Implementing a community led health systems strengthening intervention in sierra leone to address shocks, increase inclusivity, accountability and trust, and support health system resilience
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University of Sierra Leone ReBUILD for Resilience Consortium "College of Medicine and Allied Health Sciences PMB New England Ville" Sierra Leona
College of Medicine and Allied Health Sciences Ayesha Satta Idriss College of Medicine and Allied Health Sciences ReBUILD for Resilience Consortium Sierra Leona
Institute for Global Health and Development, Queen Margaret University, UK ReBUILD for Resilience Consortium United Kingdom
Institute for Global Health and Development, Queen Margaret University, UK
Publication date: 2023-04-26
Popul. Med. 2023;5(Supplement):A904
Background and objectives:
Community engagement (CE) with the relevant stakeholders is recognised as core to resilient health systems and is essential and instrumental in promoting accountability and trust. This is particularly important in Sierra Leone, a context often characterized by mistrust in the health system. This study aimed to provide insights into the current CE strategies in response to issues in Sierra Leone through an inclusivity and accountability lens and test approaches to support and improve engagement, ownership and leadership and to develop resilience capacities of the health system.

The study was a prospective participatory action research (PAR) cycle, involving four research phases, in two districts in Sierra Leone: Phase 0 mapping the current situation, Phase 1 participatory power mapping with different community leaders through a gender, equity and social inclusion lens, Phase 2 identifying leverage points and co-creating an action agenda with community stakeholders; Phase 3 implementing actions, reflecting and documenting processes, adapting and learning. The results presented are based on data collected from inception to October 2022.

A CE pathway to change that encompassed several context-driven PH interventions was co-created by the identified key community stakeholders and the research team, supporting an embedded approach to CE and community ownership. An intervention informed by this was piloted, designed to harmonize different CE initiatives, encompassing the One Health platform, nutritional programs, and maternal and child health interventions, among others. The study design, based on several phases and cycles, allowed to embed feedback loops for effective communication.

Communities should be directly involved in developing CE programs for HSS interventions. In this regard, PAR is a well-suited research method to design effective strategies to respond to local health needs. CE is a central element of comprehensive primary health care, promoting social change, increasing accountability, and building community health systems.

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