Dear All,
I would like to share with all of you a new critical resource from World Health Organization Regional Office for the Western Pacific
COMMUNITY ENGAGEMENT RESEARCH INITIATIVE
Evaluation of the WHO Community Engagement Research Initiative
9789290620082-eng.pdf (who.int) <https://apps.who.int/iris/bitstream/handle/10665/368135/9789290620082-en...
Extract from Executive summary
The coronavirus disease (COVID-19) pandemic has exposed inequities and service delivery gaps in national and global health systems. These weaknesses reveal the need for a fundamental reconfiguring of ways of working within health systems to meet the needs of the people they serve. The World Health Organization (WHO) Regional Office for the Western Pacific, in collaboration with WHO headquarters and WHO country offices, led an ambitious Community Engagement Research Initiative to fill critical research gaps and accelerate action in mitigating the impacts of the COVID-19 pandemic on vulnerable populations. Four country research teams (CRTs) carried out evaluative action-based research in Cambodia, the Lao People's Democratic Republic and Malaysia.
Starting from the conceptual foundation of systems theory, the Community Engagement Research Initiative was structured as a proof-of-concept research project that intentionally adopted a relational approach to the commissioning and implementation of action-based research and to the provision of technical support. The Research Initiative aimed to show how relational community engagement processes can emphasize meaningful interactions that place people and communities at the centre of health service delivery and health decision-making, build relationships and strengthen collaborative action, and redress power imbalances and inequities. More broadly, the Research Initiative sought to challenge traditional assumptions underpinning the science of "intervention design" in order to deepen the understanding of how processes of systemic relational engagement can create conditions for transformational change within health systems to support improved health, and how the skills involved in relational community engagement can be taught and learnt throughout the health workforce and communities, making operational the WHO Global Competency and Outcomes Framework for Universal Health Coverage.
The Research Initiative developed a distinctive technical support structure, with a "conceptual framing" founded on a rigorous evidence base provided by developments in the natural sciences, which broadened what counts as data to include the lived experiences of communities, service providers and researchers. The Research Initiative's support structure provided intensive, bespoke support for the CRTs while also modelling the kinds of behaviours that are fundamental in delivering relational community engagement. The initial health indicator data from the CRTs provide evidence of the success of the research projects in developing innovative ways of engaging communities. In two cases, there is evidence of affecting the health issue, even at this very early stage. The communities engaged by the CRTs included refugees and asylum seekers with mental health issues (Malaysia CRTs), people living with HIV (Cambodia CRT) and rural populations (Lao People's Democratic Republic CRT), as well as patient managers, community health workers, other health-care workers, district officials, high-level stakeholders, patients and local community members.
The Cambodia team explored how community engagement could better support people living with HIV. Despite the circumstances of the pandemic, which interfered with treatment adherence, in the two months following the intervention, the percentage of patients not retained in HIV treatment care fell from 2.8% to 0.6% in the intervention group compared to 0.9% to 0.7% in the control group. The research team also reported enhanced relationships between health-care workers and patients and improved communication resulting from less formal interactions.
The Lao People's Democratic Republic team wanted to understand the enabling factors for the uptake of essential services such as family planning, antenatal care, delivery with skilled birth attendants and vaccination delivery among rural populations. The team successfully engaged local governments in participating in their community engagement workshops. Following the community engagement intervention, one village health centre reported that antenatal care clinic attendance climbed to 80%, up from 41% in the corresponding period in the preceding year. Similarly, 34% of deliveries took place at local health centres after the intervention, compared to 12% during the same period in the previous year. The success of the workshops also led to the signing of a memorandum of understanding between the Ministry of Health and the Ministry of Home Affairs.
The evaluation of the Community Engagement Research Initiative identified several key features that enabled the achievement of these and other outcomes and that offer an indication of how the relational community engagement approach can be effective in new settings. Strong, trusting relations should be in place among members of teams seeking to implement and research relational community engagement interventions. These team relations provide a strong foundation for building new relations with new communities. Moreover, commissioners of relational community engagement initiatives need to invest the time and resources required to build such relations. Commissioners also need to be responsive to implementing teams, allowing them to identify the right time for action-based research work to be conducted. The timeliness of community engagement initiatives may be determined by a specific demand for interventions based on the lived realities of communities. Similarly, specific conditions in health systems can provide a demand for community engagement. Such demands function as mandates for the work, and when these mandates are present, the likelihood of success for the community engagement intervention increases.
All my best regards.
Isabelle WACHSMUTH
Integrated Health Services
Universal Health Coverage and Life Course
World Health Organization
Telephone: +41227913175
Web: www.who.int<http://www.who.int/>
Follow WHO on Facebook<https://www.facebook.com/WHO/>, Twitter<https://twitter.com/WHO>, YouTube<https://www.youtube.com/user/who>, Instagram<https://www.instagram.com/who/>
HIFA profile: Isabelle Wachsmuth-Huguet, MSc, MPH has been working for World Health Organization (WHO) since 2003 and has 20 years of expertise on international network promoting and implementing knowledge management solutions in both high and low income countries. She is also the coordinator and lead moderator of the WHO-HIFA Global Francophone Forum – Health Information For All (HIFA-Fr). hugueti AT who.int
