Exploring the interface between community health systems and primary health care in Ethiopia, Kenya, Nigeria, Rwanda, and Senegal

This paper explores the interface between Community Health Systems and Primary Health Care and the challenges from the perspective of Ethiopia, Kenya, Nigeria, Rwanda, and Senegal. We discuss how African Health Observatory Platform on Health Systems and Policies (AHOP) countries tackle the challenges of community health systems, interfacing with the formal health system, and forming multisectoral partnerships.  

Specifically, we present a cross-country analysis to help understand how community level structures and influences from the health sector and beyond, both formal and informal, improve the health of their local populations.    

We draw upon three bodies of literature to inform our research.  Firstly, we use the evolving role of Primary Health Care (PHC) to shape our understanding of the formal mechanisms in place to improve / influence health in the community.  

Secondly, by referring to the concept of community health system (CHS),  we extend our remit beyond PHC and recognise that community members and initiatives are not passive recipients of health interventions, but rather active agents with the power to shape their health and wellbeing outside of formal health structures.    

Finally, we use a Public Authority lens to tie together our thinking on the formal and informal community structures, processes, and wide range of actors that shape people’s everyday realities.  Such influences include religious/traditional organisations, aid agencies and civil society organisations.    

By bringing together these three perspectives we present some initial findings on the interplay between the formal and informal structures at the community level and how these align (or not) to the primary health care system across the 5 AHOP countries.  We refelct on the role of research in understanding these relationships.  

The objective of this work is to highlight the importance of community health systems to the wider health system ecosystem. The proposed research is intended to be of interest to academic, practitioner and policy maker audiences.