Implementation outcomes of a community dialogue intervention to improve primary care performance in a Ugandan rural...

Since the declaration of Alma Ata, community participation in health services has been promoted in making services responsive to the needs of the people. This requires effective community engagement approaches. Community dialogues have been used to engage communities in design, implementation and evaluation of health activities and interventions.

This study evaluated the implementation outcomes of a community dialogue intervention that was intended to improve primary care performance in a health sub-district in rural Uganda.

This was a mixed methods study using purposively selected key informants and a data collection form. The key informant interviews were conducted in English using a semi-structured interview guide, audio-taped and transcribed verbatim. Qualitative data was analysed using Atlas ti using a framework approach. Quantitative data was entered into an Excel spreadsheet and analysed into frequencies and percentages.

Overall, 196 community dialogues were conducted by all 16 primary care facilities, and the average attendance was 32 (range 16-46). They were found to be appropriate, acceptable and affordable and, therefore, adopted. They were feasible and implemented with fidelity, encountered minimal contextual barriers and were thought to be sustainable. Thirteen context factors enabled implementation (e.g. prior existence of regular outreach activities at each health facility), while two were barriers (e.g. community members' expectations of incentives). The intervention reached all the health facilities within the health sub-district at no direct incremental cost.

Community dialogues can be implemented through integration at no direct incremental cost and with significant reach to the population served with favourable outcomes.