An overview of community participation in health promotion in contexts of conflict and fragility: Contextual challenges faced by community actors in the Logo Health Zone, Ituri, Democratic Republic of the Congo

Abstract

Introduction Addressing the social determinants of health is a key priority for health promotion, as emphasized in the Ottawa Charter for Health Promotion (World Health Organization [WHO], 1986). However, there is limited evidence on the challenges faced by community participation bodies in fragile and conflict-affected settings such as the Logo Health Zone. Purpose This study describes local challenges and conflict-related factors that influence community dynamics in the Logo Health Zone, an area characterized by a fragile health system affected by armed conflict. Methods A cross-sectional study was conducted in 12 conflict-affected health catchment areas within the Logo Health Zone. The study targeted active community participation bodies, including Health and Development Committees (HDCs), Community Outreach Units (COUs), and Community Health Workers (CHWs) operating for at least one year, as well as head nurses (HNs). Convenience sampling was used to recruit 395 participants. Data were collected using a structured questionnaire administered through the KoboCollect application. Descriptive statistics (frequency analysis) were performed using SPSS and Microsoft Excel. Results CHWs reported poor community engagement (53.0%), requests for financial incentives (30.5%), and lack of transparency regarding bonuses for paid activities (26.6%). COUs reported poor community participation (27.3%) and poor CHW involvement (21.2%) as major barriers. Meanwhile, HDCs reported poor community ownership (33.3%) and poor collaboration with health centers (25.0%). Head nurses reported poor ownership of health initiatives (41.7%), requests for financial incentives (33.3%), and mistrust between HDCs/CHWs and health centers as major barriers. Finally, the main contextual factors contributing to conflict were population and participation body instability (75.0%) and disruption of activities (41.7%). Conclusion Strengthening supervision of community actors, improving financial transparency, and enhancing collaboration between health facilities and community bodies appear necessary to support community participation and strengthen health system resilience in fragile settings.