Evaluation of Pattern of Community Engagement in District Health Care in East Wollega: Qualitative Study

Background: Community engagement enables development of strong health care system and comprehensive use of health services resources. However, in primary health care there are inconsistencies in levels of engagement of the community that hinder much gain from the social capital and that cause unrealistic expectations from the health system. There is little research finding on the level and pattern of community engagement in primary health care unit level in East Wollega zone. Methods: Community based qualitative study was employed from April to May 2016 with sample size of 30 indepth interviews and 6 focus group discussions. Six districts were identified with simple random sampling method. Data analysis started at field and responses were transcribed, translated and systematically analyzed in themes. Results: Community engagement in the primary health care units was very constrained and mainly through labor and material contributions. The trust of the community on the primary health care level is frail and the primary health care unit level is not responsive enough and had limited capacity to deal with the demands of the community health. Certainly the Community lacks opportunity and power of decision making in setting service standards and health service and resources utilizations. Community based health care structures like Health extension workers and health development armies are not uniformly and regularly supported to enhance engagement of the community and demonstrated sluggish progress and political bias. Conclusion: The community is not empowered and engaged in the decisions of health system management and utilization at the primary health care unit level. The local political and health system administrators should work on behavioral change communication models and objective community mobilizations in the way the community can own the health care system.