IDS Working Paper 84

This is an output of the collaboration between the Training and Research Centre, Harare, and the Health and Social Change Programme at the Institute of Development Studies, Brighton. It was written while the author was a Visiting Fellow at the IDS in August and December 1998.Participation of communities is widely argued to be an important factor in improving health outcomes and the performance of health systems. This paper uses a review of past experience of participation in Zimbabwe’s health system to propose that participation be strengthened along two dimensions: Creating realistic expectations between communities and health services in their contributions towards health, and in the governance of health systems. Various examples are outlined of the relationship between social participation and control and health outcomes. The paper also outlines the features of and factors in building participation in governance of health systems. It argues for a wider inclusion of social groups from civil society, elected leadership and health systems in structures and processes that set and audit health policies and priorities. It discusses issues to be addressed in enhancing participation, including the information, processes, capacities and resources required. Finally, it reviews the proposals for and issues to be addressed in enhancing participation and accountability in Zimbabwe's health sector at district, referral hospital and national level