Around the world there is growing interest in the role of the public in holding public managers to account for their decisions about public service delivery. This paper presents the findings of a review of research studies, undertaken in lower income countries that have considered different ways of directly involving patients, citizens and the general public in decision-making about their health system.

The key messages from the review are:

The majority of empirical papers we identified on community engagement at peripheral health facilities in low- or middle-income countries focused primarily on health facility committees and groups.

Key influences on the impact of the community engagement activities are: how committee and group members are selected and their motivation for involvement; the relationship between groups or committees, health workers and health managers; and provision of adequate resources and support by local and national governments.

International interest in community accountability mechanisms linked to peripheral facilities has not been matched by empirical data. We present a conceptual framework and a set of ideas for consideration in future studies