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

• Published in: Global public health 2012-10, Vol.7 (9), p.961-973
• Main Authors: Curry, Leslie A., Alpern, Rachelle, Webster, Tashonna R., Byam, Patrick, Zerihun, Abraham, Tarakeshwar, Nalini, Cherlin, Emily J., Bradley, Elizabeth H.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Citizen participation; Community; Community health care; Community health services; Community Participation; Developing countries; Ethiopia; Female; Focus Groups; Government; Health care; Health services; Health Services Needs and Demand; Humans; Infrastructure; LDCs; Low income people; Male; Medical service; Middle Aged; Partnering; Partnership; Partnerships; Primary care; Primary health care; Primary Health Care - organization & administration; Primary Health Care - standards; Qualitative analysis; qualitative methods; Responsibilities; Responsibility; Rural areas; Rural communities; rural Ethiopia; Rural Health; Rural Health Services - organization & administration; Rural Health Services - standards; Social Responsibility; Surveillance; Young Adult
• ISSN: 1744-1692; 1744-1706
• DOI: 10.1080/17441692.2012.686114

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.