Communities in the Eastern Cape have played a role in formulating and implementing the guidance on their roles and functioning. In the Nelson Mandela Bay Health District, for example, health in 2006, a team from the Eastern Cape Provincial Department of Health invited health committee members, health service, local government, community and other local stakeholders to a meeting to contribute and to provide substance to the policy on health committees. This workshop served to frame the draft policy, which was later sent to all districts for discussion before further review and feedback by HCC representatives. The amendments made in this process were integrated into the final policy that was adopted in 2009 by the legislature in the province and published in 2010. This brief discusses this case study on the role of health centre committees as part of a series of case study briefs on the topic.
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In the 21st century there is a growing demand to channel collective energy towards justice and equity in health, and to better understand the social processes that influence health and health systems. Communities, rontline health workers and other grass-roots actors play a key role in responding to this demand, in raising critical questions, building new knowledge and provoking and carrying out action to transform health systems and improve health. There is a widening array of methods, tools and capacities – old and new – to increase social participation and power in generating new knowledge through participatory research. At the same time, we need to be clear about exactly what participatory research is and what it can offer. This reader promotes understanding of the term ‘participatory action research’ (PAR) and provides information on its paradigms, methods, application and use, particularly in health policy and systems. This version of the reader is in Spanish. It was produced through the Regional Network for Equity in Health in East and Southern Africa (EQUINET), with Alliance for Health Policy and Systems Research (AHPSR) and International Development Research Centre (IDRC) Canada. The result of team work, the reader draws on experience and published work from all regions globally and explains:
• key features of participatory action research and the history and knowledge paradigms that inform it;
• processes and methods used in participatory action research, including innovations and developments in the field and the ethical and methods issues in implementing it; and
• communication, reporting, institutionalization and use of participatory action research in health systems.
This workshop is being held to discuss the evidence from research in EQUINET and related research with a particular focus on east and southern Africa (ESA) on global health diplomacy. It will present and discuss the findings from the EQUINET research programme and from related research in Africa, and the implications for policy, negotiations and programmes in east and southern Africa; review methods and challenges for implementing research and analysis on global health diplomacy for policy relevance, from review of research and experience of the work; and discuss and propose areas for follow up policy, action and research, within ESA and through south-south collaboration. The reports of the EQUINET research are on the website
This report documents work undertaken in Cassa Banana Community from February – July 2014. The programme aimed to use Participatory Reflection and Action (PRA) methodologies in working with members of Cassa Banana to work with a representation of community members and health providers/authorities to explore and document the health challenges faced by the Casa Banana community and to formulate actions to solve these health challenges. The project also sought to support community action in demanding accountability from the relevant duty bearers in the formulation and delivery of health services, and to strengthen community/stakeholder engagement for the provision of people-centered Primary Health Care services to the Casa Banana community.
Visual and information technologies are now more diversified and widely accessible. Digital images and mapping enhance access and exchange on local realities; social media (blogs, tweets and others) provide new methods for communicating experience for collective analysis, mobile phones facilitate communication and pooling of evidence across wider social networks and mapping and crowd-sourcing technology provide systems for citizen reporting, including in poorest communities. internet based resources point to the possibilities for information technology to support peer to peer learning and participatory action research to overcome the ‘local’ nature of processes and link groups with shared interest. To support discussion on these areas this work aimed to provide an annotated description of existing internet resources that have features that may guide out thinking in developing an e platform for participatory reflection and action across similar groups in different areas.
A two-day consultation on health committees as vehicles for community participation was held in Cape Town on September 27th and 28th 2014 prior to the 3rd Global Health Systems Research Conference. The meeting, funded by the International Development Research Council (IDRC Canada), had 38 participants from 12 countries of which nine were African countries. The meeting build on previous regional networking to share experiences of health committees as vehicles for community participation from countries across the globe. The discussion focused particularly on health committees in the African region, but benefited from considerations of experiences from other countries of the South (Guatemala and India). The discussions also reaffirmed the importance of health committees for Health System responsiveness and highlighted the importance of health committees as autonomous structures able to enhance democratic governance of health systems through monitoring and evaluation of health service performance and holding the state accountable. This applies irrespective of how services are delivered. To achieve this, it is critically important for health committees to be capacitated to fulfil this role through appropriate training, health systems design and sustainable support. Government should recognize the importance of health committees for their health systems, and invest appropriate human and financial resources to ensure functional health committees. Such investments are part of state obligations with respect to realising the Right to Health. Further, strategies must be developed to obtain buy-in of health workers, managers and policy-makers in supporting meaningful participation by health committees.
