{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,6]],"date-time":"2025-08-06T12:47:39Z","timestamp":1754484459307,"version":"3.40.5"},"reference-count":50,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2023,7,18]],"date-time":"2023-07-18T00:00:00Z","timestamp":1689638400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"African Research Network for Neglected Tropical Diseases","award":["SGPIV\/0210.285"],"award-info":[{"award-number":["SGPIV\/0210.285"]}]}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>Hydrocele which is caused by long term lymphatic filariasis infection can be treated through the provision of surgery. Access to surgeries remains low particularly for hard to reach populations. This study applied community health system lenses to identify determinants to the adoption, implementation and integration of hydrocele surgeries among migrants &amp;mobile populations in Luangwa District, Zambia. A concurrent mixed methods design consisting of cross-sectional survey with hydrocele patients (n = 438) and in-depth interviews with different community actors (n = 38) was conducted in October 2021. Data analysis was based on the relational and programmatic lenses of Community Health Systems. Under the<jats:italic>Programmatic lens<\/jats:italic>, insufficient resources resulted in most health facilities being incapable of providing the minimum package of care for lymphatic filariasis. The absence of cross border collaborative structures limits the continuity of care for patients moving across the three countries. Other programmatic barriers include language barriers, inappropriate appointment systems, direct and indirect costs. In the<jats:italic>relational lens<\/jats:italic>, despite the key role that community leaders play their engagement in service delivery was low. Community actors including patients were rarely included in planning, implementation or evaluation of hydrocele services. Some patients utilized their<jats:italic>power within to<\/jats:italic>act as champions for the surgery but local groups such as fishing associations remained underutilized. Community health systems provide a potential avenue through which access amongst mobile and migrant populations can be enhanced through strategies such engagement of patient groups, knowledge sharing across borders and use of community monitoring initiatives.<\/jats:p>","DOI":"10.1371\/journal.pgph.0002145","type":"journal-article","created":{"date-parts":[[2023,7,18]],"date-time":"2023-07-18T17:22:32Z","timestamp":1689700952000},"page":"e0002145","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":6,"title":["Applying community health systems lenses to identify determinants of access to surgery among mobile &amp; migrant populations with hydrocele in Zambia: A mixed methods assessment"],"prefix":"10.1371","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8920-009X","authenticated-orcid":true,"given":"Patricia","family":"Maritim","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mwimba","family":"Chewe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9279-241X","authenticated-orcid":true,"given":"Margarate Nzala","family":"Munakaampe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adam","family":"Silumbwe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"George","family":"Sichone","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph Mumba","family":"Zulu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2023,7,18]]},"reference":[{"key":"pgph.0002145.ref001","first-page":"509","article-title":"Global programme to eliminate lymphatic filariasis: progress report, 2019","volume":"95","author":"World Health Organization","year":"2020","journal-title":"Weekly Epidemiological Record"},{"key":"pgph.0002145.ref002","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1136\/sti.2003.004093","article-title":"Genital manifestations of tropical diseases","volume":"80","author":"J. 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Lusaka, Zambia"},{"volume-title":"Diffusion of innovations","year":"2003","author":"EM Rogers","key":"pgph.0002145.ref029"},{"key":"pgph.0002145.ref030","first-page":"1","article-title":"A modified theoretical framework to assess implementation fidelity of adaptive public health interventions","volume":"11","author":"D P\u00e9rez","year":"2015","journal-title":"Implementation Science"},{"key":"pgph.0002145.ref031","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12913-020-4975-3","article-title":"Reframing implementation science to address inequities in healthcare delivery","volume":"20","author":"AA Baumann","year":"2020","journal-title":"BMC health services research"},{"volume-title":"Designing and conducting mixed methods research","year":"2017","author":"JW Creswell","key":"pgph.0002145.ref032"},{"key":"pgph.0002145.ref033","article-title":"Elimination of Neglected Tropical Diseases National Masterplan 2019\u20132023","author":"Ministry of Health, Zambia","year":"2019","journal-title":"Lusaka, Zambia"},{"key":"pgph.0002145.ref034","doi-asserted-by":"crossref","first-page":"e2714","DOI":"10.1371\/journal.pntd.0002714","article-title":"Mapping the geographical distribution of lymphatic filariasis in Zambia","volume":"8","author":"ET Mwase","year":"2014","journal-title":"PLoS Negl Trop Dis"},{"volume-title":"Integrating theory and practice","year":"2014","author":"MQ Patton","key":"pgph.0002145.ref035"},{"volume-title":"A pragmatic approach","year":"2013","author":"DL Morgan","key":"pgph.0002145.ref036"},{"key":"pgph.0002145.ref037","article-title":"A new weave of power, people & politics: the action guide for advocacy and citizen participation","author":"L VeneKlasen","year":"2002","journal-title":"World Neighbors Oklahoma City"},{"key":"pgph.0002145.ref038","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1093\/heapol\/czs066","article-title":"Actor interfaces and practices of power in a community health worker programme: a South African study of unintended policy outcomes","volume":"28","author":"U Lehmann","year":"2013","journal-title":"Health policy and planning"},{"key":"pgph.0002145.ref039","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12916-022-02365-6","article-title":"Leaving no one behind: targeting mobile and migrant populations with health interventions for disease elimination\u2014a descriptive systematic review","volume":"20","author":"MW Adams","year":"2022","journal-title":"BMC medicine"},{"key":"pgph.0002145.ref040","article-title":"Ending the neglect to attain the sustainable development goals: a road map for neglected tropical diseases 2021\u20132030","author":"World Health Organization","year":"2020","journal-title":"World Health Organization"},{"key":"pgph.0002145.ref041","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1007\/s10464-009-9229-9","article-title":"Theorising interventions as events in systems","volume":"43","author":"P Hawe","year":"2009","journal-title":"American journal of community psychology"},{"key":"pgph.0002145.ref042","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1186\/s12913-016-1860-1","article-title":"Synergies, strengths and challenges: findings on community capability from a systematic health systems research literature review","volume":"16","author":"AS George","year":"2016","journal-title":"BMC health services research"},{"key":"pgph.0002145.ref043","article-title":"What is COVID-19 teaching us about community health systems? 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