Description of Global Innovative Methods in Developing the WHO Community Engagement Package

"[P]eople-centred design and leadership in addressing problems facilitate more efficient use of resources, strengthen coordination and build local capacities."

In the global health context, the shift to people-centred approaches, as highlighted in the revised World Health Organization (WHO) risk communication and community engagement (RCCE) strategy, highlights the belief that community engagement (CE) can capacitate communities to deal with health challenges and their determinants. The project described in this article - the Community Engagement Package (CEP) - responds to the need to invest in effective social innovations grounded on CE, which use bottom-up approaches and draw on strengths of individuals, communities, and institutions while promoting synergies across sectors. The goal of the CEP is to guide health practitioners in promoting local action and to facilitate involvement, training, and synergies across health and development sectors to achieve collective outputs and outcomes. This project fills a need for a harmonised CE documentation package for training based on different local contexts and with a broad range of health and social development activities, including health emergencies, routine immunisation, neglected tropical diseases, city and urban development, nutritional interventions, and disaster risk management.

The WHO Department of Country Readiness Strengthening conceptualised and initiated the CEP project based on consultations within WHO Regional Offices and Headquarters. The CEP itself was co-created with a community of diverse teams of WHO, Social Innovation in Health Initiative (SIHI) hubs, United Nations Children's Fund (UNICEF), partner organisations, and community practitioners, who provided synergistic contributions in promoting best CE practices across the board. Together, they developed a database of CE experiences, a CE learning package (CELP), and a CE workshop package (CEWP) based on a broad scope of CE experiences in different settings. The compiled cases can guide programme managers, CE practitioners, in-service medical and non-medical trainees, non-governmental organisation staff, and multidisciplinary teams to sharpen their skills in the CE approach.

The development of the components of the CEP can be characterised as iterative, collaborative and comprehensive and can be considered CE in practice. The article outlines the process, which unfolded at the height of COVID-19 restrictions. For example, due to travel restrictions, virtual communication technologies were used to conduct interviews, surveys, and correspondence with CE practitioners, which were facilitated to identify undocumented CE practices. The working group also consulted and regularly updated the RCCE Collective Services, which is composed of WHO, UNICEF, International Federation of Red Cross and Red Crescent Societies, and the Global Outbreak Alert and Response Network. UNICEF provided inputs regarding training.

Prototypes of the packages were tested among stakeholders, particularly community mobilisers, public health practitioners, and other potential end users. Feedback from the participants was obtained through online evaluation forms and was used to guide the revision of the training design. Pilot testing for the workshop package was conducted in two phases through an online video conferencing platform. The first phase was implemented among participants from the Philippines. The pilot run tested the regional applicability and impact of the materials and content. The second phase was conducted among a global set of participants, which tested its universal applicability and impact. In both phases, user experiences were collected and used to refine the packages.

In the end, a database of experiences (356 cases) on CE was developed across public health in different settings. It features materials in various formats (documents, videos, etc.) that highlight practices, lessons and challenges in working with communities. Themes were organised according to rationale, key points and insights, facilitators of CE, and barriers to CE. The cases highlight the role of individual and community agency, building on local capacity, multidirectional communication, inclusion, and multistakeholder engagement. Barriers to CE, for example, include issues of access, acceptability, and adoption in the setting of weak health systems and societal issues. The documents and related materials are in English, Spanish, and French; summaries of documented CE cases are available in English.

From the CE materials collected, the CELP was developed and anchored on basic principles and standards of CE and grounded on actual experiences in working with communities in different contexts and settings. The CELP includes four self-instructional modules that participants may complete independently or as a ladder-type course. Each module presents basic frameworks and concepts of CE in relation to the theme of that module - mobilising communities, strengthening health systems, CE in health emergencies, and CE as a driver for health equity - and are then tied to real-world examples of CE in different contexts. It is meant for early- to mid-level professionals and practitioners applying CE in their work who may come from various disciplines such as medical and health sciences, public health, public policy and administration, programme management, social development, and other social sciences. Students both at the undergraduate and postgraduate levels of any higher education institution may also benefit from the modules.

The CEWP provides tools and templates for identifying other CE experiences in a workshop format. The contents are similar to the CELP, with a special focus on documenting new CE experiences and a walk-through of using and submitting case studies for the CE database. The CEWP allows the continuous collection of evidence and discussions with stakeholders on CE principles, practices, and frameworks. These resources will be catalogued, categorised, and used to update the database and the learning and workshop packages.

The three components of the CEP feed into each other, and the development of the CEP was the work of multiple global stakeholders providing synergistic contributions and bridging silos. It is hoped that the description of the CEP methodology provided in this article will allow replication, provide transparency into the development of the CEP, and present lessons learned during the development of what organisers describe as a robust and harmonised package.

Full list of authors, with institutional affiliations: Yolanda Vargas Bayugo, WHO; Meredith Labarda, University of the Philippines Manila; Jose Rene Bagani Cruz, University of the Philippines Manila; Jana Deborah Mier-Alpaño, University of the Philippines Manila; Pauline Marie Padilla Tiangco, University of the Philippines Manila; Ukam Ebe Oyene, WHO; Semeeh Akinwale Omoleke, WHO; Allan Ulitin, University of the Philippines Manila; Alberto Ong Jr, Alliance for Improving Health Outcomes; Marvinson See Fajardo, University of the Philippines Manila; Maria Isabel Echavarria, Centro Internacional de Entrenamiento e Investigaciones Médicas (CIDEIM) and Universidad Icesi; Jackeline Alger, Hospital Escuela and Instituto de Enfermedades Infecciosas y Parasitologia Antonio Vidal; Don Mathanga, University of Malawi; Barwani Khaura Msiska Kamuzu, University of Health Sciences; Obinna Ikechukwu Ekwunife, Nnamdi Azikiwe University; Lorena Abella Lizcano, CIDEIM and Universidad Icesi; Natalia Gomez Quenguan, CIDEIM and Universidad Icesi; Claudia Ivette Nieto Anderson, SIHI Honduras Hub; Briana Yasmin Beltran, Centro de educación medica continua Honduras; Elsy Denia Carcamo Rodriguez, Universidad Nacional Autónoma de Honduras (UNAH); Eduardo Salomón Núñez, Universidad Católica de Honduras Nuestra Señora Reina de la Paz Facultad de Ciencias de la Salud and Hospital General Santa Teresa; Vera Nkosi-Kholimeliwa, Evangelical Lutheran Development Services; Glory Mwafulirwa-Kabaghe, Joyful Motherhood; Noel Juban, University of the Philippines Manila