Training clinic health committees: a vehicle for improving community participation in health

Objectives: In South Africa, and globally, community participation has become a key feature in the health system. In order for meaningful participation to occur within the health system several mechanisms have been identified as critical and this includes formation of health committees (HCs) at health facility level. Previous research indicates that health committees are imperative in both actualizing community participation and realisation of right to health. However, few studies have been undertaken to understand the impact training health committees has on community participation and right to health. This study sought to evaluate the impact training clinic health committees in community participation, health and human rights has on participation and right to health. The training been evaluated was led by Learning Network on Health and Human Rights and targeted four clinics in Cape Town Metropole of Western Cape, South Africa. The Learning Network is a grouping of five civil society organisations (CSOs) in Western Cape, South Africa at four universities which was launched in 2008 after the recognition of a gap in documented knowledge that CSOs had on health and human rights. The study explored health committees' changes in knowledge, perceived competencies, documented member's understanding of roles and HCs sustainability as well as the trainings impact on relationship between HCs and health service providers. Methods: The study was a multiple case study with multiple qualitative methods for data collection. Narrative data was collected through twelve in-depth interviews with health committee members, one facility manager, two focus group discussions and three physical observations across four health facilities. Health facilities were purposively selected from a list of health facilities trained by the Learning Network in 2014. Inclusion criteria also included English speaking health facilities and those in close proximity to each other. 2 Results: The study revealed that training HCs contributed to improved competencies, awareness and knowledge of community participation and the right to health. After the training, HC members were perceived to be more aware and responsive to their roles and responsibilities at the health facility. It was also noted that the training aided improved HCs perspectives on sustainability and roles, improved interpersonal skills and self-esteem. Conversely, the study revealed that despite the training improving participation and right to health, power imbalances between HC members and facility staff/managers who hold authority has a bearing on when and how participation occurs. Conclusion: The study demonstrates that training health committees contributed to improving the levels of community participation such as planning, consultation and advise [Arnstein, Rifkin and Loewenson] in the realisation of right to health. It is recommended for wider community participation that trainings of such magnitude are conducted together with facility managers/staff