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

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

Public Participation in Health Care: Exploring the Co-Production of Knowledge

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Rights-based training enhancing engagement of health providers with communities, Cape Metropole, South Africa

From Frontiers via Jisc Publications RouterCommunity 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.4pubpu

Balancing responsibility for sanitation

In response to the failure of existing means of service provision, environmental health policy is increasingly adopting a framework of governance for providing sanitation. Governance refers to the patterns of interaction between civil society and government. It is viewed here in terms of four dimensions: political, institutional, technical and cultural. The interactions are often described as partnerships and imply a balancing of joint responsibility. A number of issues can be identified in the literature as requiring consideration when adopting a joint responsibility for environmental health issues. These include, the need to distinguish between community and individual rights; the extent to which there is a shared interest in a community rights issues; the institutional framework for upholding the rights of citizens and the need to guard against new inequalities. The research question was: what are the factors that may inhibit or promote the involvement of community-based organisations (CBOs) in the sanitation provision process? From October 1996 to March 1997, an exploration of these factors was conducted in Cape Town, South Africa. A multiple-case study, with an embedded design, of two CBOs was conducted. This paper focuses on the extent to which there was a shared responsibility between local government and CBOs towards sanitation provision in the context of a bill rights which provides people with a right to a healthy living environment. It was found that institutional and technical capacity, political will and cultural diversity will impact on the balance between rights and responsibility. The four dimensional framework of governance is thus a useful tool for exploring the dynamic and diverse nature of environmental health. (C) 2002 Elsevier Science Ltd. All rights reserved.</p

Balancing responsibility for sanitation

In response to the failure of existing means of service provision, environmental health policy is increasingly adopting a framework of governance for providing sanitation. Governance refers to the patterns of interaction between civil society and government. It is viewed here in terms of four dimensions: political, institutional, technical and cultural. The interactions are often described as partnerships and imply a balancing of joint responsibility. A number of issues can be identified in the literature as requiring consideration when adopting a joint responsibility for environmental health issues. These include, the need to distinguish between community and individual rights; the extent to which there is a shared interest in a community rights issues; the institutional framework for upholding the rights of citizens and the need to guard against new inequalities. The research question was: what are the factors that may inhibit or promote the involvement of community-based organisations (CBOs) in the sanitation provision process? From October 1996 to March 1997, an exploration of these factors was conducted in Cape Town, South Africa. A multiple-case study, with an embedded design, of two CBOs was conducted. This paper focuses on the extent to which there was a shared responsibility between local government and CBOs towards sanitation provision in the context of a bill rights which provides people with a right to a healthy living environment. It was found that institutional and technical capacity, political will and cultural diversity will impact on the balance between rights and responsibility. The four dimensional framework of governance is thus a useful tool for exploring the dynamic and diverse nature of environmental health. (C) 2002 Elsevier Science Ltd. All rights reserved.</p