Immediately following the 2014 Global Symposium on Health Systems Research, a one day workshop was held, convened by Training and Research Support Centre (TARSC) (www.tarsc.org) and the pra4equity network in the Regional Network for Equity in Health in east and southern Africa (EQUINET) with Asociación Latinoamericana de Medicina Social (ALAMES). The workshop was held to deepen the discussion on the use of participatory action research (PAR) in health policy and people centred health systems, including in acting on the social determinants of health. While there are many forms of participatory research, the workshop specifically focused on PAR, that is on research that transforms the role of those usually participating as the subjects of research, to involve them instead as active researchers and agents of change, where those affected by the problem are the primary source of information and the primary actors in generating, validating and using the knowledge for action, and that involves the development, implementation of, and reflection on actions as part of the research and knowledge generation process. PAR seeks to understand and improve the world by changing it, but does so in a manner that those affected by problems collectively act and produce change as a means to new knowledge. The one day workshop was open to delegates from all regions globally to foster cross regional exchange and to include people from the pra4equity network in east and southern Africa. This report presents the proceedings of the workshop.
This brief outlines the factors that affect medicines production in East and Southern Africa, drawing on the African Union, Southern Africa Development Community (SADC) and East African Community (EAC) pharmaceutical plans. It identifies the barriers to local production as: lack of supportive policies, capital and skills constraints, gaps in regulatory framework, small market size and weak research and development capacities. It highlights, from case study work in selected countries in East and Southern Africa the potential opportunities for strengthening local medicine production. In the brief we propose that African countries strengthen domestic capacities, co-operation between domestic private and public sectors within ESA countries, and regional co-operation across ESA countries to address bottlenecks. Some areas such as infrastructure development and training may be important groundwork for others, such as technology transfer and research and development. South-south cooperation in medicines production can play a role in this but it cannot be assumed. Negotiations on south-south arrangements should look not only at the immediate production investment, but at strengthening capacities for research and development, for regulation, medicines price and quality monitoring, prequalification, infrastructure and human resource development.
Participants at the Regional Meeting on Health Committees co-hosted by the Learning Network for Health and Human Rights, the Centre for Health, Human Right and Development (CEHURD) and the Network on Equity in Health in East and Southern Africa (EQUINET), 27-28 September 2014, Cape Town developed the statement from the meeting committing themselves to strengthen regional learning networks between countries of the south for advancing health committees as vehicles for community participation and calling on governments to recognise and incorporate health committees into their health systems in ways that maintain their roles as autonomous agents for democratic governance; WHO to provide guidance on inclusion of Health Committees in Health Systems Governance; and for discussions on updating the WHO Building Blocks approach to recognise the role of collective community action through Health Committees when inserting notions of public and patient engagement.
EQUINET, COPASAH and Rotterdam Global Health Initiative Erasmus University, for the participatory cluster in the SHaPeS TWG for Health Systems Global is hosting a satellite workshop at the GSHSR on ”New resources and opportunities for participatory research in health systems: areas of focus for Health systems Global” on Tuesday, 30 September from 12.00 – 14.00. We welcome all interested in this work! The satellite session will be convened by the three organisations in the participatory cluster of the SHaPeS Technical working Group in HSR global. It will present and discuss with delegates interested in the cluster the issues, resources and capacities for the field and how these could be developed through the TWG, and will make available work we have done to date, particularly through EQUINET and COPASAH. It will review the experience of using participatory action research, (PAR), community monitoring and innovations in social media in transforming local health systems, the challenges faced and the areas for future participatory work in HSR. It will launch the EQUINET, AHPSR and IDRC methods reader on participatory action research and web tools from COPASAH. The session will identify field building inputs in terms of the resources, capacity building, methods and opportunities that need to be taken forward by the participatory cluster of the SHaPeS Technical Working Group and the people who are interested in playing a role in the different areas of work. Contact admin@equinetafrica.org with GSHSR SATELLITE in the subject line for further detail or to let us know of your participation.