Table 8 Defining the architecture of community participation: the case of malaria

A systematic review on 60 years of research on malaria explored the architecture of community participation. The authors found and evaluated 60 academic papers that detailed how participation was implemented and commented on the strategies used and their effectiveness; however they found only 4 papers that explored efficacy in terms of disease impact.

The authors highlighted 20 factors across the domains of individual, household, community and government/civil society that were found to play a major role in participatory approaches for malaria. These ranged from: i) disease perceptions, stigma, incentives and acceptability (individual-level); ii) gender and power relationships, cultural norms, access and geographical setting (household-level). It also included: iii) community characteristics and priorities, disease epidemiology, the complexity of the intervention, how communities are engaged and local priorities (community-level). Finally, (iv) it highlighted: the wider political environment, quality of the primary healthcare system, decentralization policy, advocacy and support, resources and other governance factors (government/civil society-level).

The general conclusion of the review was that community participation continues to be marginalized in global efforts for malaria, despite its accepted benefits. A deficiency in the evidence-base for its effectiveness was noted, which generates problems for long-term funding and investment by global agencies with multiple, competing priorities.

From Atkinson et al. [119]