Drivers of Community Group Support for Strengthening Community Clinic-Based Health System: A Qualitative Exploration in Barishal Impact Area

This study explores the critical role of Community Groups (CGs) and Community Support Groups (CSGs) in strengthening primary healthcare services through community clinics in Barishal district, Bangladesh. Despite the government’s initiative of establishing over 13,853 community clinics since 1996, service utilization has remained suboptimal, largely due to inadequate stakeholder engagement and poor communication. Employing a qualitative research design, the study draws on in-depth interviews, focus group discussions, and key informant interviews to evaluate the motivations, challenges, and effectiveness of CG and CSG participation, comparing intervention areas supported by Save the Children International (SCI) and non-intervention areas.

Findings reveal that CGs and CSGs significantly improve community engagement, health promotion, and service delivery, particularly in intervention areas where structured training, resources, and NGO support were available. In these areas, health-seeking behavior increased substantially—from 26% in 2018 to 83% in 2024. Intervention sites also benefited from digital health innovations, such as the Integrated Management of Childhood Illness (IMCI) application, which enabled 76.5% of child patients to receive guideline-aligned treatment—up from 51% in 2018. In contrast, non-intervention areas faced limitations due to lack of resources and support, though CGs and CSGs still contributed to raising awareness and mobilizing local resources.

Motivational drivers for group participation included both intrinsic factors (community pride) and extrinsic factors (formal recognition, training, and tangible incentives). However, barriers like inadequate infrastructure, staff shortages, sociocultural constraints, and low trust in healthcare providers—especially in non-intervention areas—continue to challenge broader community engagement.

The study concludes that CGs and CSGs play an indispensable role in advancing equitable healthcare delivery. Sustained support, capacity building, and inclusive partnerships are essential to overcoming systemic barriers and enhancing community-driven health systems in Bangladesh.