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Table 2 Details of studies included in this review

From: Participation in primary health care through community-level health committees in Sub-Saharan Africa: a qualitative synthesis

Author Country(ies) Name Health Committee and roles Study description How included articles described selection of Health Committee members Methods applied in the selected articles
Lodenstein et al 2019 [21] Malawi Health Centre Advisory Committee (HCAC)
Expected roles and responsibilities
1. Bridging the communication gap between community and primary health workers in facilities
2. Inspection of conditions and drug stock in primary health facilities
3. Formulating recommendations on facility equipment
4. Management of complaints from users of primary health providers
Study explored experiences with, and perceptions on, the role of HCACs as social accountability interfaces and the approaches HCACs use to address poor service quality and performance in rural health centres. Although the selection of HCAC members is not described in this article, the Ministry of Health (MoH) guideline stipulates that members should be elected by community members. Authors conducted
• 62 individual interviews in 22 Health Centres (22 with HCAC members and 40 with primary health workers)
• 7 key informant interviews with District Health Management Team members
• Review of 12 HCAC Minutes
• Review of written communication between HCACs and health workers in Mzimba North and South Districts in Malawi
Ogbuabor and Onwujekwe 2018
Nigeria Health Facility Committee (HFC)
Expected roles and responsibilities
1. Monitor the delivery of free primary health care and identify eligible users for these services
2. Provide platforms for consultations between health workers and clients
3. Raise awareness about free primary health services
4. Mobilise communities to use public health facilities
5. Manage facility resources and facilitate implementation of the complaint systems
6. Joint problem analysis and planning with other stakeholders at the facility and policy levels
Study provided evidence on how social accountability initiatives influenced revenue generation, pooling and fund management, purchasing and capacity of health facilities implementing the free maternal and child healthcare program. HFC members are selected to represent special groups by their communities for a renewable term of 3 years Authors conducted:
• Review of 14 policy documents
• In-depth interviews (IDIs) with 44 participants (16 policymakers, 16 providers and 12 HFC leaders)
• 4 focus group discussions (FGDs) with 42 women in Enugu State in South East Nigeria
Lodenstein et al., 2017 [16] Benin, Guinea and Democratic Republic of Congo (DRC) Benin: Health Facility Management Committee (COGECS)
Guinea: Health Management Committee (COGES)
DRC: Health Development Committee (CODESA)
Expected roles and responsibilities
COGECS (Benin)
1. Monitoring of the primary facility budgeting process
2. Management of user fees generated in primary health care facilties
3. Establishment of drug inventories and orders
4. Promote financial transparency in pricing policies in primary health facilities
5. Resolution of conflicts community and primary health care providers
COGES (Guinea)
1. Plan and monitor services in primary health facilities.
2. Supervision of health workers based in primary health facilities
3. Maintain dialogue between primary health providers and the community
Planning and monitoring health services in partnership with primary health care providers
Study explored the functioning of health committees in particular with regard to their actual and potential role in the facilitation of social accountability HFCs in the three countries were constituted through elections. The article however reported diverse methods of reconstituting members after the elections. Authors conducted 95 individual interviews and 22 focus group discussion (FGDs) in: 4 Districts in Benin, 4 Zones in DRC and 4 prefectures in Guinea.
Iyanda & Akinyemi, 2017 [26] Nigeria Village Development Committee (VDC)
Expected roles and responsibilities
Serving as the interface between government and community in decision making, planning, execution, and analysis of development tasks at village level
Study assessed community participation as a major principle in the delivery of primary health care services Selection of VDC members not described in this article 45 participants were enrolled for 12 in-depth interviews (IDIs) and 4 FGDs with primary health care providers and community members in Ibadan South East Local Government Area of Oyo state, Nigeria.
McMahon et al., 2017 [25] Sierra Leone Health management committee (HMC)
Expected roles and responsibilities
HMCs on Sierra Leone do not have a standard structure and roles. They take on different forms, have different planned and actual roles, and receive support various NGOs and government programs.
