Community engagement mechanisms in response to drought-related health emergencies: a realist-informed review from sub-Saharan Africa
1
Health Policy and Management, Jimma University, Jimma, Ethiopia
2
Health Behavior and Society, Jimma University, Jimma, Ethiopia
3
Global Health and Development, London School of Hygiene & Tropical Medicine, London, United Kingdom
4
Health Policy and Planning, Ministry of Health, Addis Ababa, Ethiopia
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
INTRODUCTION:
Community Engagement and Involvement (CEI) is increasingly recognized as critical for effective public health emergency responses. However, its role in drought-related health crisis remains underexplored. In sub-Saharan Africa, where recurrent drought poses substantial health risks, limited evidence explains how CEI works, for whom, and under what conditions. This realist-informed review examined how and why CEI mechanisms contribute to health resilience during drought-related emergencies.
METHODS:
A systematic search of published and grey literature identified studies reporting CEI in drought-affected contexts across sub-Saharan Africa. Documents were appraised for relevance and rigor, and key data were analyzed using a realist approach. Context-Mechanism-Outcome Configurations (CMOCs) were extracted and synthesized into recurring patterns to generate and refine program theories.
RESULTS:
Nineteen documents met inclusion criteria, contributing 23 CMOCs. Five interconnected program theories were developed, mapped to the World Health Organization’s (WHO) CEI continuum of participation. Findings show that CEI enhances resilience when (1) understand and anticipate risk through trusted communication (Inform); (2) contribute local knowledge and feedback to guide action (Consult); (3) engage inclusively in decision making to set priorities (Involve); (4) co-design and deliver strategies with institutions; and (5) lead and govern response structures (Empower). Across the continuum, CEI functions through mechanisms that build trust, strengthen social networks, legitimize participation, and support collection ownership.
CONCLUSIONS:
CEI is most effective when initiated early, grounded in local knowledge systems, inclusive of diverse community actors, and supported by enabling institutional relationships. These insights inform policy and practice by emphasizing CEI as a dynamic, relational process rather than a one-off intervention. The resulting theories provide a foundation for designing and evaluating context-sensitive CEI strategies that enhance resilience in drought-prone settings.
Community Engagement and Involvement (CEI) is increasingly recognized as critical for effective public health emergency responses. However, its role in drought-related health crisis remains underexplored. In sub-Saharan Africa, where recurrent drought poses substantial health risks, limited evidence explains how CEI works, for whom, and under what conditions. This realist-informed review examined how and why CEI mechanisms contribute to health resilience during drought-related emergencies.
METHODS:
A systematic search of published and grey literature identified studies reporting CEI in drought-affected contexts across sub-Saharan Africa. Documents were appraised for relevance and rigor, and key data were analyzed using a realist approach. Context-Mechanism-Outcome Configurations (CMOCs) were extracted and synthesized into recurring patterns to generate and refine program theories.
RESULTS:
Nineteen documents met inclusion criteria, contributing 23 CMOCs. Five interconnected program theories were developed, mapped to the World Health Organization’s (WHO) CEI continuum of participation. Findings show that CEI enhances resilience when (1) understand and anticipate risk through trusted communication (Inform); (2) contribute local knowledge and feedback to guide action (Consult); (3) engage inclusively in decision making to set priorities (Involve); (4) co-design and deliver strategies with institutions; and (5) lead and govern response structures (Empower). Across the continuum, CEI functions through mechanisms that build trust, strengthen social networks, legitimize participation, and support collection ownership.
CONCLUSIONS:
CEI is most effective when initiated early, grounded in local knowledge systems, inclusive of diverse community actors, and supported by enabling institutional relationships. These insights inform policy and practice by emphasizing CEI as a dynamic, relational process rather than a one-off intervention. The resulting theories provide a foundation for designing and evaluating context-sensitive CEI strategies that enhance resilience in drought-prone settings.
| eISSN: | 2654-1459 |
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