Stories from the Field

Workshop with community health workers in Lentegeur CT

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CTRO HOOG LentegeurIn September, our Cape Town Regional Office held a workshop with community health workers at Lentegeur Civic Centre. Abigail Peters discussed our "Hands off our Grants" (Stop Sassa-CPS Debits) Campaign.

Participants, who came from the Mitchell's Plein and Phillipi areas, were concerned about the issues raised by the campaign.

They were fully engaged in asking questions, and informing us about unauthorised deductions from Sassa accounts that they knew were taking place in their own communities.

Black Sash RMCH Participates in Health Centres Colloquium

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RMCH 09 ColloquiumRMCH Project manager, Brittany Bunce, presented at a National Colloquium on Community Health Centres hosted by UCT which took place on 29 September 2014. It was an engagement between civil society, community health committees and NDoH on how best to support community health committees.

After the one day meeting, an exchange visit took place where committee representatives engaged with Cape Town based committees to share learning and participate in site visits and other activities. 4 representatives from each of our committees participated in the meeting and exchange programme. It was a great opportunity for further learning and networking.

Valuable Learnings from RMCH District Workshops

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RMCH Learn Wrk CollIn 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.

RMCH KZN Learning Workshop

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unnamed 2In February, Black Sash and over forty community members, local NGO representatives, and clinic workers came together for an impactful workshop to discuss the Black Sash RMCH Project in KZN. The workshop shared results of the baseline study which followed a rapid situational analysis of clinic and community health centre committees (CCS/CHCCs) and Alternative public Accountability Mechanisms (APAMs), for example NGOs/CBOs, multi-stakeholder forums.

The objective of the situational analysis was to determine whether CCs/CHCCs and APAMs are functioning effectively and whether they engage on the issues of RMCH services. The baseline report will also be used to guide the development of interventions, tools and training to strengthen public accountability mechanisms in the two focus districts, OR Tambo in the Eastern Cape and in uMgungundlovu in KwaZulu-Natal.

One of the highlights from the workshop was when the guests were given the opportunity to participate in small group discussions on the findings of the baseline study. Passions ran high as participates reflected on how the issues addressed during the presentation related to their community.

As the project moved forward, the next set of actions were to finalise the baseline study with the comments collected at the workshop, develop training manuals, tools and models, and then training facilitators to carry out a Community Scorecard Card.

Making all Voices Count: Training Trainers

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MAVC training

Black Sash has embarked on a series of 2-day "Making all Voices Count" (MAVC) training-of-trainers workshops across the country.

These workshops, conducted with partner organisations, will capacitate local monitors to monitor service delivery across selected sites in areas such as social grants and primary health care.

Pictured are workshops conducted in the Western Cape (above) and KZN (below).

Trained monitors are using technology to collect and transmit monitoring data. Monitoring has started at various sites in the Western Cape and data has started to come in reflecting information about service delivery at selected sites.

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