Unlocking Trust in Community Health Systems: Lessons From the Lymphatic Filariasis Morbidity Management and Disability Prevention Pilot Project in Luangwa District, Zambia

Document Type : Original Article

Authors

1 Department of Health Promotion and Education, School of Public Health, The University of Zambia, Lusaka, Zambia

2 Department of Health Policy and Management, School of Public Health, The University of Zambia, Lusaka, Zambia

3 Department of Community and Family Medicine, School of Public Health, The University of Zambia, Lusaka, Zambia

4 Department of Environmental Health, School of Public Health, The University of Zambia, Lusaka, Zambia

5 Participatory Research and Innovations Management (PRIM), Lusaka, Zambia

6 Rigor Data Research, Consultancy Firm, Lusaka, Zambia

7 Ministry of Health, Lusaka, Zambia

8 Department of Epidemiology and Biostatistics, School of Public Health, The University of Zambia, Lusaka, Zambia

Abstract

Background 
Surgery for hydrocele is commonly promoted as part of morbidity management and disability prevention (MMDP) services for lymphatic filariasis (LF). However, uptake of these surgeries has been suboptimal owing to several community level barriers that have triggered mistrust in such services. This study aimed at documenting mechanisms of unlocking trust in community health systems (CHSs) in the context of a LF hydrocele management project that was implemented in Luangwa District, Zambia.
 
Methods 
Qualitative data was collected through in-depth interviews (IDIs) and focus group discussions (FGDs) (n = 45) in February 2020 in Luangwa District. Thirty-one IDIs were conducted with hydrocele patients, community health workers (CHWs), health workers, traditional leaders and traditional healers. Two FGDs were also conducted with CHWs who had been involved in project implementation with seven participants per group. Data was analyzed using a thematic analysis approach.
 
Results 
The use of locally appropriate communication strategies, development of community driven referral systems, working with credible community intermediaries as well as strengthening health systems capacity through providing technical and logistical support enhanced trust in surgery for hydrocele and uptake of the surgeries.
 
Conclusion 
Implementation of community led communication and referral systems as well as strengthening health services are vital in unlocking trust in health systems as such mechanisms trigger authentic partnerships, including mutual respect and recognition in the CHS. The mechanisms also enhance confidence in health services among community members.

Keywords

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History

  • Receive Date: 23 February 2021
  • Revise Date: 06 July 2021
  • Accept Date: 19 September 2021
  • First Publish Date: 20 September 2021

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