Study described the roles played by members of HMCs and related forms of community-based voluntary engagement during the Ebola outbreak in two districts of Sierra Leone. The process of constituting HMC was not described in this article Authors analysed data from 13 FGDs with health committee members in 8 peripheral health units in urban and rural settings across Bo and Kenema districts, which represented areas of low and high Ebola transmission, respectively.
Abimbola et al., 2016 [20] Nigeria Community Health Committee (CHC)
Expected roles and responsibilities
1. Identify the health needs of the community, and address them by drawing on human and material resources within the community, including raising funds when necessary within the community;
2. Liaise with the government and NGOs in finding solution to health needs of the community
3. Supervise and support health activities in the community and at the health facility, including the drug revolving funds
4. Signatories to primary health facility bank accounts (chairman, treasurer and secretary)
Study conducted an in-depth exploration of how and under what circumstances community health committees function. Primary health care managers and NGOs convene town hall meetings with community members where they community members to nominate members to the health committee
in accordance with federal guidelines, and read out to committee
members their expected roles and responsibilities
Authors reviewed 581 meeting minutes of 129 CHCs in Lagos, Kaduna, Benue and Nasarawa States of Nigeria using a realist synthesis approach.
Turinawe et al 2015
Uganda Village Health Team* (VHT)
Expected roles and responsibilities
Mobilizing communities to utilize primary health services, health promotion and education, follow up clients that utilize primary health services and management of community information systems.
Study examined the process used to introduce the VHT strategy and how team members were selected in one rural community. The study also examined how these processes may have influenced the work of VHTs Selection of VHT members was not done in accordance with MoH guidelines by Local Councils. This study utilized ethnographic approaches that entailed:
• Participant observation provided a point of entry into the community through joining in the activities of daily life
• Spontaneous interactions yielded insights into the lives of community members
• Field notes were taken on a daily basis to keep track with common activities
• 12 FGDs and 14 IDIs with community members
• 4 key informant interviews
Turinawe et al 2016
Uganda Village Health Team* (VHT)
Roles are described in the article by Turinawe et al. 2015
Study critically examined the interplay between health officials and the community in the selection of VHTs in Ugandan rural setting. Selection process similar to Turinawe et al. 2015
Authors used ethnographic approaches to conduct:
• Observation of community events
• 35 IDIs
• 20 FGDs
• 15 informal conversations, and;
Review of project documents in Luwero District in Uganda
Maluka & Bukagile, 2016 [17] Tanzania Health facility committees (health centre committees and dispensary committees)
Expected roles and responsibilities
1. Discuss and pass health centre plans and budgets
2. Identify and solicit financial resources for running health centre
3. Ensure delivery of healthcare services
Study examined the differences in practice of health facility committees in a well- functioning district and one that is not. Health Committee members were selected by Village Executive
Officers and Ward Executive Officers after applying to be members.
The list of shortlisted members was submitted to the Ward Development Committee for final selection and then forwarded to the District council for endorsement.
Authors reviewed policy documents MoH guidelines, minutes, committee records, schedule of meetings) and conducted:
• 83 interviews
• 449 structured exit interviews with clients seeking outpatient services
• Health facility visits to verify and validate key issues identified by respondents
Capurchande et al., 2015 [12] Mozambique Community Health Committee (CHC)
Expected roles and responsibilities
1. Promote the use of family planning services
2. Mobilising and counselling community members to take up family planning services in primary health care facilities
Study examined how CHCs implemented family planning promotion activities and the complexities involved in the triangle of health. Workers, committee members and clients The process of constituting CHC was not described in this article Authors conducted:
6 FGDs; 4 informal conversations and reviewed policy documents and literature focusing on family planning observations in Boane and Ndlavela Administrative regions, Mozambique.
