Health Committees as Vehicles for Democratic Governance in Health Systems: Lessons from Selected Health Unit Management Committees in Uganda

Introduction: For over forty years, community participation has been a central component of a well-functioning health system. Despite its important role there are many difficulties in defining and understanding community participation as part of governance. Through a case study of selected health unit management committees in Uganda, this paper demonstrates that these committees can be structures for community participation and vehicles for democratic governance in health systems that advance health equity. Guided by the theoretical underpinnings of deliberative democracy the paper evaluates the performance of health unit management committees as a mechanism for citizen participation in health systems. Methods: This paper uses a qualitative, case-study methodology. Through an in-depth look at the health unit management committees of Kiboga and Kyankwanzi in Uganda, the study considered these as examples of structures for democratic community participation in health system. The study undertook literature review on the theories of deliberative democracy and human rights principles, and this provided the theoretical underpinnings of the study. Findings: Our findings underscore that community participation in health systems through health unit management committees ought to be grounded in the principles of deliberative democracy. The core of deliberative democracy is considered to be authentic deliberation and consensus decision-making, which can happen in both direct and representative democracies, giving rise to the notions of populist and elitist deliberative democracy, respectively. As such, a balance needs to be struck between the competitive notions of democracy and the public health requirements of inclusive and direct participation of communities in decision making processes on matters that affect their health. Conclusions: Community participation in the health sector in Uganda hinges on health unit management committees at the lower service provision points. These HUMCs are also perceived as vehicles to strengthen health governance through realizing the right to health of the communities. However, these have been established without attention to investing in capacity building needed to enable them to exercise community voice in the health system.

Village health workers as health diplomats: negotiating health and study participation in a malaria elimination trial in The Gambia

Background Although many success stories exist of Village Health Workers (VHWs) improving primary health care, critiques remain about the medicalisation of their roles in disease-specific interventions. VHWs are placed at the bottom of the health system hierarchy as cheap and low-skilled volunteers, irrespective of their highly valued social and political status within communities. In this paper, we shed light on the political role VHWs play and investigate how this shapes their social and medical roles, including their influence on community participation. Method The study was carried out within the context of a malaria elimination trial implemented in rural villages in the North Bank of The Gambia between 2016 and 2018. The trial aimed to reduce malaria prevalence by treating malaria index cases and their potentially asymptomatic compound members, in which VHWs took an active role advocating their community and the intervention, mobilising the population, and distributing antimalarial drugs. Mixed-methods research was used to collect and analyse data through qualitative interviews, group discussions, observations, and quantitative surveys. Results and discussion We explored the emic logic of participation in a malaria elimination trial and found that VHWs played a pivotal role in representing their community and negotiating with the Medical Research Council to bring benefits (e.g. biomedical care service) to the community. We highlight this representative role of VHWs as ‘health diplomats’, valued and appreciated by community members, and potentially increasing community participation in the trial. We argue that VHWs aspire to be politically present and be part of the key decision-makers in the community through their health diplomat role. Conclusion It is thus likely that in the context of rural Gambia, supporting VHWs beyond medical roles, in their social and political roles, would contribute to the improved performance of VHWs and to enhanced community participation in activities the community perceive as beneficial.

Forms of community participation in preserving local wisdom in the traditional ceremony of bersih desa

Society has an essential role in the implementation and development of a tradition in its environment. The traditional ceremony of Bersih Desa in Kedungbendo Village is one of the traditions still carried out today. The community also plays a role in the implementation of the traditional ceremony of Bersih Desa in Kedungbendo Village. This study used the descriptive qualitative method. The sources of data in this study came from informants, places, events, and documents. The data was collected by using interviews, direct observation, and documents. Based on the study results, it can be concluded that the reason people still carry out the tradition of Bersih Desa is that it belongs as a legacy from their ancestors. Since it is a legacy, its existence must be preserved. The traditional ceremony of Bersih Desa is also used as a medium between humans to express gratitude to God for the blessings and redemption given. The traditional ceremony of Bersih Desa is also carried out with the purpose and hope that the village community's life will be much better with the blessings received so that nothing terrible happens to the village community.

Community Participation in the National Development Plan Through Primary Health Care

The chapter explores and describes community participation in the National Development Plan through Primary Health Care by using case studies of LGBT organizations in South Africa. Post-Apartheid and democratic South Africa has endorsed community participation as one of the fundamental pillars of the public Primary Health Care approach in its governance structures. This chapter focuses on the current major health issue in South Africa, the HIV epidemic, which is one of the leading causes of death in the country. Particular attention is paid to members of the LGBT community because of their discrimination in public healthcare facilities on grounds of their sexual orientation. The chapter relies on secondary sources of data collection from extant literature, textbooks, journal articles, and internet sources. Challenges to address LGBT community discrimination in HIV testing, prevention, treatment, care, and support were identified and solutions to uphold their human rights were proffered. These solutions are based on the principles of social justice, inclusion, diversity, and equality.

Can Community Education Promote Community Participation in the Local Economic Development (LED) Activities in this Era of 2019-nCoV

The 2019-nCoV has come as an unexpected wicked challenge especially to the vulnerable ones as it has significantly affected the local economic development (LED) activities of many local people in communities of South Africa. In this chapter, the role of community education as a problem-solving measure in promoting community participation in LED will be explored as limited participation in those activities prevail especially in the wake of the Coronavirus pandemic. The study provides the challenges posed by the limited participation in the communities and the economy and explains how the local participation is important through community education (CE) programmes in LED activities. Since community education indeed plays a huge role in enhancing community participation in LED activities, the government officials, policymakers and others need to work closely with local people so that they can understand the essence of socio-economic issues that communities daily encounter in the wake of the pandemic.

Towards Building Direct Democratic Governance Through the Ward Committee System in South African Local Government

This chapter interrogates the ward committee system as an instrument in an institutionalised local government level to advance direct participatory governance. The ward committee has a constitutional mandate upon which accountability, democratization, community governance, and inclusive participation in the municipal decision-making is enhanced. The ward committee system was legislated to create a platform for community participation and enhance accountable local governance. Structuration theory has been used to engage with elements of representativity, powers, skills, functionality, access to information, influence in decision-making, and relationship with others structures as developed by Smith and de Visser. The chapter made use of various case studies to interrogate the role, potential, and challenges of the ward committee system in forging direct participatory governance.