Submission ID 131399
| Issue/Objective | In fragile settings, child survival depends not only on service availability, but also on whether communities trust, access, and use services amid insecurity, poverty, and chronic health system strain. Yet evidence remains limited on how community engagement strategies and interventions (CESIs) strengthen resilient child health systems in practice. This study examined how CESIs shape child health resilience in rural Somalia, and the conditions under which they support equitable service uptake and continuity of care, with relevance to the conference focus on global health equity and resilient systems serving marginalized communities. |
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| Methodology/Approach | Guided by an adapted Child Health Resilience Framework, this convergent mixed-methods study was conducted in rural Awdal, Somalia, between 2025 and 2026. It integrated three evidence streams: a scoping review; qualitative data from key informant interviews with Ministry of Health, UN, NGO, maternal and child health stakeholders and healthcare workers, plus focus group discussions with community and health workers; and a household survey of mothers and caregivers of children under five. Qualitative and quantitative data were analyzed separately and then triangulated to synthesize findings on implementation, barriers, facilitators, and outcomes. |
| Results | Integrated findings showed that CESIs strengthened child health resilience by improving trust, care-seeking, and continuity of care through health education, house-to-house outreach, referral pathways, defaulter tracing, and community-based surveillance. Community health workers, religious leaders, and community leaders emerged as critical actors linking households to services and reinforcing legitimacy. However, effectiveness was constrained by transport barriers, poverty, low literacy, gendered decision-making, weak and uneven incentives for frontline workers, and donor dependence. Overall, service availability alone did not ensure use; uptake improved when CESIs were trusted, operationally supported, and in routine service delivery. |
| Discussion/Conclusion | These findings suggest that resilient child health systems in fragile settings require more than short-term mobilization; they require sustained investment in frontline workers, referral systems, community trust, and local accountability. Policy and program efforts should institutionalize CESIs within primary-care, strengthen supervision and incentives for community actors, and scale trusted outreach and referral models rather than stand-alone campaigns. The study aligns with the GH equity by showing how resilient systems and communities can serve marginalized populations through implementation-ready community engagement. |
| Presenters and Affiliations | Samia Mohamed Badar University of Ottawa Samia Mohamed Badar University of Ottawa |
