Abstract
Community participation is an essential component in a primary health care (PHC) and a human rights approach to health. In South Africa, community participation in PHC is organised through health committees linked to all clinics. This paper analyses health committees' roles, their degree of influence in decision-making and factors impacting their participation. Data were collected through a mixed-methods study consisting of a cross-sectional survey, focus groups, interviews and observations. The findings from the survey were analysed using simple descriptive statistics. The qualitative data were analysed using thematic content analysis. Data on health committees' roles were analysed according to a conceptual framework adapted from the Arnstein ladder of participation to measure the degree of participation. The study found that 55 per cent of clinics in Cape Town were linked to a health committee. The existing health committees faced sustainability and functionality challenges and primarily practised a form of limited participation. Their decision-making influence was curtailed, and they mainly functioned as a voluntary workforce assisting clinics with health promotion talks and day-to-day operational tasks. Several factors impacted health committee participation, including lack of clarity on health committees' roles, health committee members' skills, attitudes of facility managers and ward councillors, limited resources and support and lack of recognition. To create meaningful participation, health committee roles should be defined in accordance with a PHC and human rights framework. Their primary role should be to function as health governance structures at facility level, but they should also have access to influence policy development. Consideration should be given to their potential involvement in addressing social determinants of health. Effective participation requires an enabling environment, including support, financial resources and training.
Highlights
Community participation has been viewed as a central part of the primary health care (PHC)1 approach since the Alma-Ata Declaration, which emphasises participation in planning and implementing health care (World Health Organization, 1978)
The research identified 62 health committees linked to 82 clinics, equivalent to 55 per cent of all 149 clinics in the Cape Town Metropole
The existence of health committees at 55 per cent of all clinics falls short of the National Health Act of 2003 (NHA) target, which stipulates that each clinic should have a health committee
Summary
Community participation has been viewed as a central part of the primary health care (PHC) approach since the Alma-Ata Declaration, which emphasises participation in planning and implementing health care (World Health Organization, 1978). In South Africa, community participation in PHC is organised through health committees linked to all clinics. Aims: This paper analyses health committees’ roles, their degree of influence in decision-making and factors impacting their participation. The existing health committees faced sustainability and functionality challenges and primarily practised a form of limited participation Their decision-making influence was curtailed, and they mainly functioned as a voluntary workforce assisting clinics with health promotion talks and day-to-day operational tasks. Conclusions: To create meaningful participation, health committee roles should be defined in accordance with a PHC and human rights framework. Their primary role should be to function as health governance structures at facility level, but they should have access to influence policy development. Effective participation requires an enabling environment, including support, financial resources and training
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