Rights-Based Training Enhancing Engagement of Health Providers With Communities, Cape Metropole, South Africa

Abstract

Community participation, the central principle of the primary health care approach, is widely accepted in the governance of health systems. Health Committees (HCs) are community-based structures that can enable communities to participate in the governance of primary health care. Previous research done in the Cape Town Metropole, South Africa, reports that HCs' potential can, however, be limited by a lack of local health providers' (HPs) understanding of HC roles and functions as well as lack of engagement with HCs. This study was the first to evaluate HPs' responsiveness towards HCs following participation in an interactive rights-based training. Thirty-four HPs, from all Cape Metropole health sub-districts, participated in this qualitative training evaluation. Two training groups were observed and participants completed pre-and post-training questionnaires. Semi-structured interviews were held with 10 participants 3-4 months after training. Following training, HPs understood HCs to play an important role in the communication between the local community and HPs. HPs also perceived HCs as able to assist with and improve the quality and accessibility of PHC, as well as the answerability of services to local community needs. HPs expressed intentions to actively engage with the facility's HC and stressed the importance of setting clear roles and responsibilities for all HC members. This training evaluation reveals HPs' willingness to engage with HCs and their desire for skills to achieve this. Moreover, it confirms that HPs are crucial players for the effective functioning of HCs. This evaluation indicates that HPs' increased responsiveness to HCs following training can contribute to tackling the disconnect between service delivery and community needs. Therefore, the training of HPs on HCs potentially promotes the development of needs-responsive PHC and a people-centred health system. The training requires ongoing evaluation as it is extended to other contexts.

Lessons from community participation in primary health care and water resource governance in South Africa: a narrative review

“…The Western Cape lagged behind in implementing the legislation [ 45 ]. Even though health committees were supposed to provide a link between the community and the health system, eight studies reviewed indicated that their influence in decision-making, prioritization and implementing health services specific to their community were limited [ 31 , 32 , 34 , 40 , 41 ].…”

“Like a broom tied together”: A qualitative exploration of social cohesion and its role in community capacity strengthening to support integrated health in Nigeria

“…Community health committees are community-based structures that can enable communities to participate in the governance of their primary health care [ 33 ]. Ward development committees (WDCs) and village development committees (VDCs) exemplify these committees as significant means of encouraging local leadership, credibility, engagement, and governance.…”

“…For example, a qualitative study that examined capacity building for WDCs to promote health in Nigeria showed that following capacity-building activities such as training, mentoring, and supportive supervision, there was increased participation and commitment by the WDCs that translated to increased support for health facilities to provide quality health services in the community [ 28 , 35 ]. Community-based structures can enable communities to participate in the governance of primary health care [ 33 ].…”