\": [\"T2\"], \"section\": \"Study Participants Selection\", \"text\": \"Participants were purposively selected based on their roles and involvement in health service provision to ensure a representative sample. They included policymakers, health programme managers, formal healthcare providers, informal healthcare providers, Civil Society Organizations (CSOs)/Non-Governmental Organizations (NGOs), community leaders, and community groups, to ensure diversity in views. The participants were recruited through a face-to-face encounter, where they agreed to partake in the study. At the end of the interview process, 102 successful interviews were recorded, comprising 90 in-depth interviews (IDIs) and 12 focus group (FGD) discussions with male and female groups of respondents, as summarized in Table 2.\"}, {\"pmc\": \"PMC11180759\", \"pmid\": \"38887723\", \"reference_ids\": [\"T3\"], \"section\": \"Results\", \"text\": \"Major actors within the community include formal healthcare providers, informal health providers, community organizations, community leaders, and community members. Each of these actors played different roles that contributed to enhancing the use of primary healthcare facilities in communities as summarized in Table 3.\"}, {\"pmc\": \"PMC11180759\", \"pmid\": \"38887723\", \"reference_ids\": [\"F2\"], \"section\": \"Results\", \"text\": \"The roles they played centered around sensitization/awareness creation, advocacy, and paying for impoverished community members to access care. They also donated lands for building of PHCs, renovated PHCs, and created structures that will promote the penetration of health programmes and interventions. These roles played by various community members to improve access to health facilities are presented under the collaborations that occurred in the community: PHC-led collaboration, Community organization-led collaboration, and Individual-led collaboration. These are depicted in Figure 2 and described below.\"}, {\"pmc\": \"PMC11180759\", \"pmid\": \"38887723\", \"reference_ids\": [\"B28\", \"B29\", \"B30\", \"B31\"], \"section\": \"Discussion\", \"text\": \"The findings show that actors in all study areas were keen on ensuring that health works for all. Collaboration and participation were seen among community individuals and organizations to ensure improvement in the use of PHC facilities. Community members at the level of religious bodies, primary healthcare facilities, and informal providers collaborate and strategize to enhance the use of PHC facilities. Community committees and philanthropists in the organization also contribute to the enhancement. This collaborates with a Mexico study which reported that patients barely had access to advanced treatment, before the involvement of the community in the activities of the PHCs in rural Mexico [28]. It also aligns with studies done in Cross River state and Ibadan, Nigeria. They reported how the involvement of community members worked towards ensuring that quality care is available for all. They sensitized, created awareness, and mobilized resources to ensure the use of available healthcare services [29, 30]. On the contrary, Gholipour et al., 2023 reported community involvement as theory rather than practice in Iran. This could stem from not setting it up as an independent service unit [31].\"}, {\"pmc\": \"PMC11180759\", \"pmid\": \"38887723\", \"reference_ids\": [\"B32\", \"B32\"], \"section\": \"Discussion\", \"text\": \"Collaborations with local actors took different approaches. Training and retraining of informal providers contributed invariably. It enhanced the minds of these providers and opened their minds to the possibility of better healthcare service delivery for community members. This worked as much as involving them in healthcare services. A study conducted in Uganda reported that TBAs tried to bridge the gaps of power dynamics in homes because of the trust that some men have in them. This arose when women sought care in the informal sector because their husbands did not permit formal healthcare services [32]. This study reported that men are free when interacting with TBAs concerning their wives\\u2019 problems during pregnancy and childbirth. This creates an avenue for these TBAs to step in and give them reasons why their wives need to access care informal healthcare centres [32].\"}, {\"pmc\": \"PMC11180759\", \"pmid\": \"38887723\", \"reference_ids\": [\"B33\", \"B34\"], \"section\": \"Discussion\", \"text\": \"Sensitizing community members on the need to enroll and utilize the PHC facilities was another collaboration measure. This collaborates an Indian study that buttressed community involvement in healthcare delivery through the use of participatory learning action. It emphasized the need for the mechanism to be included through professionalism and teamwork attitude to bring about the necessary transformation in the health system [33]. A Belgium study maintained that increasing health literacy of a communities can optimize the use of healthcare services [34].\"}, {\"pmc\": \"PMC11180759\", \"pmid\": \"38887723\", \"reference_ids\": [\"B35\", \"B36\", \"B4\", \"B37\"], \"section\": \"Discussion\", \"text\": \"An equipped hospital with keen staff is an avenue to increase the people\\u2019s trust and ensure their reliability on the system, to enable utilization. Brals revealed that an upgraded healthcare facility tends to increase the utilization of healthcare services [35]. A study in Indonesia reported that one of the major factors to improve quality of care is by having high-quality medical staff, which in turn increases the use of health facilities. These staff should keep getting trained to enhance efficiency [36]. A study in sub-Saharan Africa reported that health workers were kept on their toes by monitoring absenteeism, the quality of healthcare delivered, and the expenditures in the system. Health workers in some sub-Saharan Africa need enlightenment on the need for community involvement in healthcare [4]. A similar study in South Africa reported that committees monitored health workers\\u2019 absenteeism and quality of healthcare delivery. However, these committees were considered illegitimate because they lacked transparency, and participation in selecting group members were male-dominated. These committee members were barely involved in the planning process, owing to health workers considering them uneducated and uninformed [37].\"}, {\"pmc\": \"PMC11180759\", \"pmid\": \"38887723\", \"reference_ids\": [\"B29\"], \"section\": \"Discussion\", \"text\": \"Enabling the proximity of health centers to the people occurred through collaborations. Most of these communities contributed to building the health centre by donating land, soliciting support, and combining resources to build and restructure hospitals. Cost minimization for community members who cannot afford healthcare was eminent too. Resources were mobilized and secured and used to ensure that those that need healthcare but cannot afford it, could access it. Collaborations and strategies also had community members making transport arrangements to enable access. This aligns with a Cross River study. They reported that community members were involved in building health centres and engaged in many developmental activities to better the lives of those in the community. The finding agrees with Adie et al., 2014 that activities are effective with proper mobilization [29].\"}, {\"pmc\": \"PMC11180759\", \"pmid\": \"38887723\", \"reference_ids\": [\"B38\"], \"section\": \"Discussion\", \"text\": \"The involvement of religious leaders was an approach that enhanced the use of PHC facilities because some communities consider their opinion final and the words of God. Their collaboration with formal providers contributed to a change of heart of certain men and women in the community. Akinloye\\u2019s study reported that religious leaders are seen as change ambassadors in Nigeria. He pointed out that this is the avenue for motivating and training them to advocate, educate and train their members on the need to utilize the primary healthcare centres in the community. A move that could do justice more in the development and the sustenance of PHC centres than the media [38].\"}, {\"pmc\": \"PMC11180759\", \"pmid\": \"38887723\", \"reference_ids\": [\"B39\", \"B40\"], \"section\": \"Discussion\", \"text\": \"Evidence from this research showed that these collaborations and varying involvements resulted in improved use of primary healthcare facilities. The result is an improvement in the health of community members. Maternal deaths and under-five mortalities were at bare. The finding from this study corroborates a study done in Korea which showed increased community involvement and capacity to enhance the community health status [39]. This also aligns with an Australian study that confirmed that involvements and engagements with community members were attributed to healthcare quality, access, utilization, and responsiveness, which in turn results in improved health outcomes in Australia [40].\"}]"

Metadata

"{}"