What do we want to know?
The aim was to identify, analyse and summarise the findings of existing systematic reviews that have examined the effectiveness of community engagement/participation approaches in improving health, service delivery and sustainability outcomes. The overarching research question of interest was: How effective are community engagement/participation approaches for delivering better health outcomes, improving service delivery and sustaining benefits?
Who wants to know and why?
Community engagement and participation may be considered the ‘direct or indirect process of involving communities in decision-making and/or in the planning, design, governance, and delivery of services using methods of consultation, collaboration, and/or community control’. Community engagement and participation approaches have been adopted in many LMICs, including South Asia and Nepal, as a response to critical shortages of human resources for health. This evidence summary seeks to assess the effectiveness of community engagement and participation from the perspective of assisting policy-makers and researchers to assess the evidence within the context of their regional setting and conditions.
What did we find?
We identified 31 systematic reviews that examined community engagement/participation approaches in improving health (maternal and child health, infectious or communicable diseases, ‘other’ disease areas), service delivery and sustainability outcomes. There was wide variation in the aims and objectives, and methods of analysis across the included systematic reviews. In part, this reflected a lack of a standard definition or terminology in how community engagement and participation approaches were described or characterised. The overall strength of the systematic review-level evidence has been categorised as of limited or moderate, however many systematic reviews reported consistent findings.
The general trend in the evidence identified suggests that community engagement and participation approaches have played a role in successful intervention delivery across health system domains and areas of health. However, the extent to which community ownership and empowerment is achieved greatly impacts on the sustainability of these approaches and our evidence summary draws out some key factors for consideration in the delivery of successful community engagement and participation approaches.
What are the implications?
We identified that the evidence relating to maternal and child health is most relevant to communities in South Asia and Nepal. To ensure the findings are put into practice, NGOs and their local partners, community members and their representatives are required to take action and enable policy options to be optimised. We identified key messages that outline the potential policy implications and options that could lead to successful and sustainable community engagement and participation approaches to improving health outcomes.
How did we get these results?
We did an evidence summary comprising an overview of existing systematic reviews based on standard systematic review methodology involving comprehensive literature searching, study selection, data extraction, quality assessment and narrative synthesis.
This report should be cited as: Pilkington G, Panday S, Khatib MN, Kotas E, Hill RA, Simkhada P, Jones L (2018) The effectiveness of community engagement and participation approaches in low and middle income countries: a review of systematic reviews with particular reference to the countries of South Asia. London: EPPI Centre, Social Science Research Unit, Institute of Education, University of London