How does community health feature in Global Financing Facility planning documents to support reproductive, maternal, newborn, child and adolescent health and nutrition (RMNAH-N)? insights from six francophone West African countries.

BACKGROUND: Community health is key for improving Reproductive, Maternal, Newborn, Child, and Adolescent Health and Nutrition (RMNCAH-N). However, how community health supports integrated RMNCAH-N service delivery in francophone West Africa is under-researched. OBJECTIVE: We examined how six francophone West African countries (Burkina Faso, Côte d'Ivoire, Guinea, Mali, Niger, and Senegal) support community health through the Global Financing Facility for Women, Children and Adolescents (GFF). METHODS: We conducted a content analysis on Investment Cases and Project Appraisal Documents from selected countries, and set out the scope of the analysis and the key search terms. We applied an iterative hybrid inductive-deductive approach to identify themes for data coding and extraction. The extracted data were compared within and across countries and further grouped into meaningful categories. RESULTS: In country documents, there is a commitment to community health, with significant attention paid to various cadres of community health workers (CHWs) who undertake a range of preventive, promotive and curative roles across RMNCAH-N spectrum. While CHWs renumeration is mentioned, it varies considerably. Most community health indicators focus on CHWs' deliverables, with few related to governance and civil registration. Challenges in implementing community health include poor leadership and governance and resource shortages resulting in low CHWs performance and service utilization. While some countries invest significantly in training CHWs, structural reforms and broader community engagement are lacking. CONCLUSIONS: There is an opportunity to better prioritize and streamline community health interventions, including integrating them into health system planning and budgeting, to fully harness their potential to improve RMNCAH-N.

Main findings: Although community health is a key component of the Investment Cases and the Project Appraisal Documents of most of the six francophone West African countries studied, the level of investment varies considerably between countries, and mostly skewed to community health workers, with very little left over for broader community engagement and oversight processes.Added knowledge: The study describes community health actors, community health interventions and monitoring within a global health initiative, how they fit into the wider health system, the challenges and weaknesses they face and the measures taken to mitigate them, and how they are budgeted.Global health impact for policy and action: There is a need to adopt a holistic community health systems approach, rather than one focused mainly on CHWs, to fully harness community health's potential to improve reproductive, maternal, newborn, child, and adolescent health and nutrition.

Barriers and facilitators to reproductive health service utilization in Cote d'Ivoire: A community-based qualitative study / Barrières et facilitateurs de l'utilisation des services de santé de la reproduction en Côte d'Ivoire : une étude qualitative auprès de la communauté

Introduction: Improving Reproductive Maternal Newborn Child Adolescent Health Plus Nutrition (RMNCAH+N) indicators is a challenge for health systems, especially those in sub-Saharan Africa. The objective of this study was to identify barriers and facilitators to the use of RMNCAH+N services in areas with low indicators in Cote d'Ivoire. Methods: A qualitative case study was conducted in September 2021, with 76 beneficiaries of RMNCAH+N services in the health districts of Boundiali, Toulepleu and Tanda. Individual interviews (09) and focus groups (09) were conducted with community leaders/tradi-practitioners/midwives and pregnant women/ women of childbearing age/men who have or are responsible for a child under the age of 5, respectively. A thematic analysis was performed after coding the data in NVivo 12. Results: Barriers to utilization of RMNCAH+N services were unavailability of certain equipment/amenities, disrespectful care in some RMNCAH+N services, women's lack of financial autonomy, lack of autonomy in decision making, and male healthcare providers. Facilitators identified were geographic accessibility, men's involvement in the mother-child dyad's health, and community awareness. Conclusion: Improving utilization of RMNCAH+N services requires the implementation of interventions that address these barriers and facilitators, such as raising community awareness of RMNCAH+N services and promoting respectful, patient-centered, humanized care among healthcare providers.

Introduction: L'amélioration des indicateurs de santé reproductive, maternelle, néonatale, infantile et adolescente et de la nutrition (SRMNIA+N) représente un challenge pour les systèmes de santé, principalement ceux des pays d'Afrique subsaharienne. Cette étude avait pour objectif d'identifier les barrières et facilitateurs à l'utilisation des services de SRMNIA+N dans les zones à faibles indicateurs en Côte d'Ivoire. Méthodes: Une étude de cas par approche qualitative auprès de 76 bénéficiaires des services de SRMNIA+N a été menée en septembre 2021 dans les districts sanitaires de Boundiali, Toulepleu et Tanda. Des entretiens individuels et des discussions de groupe (focus groups) ont été organisés respectivement auprès des leaders communautaires, tradipraticiens ou matrones et des femmes enceintes ou en âge de procréer et des hommes ayant la charge d'un enfant de moins de 5 ans. Une analyse thématique a été réalisée après codage des données dans NVivo 12. Résultats: Les barrières à l'utilisation des services de SRMNIA+N étaient la non-disponibilité de certains équipements ou commodités, les soins irrespectueux dans certains services de SRMNIA+N, le manque d'autonomie financière et/ou décisionnelle des femmes et la présence de prestataires de sexe masculin. Les facilitateurs identifiés étaient : l'accessibilité géographique, l'implication des hommes dans la santé du couple mère/enfant, la sensibilisation de la population. Conclusion: L'amélioration de l'utilisation des services de SRMNIA+N nécessite la mise en œuvre d'interventions adressant ces barrières et facilitateurs tels que la sensibilisation de la communauté sur les services de SRMNIA+N, la promotion auprès des prestataires de santé des soins humanisés respectueux et centrés sur le patient.