Lessons from community participation in primary health care and water resource governance in South Africa: a narrative review
Date
2022
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Abstract
Background: In South Africa, community participation has been embraced through the
development of progressive policies to address past inequities. However, limited information
is available to understand community involvement in priority setting, planning and decisionmaking in the development and implementation of public services.
Objective: This narrative review aims to provide evidence on forms, extents, contexts and
dynamics of community participation in primary health care (PHC) and water governance in
South Africa and draw cross-cutting lessons. This paper focuses on health and water governance structures, such as health committees, Catchment Management Agencies (CMA), Water
User Associations (WUAs), Irrigation Boards (IBs) and Community Management Forums
(CMFs).
Methods: Articles were sourced from Medline (Ovid), EMBASE, Google Scholar, Web of
Science, WHO Global Health Library, Global Health and Science Citation Index between
1994 and 2020 reporting on community participation in health and water governance in
South Africa. Databases were searched using key terms to identify relevant research articles
and grey literature. Twenty-one articles were included and analysed thematically.
Results: There is limited evidence on how health committees are functioning in all provinces
in South Africa. Existing evidence shows that health committees are not functioning effectively due to lack of clarity on roles, autonomy, power, support, and capacity. There was slow
progress in establishment of water governance structures, although these are autonomous
and have mechanisms for democratic control, unlike health committees. Participation in
CMAs/WUAs/IBs/CMFs is also not effective due to manipulation of spaces by elites, lack of
capacity of previously disadvantaged individuals, inadequate incentives, and low commitment to the process by stakeholders.
Conclusion: Power and authority in decision-making, resources and accountability are key for
effective community participation of marginalized people. Practical guidance is urgently
required on how mandated participatory governance structures can be sustained and linked
to wider governance systems to improve service delivery.
Description
Keywords
Community participation; primary health care; water governance; health committees; catchment management agencies