Kilewo & Frumence, 2015 [15] Tanzania Health Facility Governing Committee (HFGC)
Expected roles and responsibilities
1. Develop plans and budget for primary health facilities
2. Mobilize local communities to contribute to community insurance funds (e.g. Community Health Fund)
3. Ensuring the availability of drugs and equipment in primary health facilities
4. Reporting health provider employment and training needs to the district council, and ensuring adequate staffing levels in local primary health facilities
5. Liaise with Dispensary Management Teams (DMT) and other actors to ensure the delivery of quality primary health services.
Study explored factors that hinder community participation in developing and implementing Comprehensive Council Health Plans. Constituting HFCGs varied from one health facility to another. Some members were handpicked by health workers, while others were elected by community members. Authors conducted IDIs and discussions with 18 key informants in Singida Region, Manyoni District, Tanzania.
Frumence, Nyamhanga, Mwangu, & Hurtig, 2014
Tanzania Health Facility Governing Committee (HFGC)
Same as in Kilewo & Frumence, 2015 [15]
Study explored the challenges and benefits of the participation of HFGCs in health planning in the decentralised health system in Tanzania. Formation of HFCGs not described in this paper. We assume that the process is similar to the process described in the article by Kilewo & Frumence, 2015 [15] Authors conducted document reviews, 13 key informant interviews and 6 FGDs at different health system levels in Kongwa district, Tanzania.
Falisse, Meessen, Ndayishimiye, & Bossuyt, 2012
Burundi Comité de Santé (COSA)
Expected roles and responsibilities
1. Facilitate relations between client population and primary health care providers
2. Technical co-management of the primary health facilities (planning and evaluation),
3. Administrative co-management of primary health facilities, including controlling the finances
4. Participate in health promotion activities in their communities
Study aimed to analyse the place of two downward accountability mechanisms in a performance-based financing scheme. COSA members were elected by residents living in the catchment areas of a Health Centre Semi-structured questionnaires were conducted combining a classical ‘community participation in health’ framework and interviews in 6 provinces of Burundi.
Goodman, Opwora, Kabare, & Molyneux, 2011
Kenya Health Facility Committee (HFC)
Expected roles and responsibilities
1. Oversee the general operations and management of primary health facilities
2. Advise the community on matters related to the promotion of health services
3. Represent and articulate community interests on matters pertaining to health in local development forums
4. Facilitate a feedback process to the community pertaining to the operations and management of primary health facilities
5. Implement community decisions pertaining to their own health
6. Mobilise community resources towards the development of health services within their area
Study assessed the nature and depth of managerial engagement of HFCs at the facility level and how this has contributed to community accountability in the context of the Direct Facility Financing mechanism. Health Facility Committee members were selected in two ways. First, HFC members were elected by community members living in the catchment area of the Health Centre.
Secondly, Chair persons of Village Health Committees (now referred to as Community Health Committees) were automatically nominated to the HFC as members.
Authors implemented:
• 30 Structured interviews with Health workers in charge of primary health facilities
• 292 structured exit interviews with community members seeking outpatient services in primary health facilities
• 7 IDIs with District health Managers
• 6 group discussions with health workers in 7 districts within Kwale and Tana River Counties
O’Meara et al 2011
Kenya Health Facility Committee
Same as in Goodman, Opwora, Kabare, & Molyneux, 2011
Study described the national guidelines for the 2008–2009 annual planning process and discussed how these guidelines were implemented in Kilifi County. The study also highlighted the strengths and weaknesses of the planning process with regard to capacity at the implementation level and the engagement of communities in setting priorities in health. The process selecting HFMC members was not described in this article. We assume he process is same as the process described in Goodman, Opwora, Kabare, & Molyneux, 2011
Authors employed:
• Structured observation of the annual work plan and budget development forums and processes
• Review of national guidelines for the planning and budgeting process
• In-depth review of all minutes produced during meetings of facility committees related to the planning process.
• Analysis of targets from the work plans produced by each primary health facility during the planning process in Kilifi County
  1. MoH Ministry of Health, IDI In-depth Interview, FGD Focus group discussion