|Parallel session PS31, Tuesday, April 20 2010, 16:00-17:30, Room 4|
|Chair(s): Arthur Marx, Health Policy Advisor, Swiss Agency for Development and Cooperation, Switzerland|
|Improving Health Services through Empowered Community Governance Structures in Tanzania|
|Jacques Mader, Assistant Country Director, Swiss Cooperation Office, Tanzania|
|Health Promotion in Tajikistan within Family Medicine Services: The Participative Rapid Appraisal|
|Gulzira Karimova, Health Service Liaison Coordinator, Sino Project, Tajikistan|
Implementing participatory approaches in healthcare provision presents many challenges. The three case studies presented in this session identify successes and issues being faced by organisations working to increase community participation in Tajikistan, Tanzania and the International Memory Project based in five East-African countries.
Arthur Marx, Health Policy Advisor for the Swiss Agency for Development and Cooperation, chaired the session. Participatory approaches to health was the subject of a workshop during the morning session of the conference, which helped participants to identify some of the key benefits and challenges of community participation in developing healthcare delivery. This session described the outcomes of participatory approaches to healthcare from the field.
Assistant Country Director of the Swiss Cooperation Office in Tanzania, Jacques Mader, described the community driven governance structure of the healthcare sector in Tanzania. Two participatory structures, the Health Facility Governing Committees (HFGC) and the Council Health Service Boards (CHSB) are responsible for priorities and accountability in health service delivery. Councillors are elected in each district. This participatory structure has had many achievements. For example, one district’s efforts to lobby for increased supplies and human resources resulted in reduced waiting time for services. Nonetheless, many challenges remain. An evaluation of the structure, including interviews and focus groups with community, provider and hospital stakeholders, found variable performance across councils and certain challenges and problems leading to poor performance including limited capacity and resources; problems of relevance and legitimacy; lack of transparency in selecting members and a lengthy process to replace board members.
The report outlines key recommendations: to build the capacity of council and board members through training; to ensure continuity, for example by introducing longer and staggered tenure; to allocate a budget for meetings and associated costs; to provide incentives for community participation; to clarify power relations and channels of interaction; and to create a structure for monitoring and evaluation.
Mr. Mader concluded by stating that the Ministries of Health and Social Welfare in Tanzania have welcomed the study. They have agreed to change guidelines of committees and boards to improve healthcare and health outcomes, and they formally endorsed priorities at council level.
A project, which aims to improve health promotion within Family Medicine Services in Tajikistan, based on Participatory Rapid Appraisal (PRA), was presented to the meeting by Ms. Gulzira Karimova, the Health Service Liaison Coordinator of the Sino Project. Tajikistan inherited its health system from the Soviet period with a focus on hospitals and specialty care instead of primary health care, prevention and community involvement. In 2002, the ministry embarked on healthcare reform as a key element in medicine. The goal of this undertaking is to strengthen primary care, link communities and primary healthcare teams, and to promote health and prevention activities at community level. To be more responsive to community needs, they implemented a bottom-up approach. Health problems are prioritised in PRA sessions, which enable individuals in the community to identify the health priority issue in their village. Community coordinators then work with individuals in the village to develop locally-sensitive responses and generate solutions. This cost-effective approach has increased participation rates and the confidence of communities, has helped to identify health priorities and is a sustainable model as it requires no extra funding.
David Musendo from HealthLink World Wide in the UK introduced Healthlink, a UK-based NGO which works to improve the health and well being of disadvantaged and vulnerable people through a rights-based approach, using participatory methods to strengthen communication and using evidence-based medicine.
Mr. Musendo described the International Memory Project, an activity that is rooted in oral history approaches, encouraging the transmission of knowledge between generations as a way of building cultural identity. In particular this has been developed to support children of parents suffering from HIV/AIDS. It aims to improve communication between parents and children, support parents in disclosing their HIV status, encourage succession planning and the documentation of family history.
This project has succeeded in helping foster improved communication between parent and child and in developing a more positive approach in dealing with HIV/AIDS, reducing the stigma attached to this condition. Improved acceptance of the situation leads to increased access to treatment and a greater ability to plan for the future of the family. Challenges include a lack of resources and funding for the work: seeking funding is a challenge, as quantifiable impact and outcomes are hard to identify. There is a need for legislation and policies at national level, and so far limited male involvement in the project.
While there have been significant achievements in implementing participatory approaches, these case studies illustrate that there remain certain challenges to cementing community participation in healthcare provision.