In Feb 2014, Black Sash conducted two 'RMCH District Learning Workshops' to share the results of our RMCH baseline study, following a rapid situational analysis of community health committees and alternative accountability mechanisms focussing on health and/or RMCH issues. These workshops were conducted in Mthatha in the Eastern Cape (EC) & Pietermaritzburg (PMB) in KwaZulu-Natal (KZN). In both provinces we were afforded great turnout and participation, particularly from community health committees.
Our team presented the key findings and recommendations of the baseline study which include some of the following insights:
• Challenges with Election Process, Composition and Recruitment: Representatives of committees are often not democratically elected by the catchment population of the clinic or Community Health Centre. Instead they are chosen by the facility manager, the induna/ traditional leader or another DoH official. It was often found that inadequate mobilisation and awareness raising was undertaken prior to the election date.
• Low Levels of Literacy and Inadequate and Inappropriate Training: Literacy was found to be a key barrier to the functionality of committees. In spite of the great need for training and capacity building for committees to play the role envisioned for them, in neither district have formal training manuals and programmes been developed. Existing training is often limited to providing representatives with the complex national and provincial policies for community health committees which are difficult to comprehend without thorough training to engage with its content.
• Conundrum of Stipends and Incentives to Participate: Across the board there is a huge demand for stipends from members of committees. They are currently operating as an unfunded entity and representatives (often from poor households) have to pay for transport and other running costs. Poor attendance at committee meetings is often due to members being unable to pay for transport to attend, especially where they live far away from the facility. A lack of youth participation was reported as they are not willing to serve in structures where there is no remuneration.
• Lack of engagement between committees and the community: Most committee engagement with the community in both districts was limited to the suggestion box placed at the clinic.
• Poor Understanding of the Reporting Structure & Health Governance System: Key informants identified certain officials as acting as gatekeepers however since committees do not understand the reporting system, they are unable to navigate themselves past gatekeepers to ensure challenges are resolved at higher levels of the district health system if need be.
• Findings on alternative accountability mechanisms (Civil society/multi-stakeholder organisations and forums):We found that there are a number of civil society organisations and forums which are functioning well, focusing on RMCH issues and which are already engaging in accountability tools such as community monitoring, public hearings or budget tracking. Currently there is limited to no engagement between the community health committees and alternative accountability mechanisms. Communities recommended that we engage with Imbizos, and War Rooms (specifically in KZN) as important community forums. Black Sash will aim to create institutional linkages between them and the committees.
Some of the key recommendation Black Sash made to address these challenges included:
* Training around appreciation of the democratic process and increased vigilance around elections of committees
* Focus on mobilising youth to participate in committees
* We must develop appropriate training programmes for committees which takes the literacy challenge into account
* Appropriate methods for community mobilisation and consultation should form part of the training *Ensure clear designation of responsibility within DoH to oversee & provide the training and adequate resourcing to realise this
* Reimbursement for out of pocket costs needs to be provided by the DoH & commitment secured in district health plan & budget as well as in legislation
Read more about general feedback following the presentation of the baseline findings from stakeholders; presentation on proposed intervention strategy to strengthen community health committees; general feedback following the proposed Black Sash RMCH intervention.