Strengthening the effectiveness of community health system: assessing the factors that enhance or constrain the delivery of health services within communities in Nigeria

Abstract

Introduction: Sub-optimal community health service delivery (CHSD) has been a challenge constraining community health system (CHS) globally, especially in underdeveloped countries like Nigeria. This paper examined the key factors that either enhance or constrain CHSD in Nigeria at individual, community/facility and governmental levels while recommending evidence-based solutions for sustaining and improving CHSD within the framework of CHS. Methods Data was collected through a qualitative study undertaken in three states (Anambra, Akwa-Ibom and Kano) in Nigeria. Respondents were formal/informal health providers; community leaders and representatives of civil society organizations all purposively sampled. There were 90 in-depth interviews and 12 focus group discussions, which were audio-recorded, transcribed verbatim, and analyzed thematically using codes to identify key themes. Results Factors constraining CHSD at the individual level were: poor health seeking behavior and male dominance. At the community/facility level: superstitious/cultural beliefs and poor attitude of facility workers; at the governmental level were: inadequate financial support, embezzlement of funds, inadequate social amenities... Conversely, the enabling factors at the individual level were: community members participation, compassionate attitude of informal providers… At the community/facility level were: synergy between formal and informal providers; and support from community-based organizations and structures. At the governmental level were: government’s support to community-based formal/informal providers and clear line of communication. Conclusions CHSD through functional CHS can improve overall health systems strengthening and lead to improved community health. Policymakers should integrate CHSD in all program implementation and ultimately work with CHS as a veritable platform for effective community health service delivery.