The role of and key ingredients to community participation in health systems strengthening: a case study of the Matobo Village Health Sponsorship Model

BackgroundCommunity participation is central to health systems strengthening and promoting healthcare provision in resource-limited settings. Several interventions have utilised community participation as a propellant to increase the access to and uptake of health interventions. However, while evidence supporting interventions using community participation exists, there is a gap in understanding the relative influence of various factors that enable or inhibit successful community participation. This study, which explored the enabling and inhibiting factors influencing community participation in the implementation of the Village Health Sponsorship Model (VHSM) in Matobo district addresses this gap. The VHSM is a primary healthcare intervention in Matobo, Zimbabwe, which by design and implementation relied heavily on community ownership and engagement. MethodsA case study approach was employed to explore the enabling and inhibiting factors influencing community participation in the design and implementation of the VHSM. Data were collected in September 2022, in the form of key informant interviews (n=23), in-depth interviews (n=13) and participatory workshops (n=6). The data were audio-recorded and transcribed. The analysis process that followed included deductive coding and thematic analysis, both carried out manually. ResultsThe socio-economic challenges in the Matobo community, along with limited availability and accessibility to healthcare services, and increased maternal, neonatal and child mortality were identified as key drivers fostering the communitys commitment to improving health outcomes in Matobo. Strong and effective community leadership, a sense of ownership, and a spirit of volunteerism were key to problem-solving. Locally sourced resources including manpower, water, and river sand contributed to the successful construction of three healthcare facilities, under the VHSM. The successful construction of the healthcare facilities in rural Zimbabwe provided evidence that community participation is an effective driving force towards achieving health systems strengthening in resource-limited settings. ConclusionThrough community consultations, community involvement in resource sourcing, accountability of the community leadership, and public-private partnerships, three health facilities were constructed in the resource-limited setting of Matobo District. As we reflect on successful community participation driving the VHSM model and recommend this model for future interventions, we call for a shift towards health systems strengthening funding mechanisms that recognise communities as active agents of change.