The Role of Health Development Committees (CODESA) in Community Governance of Vaccination in Fragile Contexts: A Comparative Analysis Between the Health Zones of Idjwi and Ruzizi (DRC)
Abstract:
In fragile settings, community
governance plays a vital role in maintaining vaccination services. This study
analyzes the performance of Health Development Committees (CODESA) in two
contrasting health zones of South Kivu province in the Democratic Republic of
Congo (DRC): Idjwi (relatively stable) and Ruzizi (unstable). Using a
mixed-methods approach that combined structured surveys and qualitative
interviews, the study assessed the functionality of CODESAs, their coordination
with community health workers (RECOs), and their contribution to DTP3
vaccination coverage. Findings show that CODESAs in Idjwi are better organized,
exhibit stronger coordination with RECOs, and engage in more structured
community mobilization. These features are correlated with significantly higher
vaccination coverage rates. Multivariate analysis revealed that joint community
mobilization is the strongest predictor of vaccination performance,
particularly in stable zones. The study concludes that community governance
mechanisms, when well supported, can enhance the resilience of health systems
in fragile contexts. Institutional support to CODESAs is thus critical to
improving vaccination outcomes in vulnerable areas.
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