Title: From experts to locals hands healthcare service planning in sub-Saharan Africa: An insight from the integrated community case management of Ghana


Background: Although community participation remains an essential component globally in healthcare serviceplanning, evidence of how rural communities participate in theplanning of rural-based healthcare programs hasless been explored in Sub-SaharanAfrica. Objective: We explored communities’ participation in health care planning in hard-toreach communities, withinthe context of Integrated Community Case Management(iCCM), a community-based health program implementedin Ghana. Methods: Qualitative data were collected from eleven (11) hard-to-reach communities through Focus GroupDiscussions (FGDs), Key Informant Interviews (KIIs) as well as district-level studies (Nadowli-Kaleo, and WA Eastdistricts of Ghana). The Rifkin’sspider-gram, framework, for measuring and evaluating community participation inhealthcare planning was adapted for the study. The results: The study found that community participation was superficially conducted by the CHOs. A holisticcommunity needs assessment to create awareness, foster a common understanding of health situations,collaboration, acceptance and ownership of the program were indiscernible. Rather, it took the form of an event,expert-led-definition, devoid of coherence to build locals understanding to gain their support asbeneficiaries of theprogram. Consequently, some of the key requirements of theprogram, such as resource mobilization by ruralresidents, Community-based monitoring of the program and the act of leadership towards sustainability of theprogram were not explicitly found in the beneficiaries’ communities. Conclusion and recommendation: The study concludes that there is a need to expand theconcept ofcommunity involvement in iCCM to facilitate communities’ contribution to their healthcare. Also, a transdisciplinaryapproach is required for engineering and scaling up community-based health programs, empowering VHCs, CBHVsand CHAs to realize success.