Table 2 How community health committees limit informal health care providers in Nigeria
Outcome (Outcome Strategies) | Mechanism (Modes of Functioning) | Context (Enablers and Constraints) |
|---|---|---|
Information Formal – Encouraging the use of formal services at the health facility through personal contact and campaigns Informal – Discouraging the use of informal health care providers community through personal contact | Mode I: Village Square Mode II: Community Connectors Mode III: Government Botherers Mode IV: Back-up Government Mode V: General Overseers * Triggered by need to reduce the transaction costs of accessing health care | ■ Having the autonomy to modify membership to have committee members with rich personal network and wide reach in the community. ■ Significant health events like disease outbreaks and vaccine refusal and support to conduct information campaigns from governments, NGOs and traditional leaders. ■ High cost of participation in meetings and information campaigns in large communities and where members cannot afford the cost of transportation. ■ The extent of competition from informal providers in the local health care market – low levels of competition removes necessity for information campaigns. |
Regulation Formal – Monitoring formal health service delivery to ensure responsiveness, quality and credibility Informal – Monitoring informal health care providers to keep their activities within safe limits | Mode I: Village Square Mode II: Community Connectors Mode III: Government Botherers Mode IV: Back-up Government Mode V: General Overseers * Triggered by need to reduce the transaction costs of accessing health care | ■ Having responsive government PHC managers who discipline health workers or transfer them elsewhere at the behest of committee members. ■ Traditional leaders who admonish health workers or facilitate the link of committees to government PHC managers to effect behaviour change among health workers. ■ More challenging to monitor and regulate informal providers out of the market when they are many and control a large share of the local health care market. ■ Mentoring by NGOs to facilitate monitoring of traditional birth attendants and inviting them provide services in the health facility to enhance monitoring. |
Coordination Formal—Mobilising resources to improve the quality and accessibility of formal services at the health facility Informal—Facilitating referral from informal to formal health care providers in the community | Mode I: Village Square Mode II: Community Connectors Mode III: Government Botherers Mode IV: Back-up Government Mode V: General Overseers * Triggered by need to reduce the transaction costs of accessing health care | ■ Having high income people on the committee and in the community who rely on the health facility, else committees need traditional leaders to help raise funds from them. ■ Highly networked communities where committee members belong to other community groups helps fund-raising from religious, women’s, youth and cultural groups. ■ Mentoring on fund raising by and donations from NGOs and traditional leaders; and mentoring on fund raising from government PHC managers. ■ Having traditional leaders, women’s groups and NGOs that help committees to broker agreements between informal providers and the health facility. |