Book Review: “Engaging Communities for Improving Mothers’ and Children’s Health: Reviewing the Evidence of Effectiveness in Resource-Constrained Settings”

The book Engaging Communities for Improving Mothers’ and Children’s Health by Henry B. Perry and colleagues represents one of the most ambitious syntheses of evidence ever undertaken on the role of community-based primary health care (CBPHC) in improving maternal, neonatal, and child health (MNCH) in low- and middle-income countries. Produced with contributions from a large international team of experts, the volume systematically examines decades of global experience with community-based health interventions. Drawing on an extensive database of nearly 700 assessments of programs and projects, the book seeks to answer a fundamental question in global health: Can community-based approaches significantly improve maternal and child survival in resource-constrained settings?

This comprehensive work combines historical perspective, methodological rigor, and policy-oriented insight. It stands both as a scholarly synthesis and as a practical guide for policymakers, program implementers, and researchers seeking evidence-based strategies for strengthening primary health care systems. The book begins by situating community-based primary health care within the broader history of global health. The origins of CBPHC can be traced to the recognition in the mid-twentieth century that hospital-centred health systems were failing to reach large segments of rural and impoverished populations. Early pioneers, such as Carl Taylor and the Berggrens, demonstrated that health improvements could be achieved by bringing preventive and basic curative services directly to communities, rather than relying solely on facilities. These ideas culminated in the 1978 Declaration of Alma-Ata, which framed primary health care as the cornerstone of achieving “Health for All.” The book effectively demonstrates how the Alma-Ata vision, including community participation, prevention, intersectoral collaboration, and equity, remains highly relevant today.

Yet the editors argue that despite decades of evidence, community-based primary health care remains underdeveloped in many health systems, particularly in low-resource settings where facility-based care cannot adequately meet population needs. This gap between evidence and implementation forms the central motivation for the review. One of the book’s most impressive features is the scale and rigor of its evidence base. The authors identified more than 12,000 reports in the scientific literature, ultimately including 700 assessments that met strict criteria for evaluating the effectiveness of community-based interventions for maternal and child health. Their review encompasses programs from across the globe, particularly in Africa and South Asia. Each assessment was examined using standardized extraction forms and independent reviewers to ensure methodological reliability. Outcome measures included maternal mortality and complications, neonatal and child mortality, nutritional status, coverage of key interventions such as immunization or antenatal care, utilization of health services, and equity of health outcomes.

The book also examines contextual variables, such as program scale, duration, funding sources, and implementation strategies, to understand why some community-based interventions succeed while others fail. This approach allows the editors to move beyond narrow evaluations of single interventions and instead analyse how community-based systems operate in real-world settings. The central finding of the book is clear: community-based primary health care can substantially improve maternal, neonatal, and child health outcomes. Across diverse settings, CBPHC interventions have demonstrated measurable improvements in reductions in child mortality, increased use of antenatal and postnatal care, improved nutrition and breastfeeding practices, higher vaccination coverage, and improved recognition and treatment of childhood illnesses.

In many cases, the book highlights the critical role of community health workers (CHWs), who serve as the bridge between formal health systems and local populations. These workers, often drawn from the communities they serve, can deliver preventive services, provide health education, detect illness early, and refer patients to facilities when necessary. Importantly, the review shows that community-based interventions are particularly effective when multiple strategies are combined, including health education, community mobilization, and direct service delivery.

Beyond demonstrating effectiveness, the book identifies common characteristics of successful community health programs. These include: (i) strong community engagement (programs that actively involve communities in planning, implementation, and evaluation tend to achieve better outcomes; community participation fosters trust, ownership, and sustainability); (ii) use of community health workers – CHWs (they are central to many successful initiatives; they expand the reach of health systems into households and remote areas); (iii) integration with health systems (community-based activities must be linked to formal health services; referral systems, supervision, and supply chains are essential for maintaining program quality); (iv) focus on behaviour change (many interventions succeed because they promote changes in household practices, such as breastfeeding, hygiene, and care-seeking behaviour, rather than relying solely on medical treatment); (v) long-term commitment (short-term projects often produce limited impact; sustained programs integrated into national health systems are more likely to achieve lasting improvements in population health); (vi) equity and access (a particularly valuable contribution of the book is its attention to equity; the evidence shows that community-based approaches are especially effective at reaching marginalized populations, e.g., rural communities, urban slums, and the poorest households; traditional health systems often fail to reach these groups due to geographic, financial, and social barriers; community-based programs help overcome these obstacles by bringing services directly to households and by engaging trusted local actors and this focus aligns closely with contemporary global health priorities, particularly the Sustainable Development Goals (SDGs), which emphasize reducing health inequalities and ensuring universal access to care).

The book makes a compelling case that strengthening community-based primary health care should be a central strategy for achieving global health targets. Despite decades of progress in reducing child mortality, from 12.7 million deaths in 1990 to 5.8 million in 2015, millions of preventable deaths still occur each year, particularly in low-income countries. The authors argue that scaling up community-based platforms could accelerate progress toward ending preventable maternal and child deaths by expanding coverage of proven interventions, improving early detection and treatment of illness, strengthening community demand for health services, and addressing social determinants of health. Importantly, the book emphasizes that community-based approaches are not a substitute for health facilities, but rather a complementary component of comprehensive health systems.

The book has several notable strengths. Firstly, it shows an exceptional breadth of evidence. The inclusion of nearly 700 program assessments provides an unparalleled overview of global experience with community health programs. Then, it is not merely theoretical; it has practical relevance and it offers concrete lessons for program design and policy implementation. Moreover, it has interdisciplinary perspective, because by integrating epidemiology, health systems research, and social science perspectives, the book captures the complexity of community health interventions. Published in the early years of the SDG era, the book is timely in terms of policy relevance and it provides a roadmap for strengthening primary health care systems in pursuit of universal health coverage.

In addition to its strengths, the book also acknowledges several limitations. The review relies heavily on published evaluations, which may introduce publication bias. Failed programs and unsuccessful interventions are less likely to be documented in the literature. Second, the diversity of interventions and evaluation methods makes it difficult to quantify the exact magnitude of impact for specific strategies. Also, many of the programs analysed were supported by international donors and implemented under favourable conditions. As a result, the findings may not fully reflect the realities of routine health system operations. Nevertheless, these limitations do not diminish the overall strength of the evidence presented.

Engaging Communities for Improving Mothers’ and Children’s Health makes an important contribution to global health literature. It bridges the gap between historical experience, empirical research, and policy advocacy. The book reinforces a central lesson that has emerged repeatedly in global health: health improvements cannot be achieved solely through hospitals and clinics. Effective health systems must extend into communities, households, and everyday life. By documenting the cumulative evidence for community-based primary health care, the authors provide a powerful argument for renewed investment in this approach.

In conclusion, Henry B. Perry and his collaborators have produced a landmark synthesis of global evidence on community-based primary health care. The book demonstrates convincingly that engaging communities is not merely a desirable ideal but a practical and effective strategy for improving maternal and child health in resource-constrained settings. At a time when global health systems face persistent inequalities and emerging challenges, the lessons contained in this book are more relevant than ever. Policymakers, researchers, and program leaders will find in this book both a rich body of evidence and a clear call to action: to strengthen community-based platforms as an essential pillar of equitable and effective health systems.

Citation: Henry B. Perry (Ed): Engaging Communities for Improving Mothers’ and Children’s Health: Reviewing the Evidence of Effectiveness in Resource-Constrained Settings. JoGH, Edinburgh, 2017. ISBN 978-0-9933638-5-6