I totally agree with what has been written that H. C. C. can bring life into our health systems.<br>In Zambia these Committes are poorly funded. The H. C. C.members are volunteers for aperiod of two years. Most of these come with a view of earning a living and once they discover that their hopes come to nothing they become inactive and zones where they come from suffer greatly.<br>We need members who have the spirit of volunteerism with or no financial gains for them. The tenure of office for two years for volunteers, in some cases, removed. In some cases, you will find effective volunteers are removed because of their two year period has come to an end. Once person leaves, it has hard for him/her to come back.<br><br>Claudio Schuftan <schuftan@gmail.com> wrote:<br><br><div dir="ltr">
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<p class="MsoNormal"><span style>EFFECTIVE HEALTH CENTRE COMMITTEES CAN
BRING LIFE INTO OUR HEALTH SYSTEMS<br>
</span><span style="font-size:10pt">(The EQUINET Regional Meeting On Health
Centre Committees<br>
February 2014)<span style> </span>EXCERPTS</span><span style><br>
Social participation is central to the success ofprimary health care (PHC)
oriented health systems. There are, however, wide differences in how far they
are implementing this policy view. There are many shortfalls in meaningful
levels of<br>
social participation in health systems. Health Centre Committees (HCCs) are<br>
known by a range of names in different countries but are joint community-<br>
health worker structures at primary care level. They offer one way for<br>
systems to facilitate social participation and shared decision making<br>
between communities and health personnel. There is evidence that they can<br>
contribute to quality of and equity in access to health care and improved<br>
health outcomes. HCCs provide a key mechanism for communities to participate in
revitalising PHC and for strengthening and monitoring service delivery.<br>
<br>
Despite this, while HCCs exist in some form in most countries, they often<br>
have no formal legal status or are not trained, resourced or active. Generally
while guidelines often set HCC composition and duties, they are less clear on
how they are funded or on their role in towards social accountability. Despite
their role in bringing community voice to service planning and the requirement
that they represent communities, HCC members are not always elected by
communities, have<br>
variable levels of community involvement and influence and may be liable to<br>
political control.<br>
<br>
To some extent this reflects ambivalence towards whether HCCs are more a<br>
voice for the community to influence health services, or an outreach for<br>
services to reach and influence communities. Both roles are important, but<br>
where do HCCs focus their time and energies? There is concern that in some
countries HCC roles have become ‘commodified,’ with the resources available to
them based less on community interests or needs than on what is paid for, often<br>
by international organisations.<br>
<br>
Hence rather than the common practice of a long list of apparently delinked<br>
and equally weighted roles, the meeting identified roles of an HCC in a more<br>
systemic way, linking these to processes in health systems. The process<br>
starts with building an informed health literate community, obtaining<br>
community views and drawing on this to bring community voice and experience<br>
into the interaction with health service personnel, to jointly design and<br>
implement plans and budgets for the health system at primary care and<br>
community level. This joint role in governance gives the HCC the<br>
information, authority and motivation to go back to communities to<br>
facilitate dialogue and social action on health plans; to make sure that the<br>
agreed plans have been implemented, and that the duty bearers are<br>
capacitated, supported and resourced to deliver on plans and that they do so<br>
in a manner that is responsive to the community. HCC members should thus<br>
bring the direct experience and views of communities into the system,<br>
supporting understanding and reflection within communities on how to improve<br>
health, and advocating for improvements, with other sectors or at higher<br>
levels of the health system. This means that HCCs are more likely to thrive<br>
where health systems are themselves PHC oriented, facilitate action on the<br>
social determinants of health and support participatory planning and<br>
practice, than where they are organised largely around individual medical<br>
care with top down power.<br>
<br>
HCC members need to have resources and skills across all these areas of<br>
functioning to complement their inherent social capacities and to enable<br>
them to overcome power imbalances in the relationships between themselves<br>
and health authorities. While there is a lot of training activity taking<br>
place, this may be limited to specific disease problems or interventions,<br>
may not address the general community health literacy or spectrum of HCC<br>
abilities needed and may lack follow up to evaluate its effectiveness or to<br>
sustain it. Training may not include some key areas such as budget tracking<br>
or assessment of community benefit. Further those providing training for<br>
HCCs may themselves lack competencies to build skills in areas such as<br>
budget planning or tracking.<br>
For HCCs to be effective in PHC oriented roles, communities themselves need to
be health literate and empowered. <br>
Social rights to health care, to information and meaningful participation<br>
can provide a foundation for this and should be included in all<br>
constitutions of the region and in updated national or public health law.<br>
Regulations should more clearly define the duties, powers, roles and<br>
constitution of HCCs, and guidelines set these in a more systematic manner.<br>
However all this is likely to remain on paper unless it is accompanied by<br>
processes for capacitating systems and for supporting social activism and<br>
information.<br>
<br>
A number of areas for follow up need attention and action by national
authorities and organisations working in health, in relation to legal
provisions, guidance, election, composition, functioning and capacity building
of HCCs. While the specific cultural contexts differ, minimum guidance for
these areas can be set,<br>
such as on the core content of and processes for comprehensive HCC training,<br>
and that countries budget for the capacity building and functioning of HCCs.<br>
As for all other areas of health system performance, it is proposed that<br>
the health information system and communities monitor and collect<br>
information on the functioning, performance and impact of HCCs. </span></p>
<p class="MsoNormal"><span style>The commitment to network by practitioners
working with HCCs must continue to link regionally, including to document, to
share and make their work more visible. At a time of increasing attention to
domestic resources for health, the most critical resources are people. The
challenge is for policy actors to turn commitments into action and to give systematic
attention to the effective functioning of HCCs, as key social assets for
health.<br>
<br>
Please send feedback or queries on these issues to the<br>
EQUINET secretariat: <a href="mailto:admin@equinetafrica.org">admin@equinetafrica.org</a>.
For more information on the<br>
issues raised please visit <a href="http://www.equinetafrica.org">www.equinetafrica.org</a></span></p>
</div>