About the Community Systems Strengthening (CSS) Project

This is a joint project with Training for Transition, Women on Farms, Health Committees in Belhar and Gugulethu under the Cape Metro Healthcare Forum and Health monitors in Klapmuts. Funded by the European Union (EU), this project aims to identify opportunities for best practice in utilising community participation as a vehicle for realising health rights. The focus on developing models for community participation in health is intended to speak to strategies that advance health equity and strengthen governance systems for health. By testing approaches and sharing experience gained using rights-based approaches to health, we anticipate generating knowledge of relevance to other developing country contexts. The focus has been on identifying training needs for health committees and advocacy and networking to strengthen health committees’ voice, both locally and internationally. Strong links have been built regionally and internationally with an emphasis on building the agency of community structures to articulate more strongly claims for health rights, with a view to proposing models for best practice.

The wider health system governance interventions, including training for health care providers, testing of models for using complaints as learning opportunities, and policy interventions aimed at raising awareness amongst key leaders also form a prominent component of the work. While the focus is on strengthening civil society agency, it will also advance conceptual understanding of how to frame health rights in ways that are complementary to strengthened health governance.

Training and capacity building for health committees has involved the development of a curriculum drawing heavily on results of the audit of Health Committees in the Cape Metro completed early in 2012. The curriculum includes four broad areas (a) understanding the health system; (b) skills to act as agents of change; (c) understanding of health rights; and (d) meeting and procedural skills to support organizational work. Building Civil Society networks has been a strong and successful feature of the project demonstrated in mutual support between LN members. Engagement with health officials has yielded mixed results. On the one hand, the LN submission on amendments to the Hospital Facilities Board Act has been well received and elements included in the Provincial Health Plan for 2020. On the other hand, there has been no movement for formal adoption of policy or regulations to empower health committees, and the establishment of District Health Councils appears to hindered rather than helped community participation. Nonetheless, there are promising links with high level officials supportive of increasing patient voice in the health services in a meaningful way.