Bibliography

Community participation in health has been a tenet of the primary health care approach since the Alma Ata declaration (1978). In South Africa, community participation in planning and provision of health care services has been outlined in The White Paper on Transformation of the Health System (Department of Health, 1997) and is seen as part of a wider reform of the health system. Community participation has been formalised in The National Health Act 61 of 2003 (Department of Health, 2004) with provisions for the establishment of health committees, hospital boards and district health councils. Health committees are intended to serve as a link between the health services and the communities they serve. With regard to health committees, the Act stipulates that each clinic/community health centre or a cluster of these should have a health committee. The Act stipulates that health committees should be constituted by one or more local government councillor(s), the head(s) of the health facility/facilities, and one or more members of the community in the area served by the health facility/facilities. The Act furthermore requires that the provincial governments must develop legislation that stipulates the functioning of health committees in the provinces. According to Padarath and Friedman (2008), provincial legislation is in varying stages of development. In the Western Cape, a Draft Policy Framework for Community Participation/Governance Structures for Health is yet to be implemented. Research has shown that health committees have the potential to impact positively on health and health care services and on the right to health (Loewenson et al 2004, Glattstein-Young 2010). Despite the importance of community participation, studies indicate that health committees in South Africa are not functioning optimally (Boulle et al 2008, Padarath and Friedman 2008). This study, conducted in partnership with the Cape Metro Health Forum (CMHF), aimed to obtain an overview of how health committees in the Cape Town Metro function, and to identify factors that impact on their functioning. Furthermore, it aimed to draw up recommendations on how to strengthen health committees and community participation, with a focus on identifying capacity and training needs. The study used multiple methods, including surveys, focus groups, participant observations and in-depth interviews.