Towards community centred health care

June 5, 2014 Musah Gwaunza

Health Centre Committees are a mechanism through which community participation can be effectively integrated to achieve a sustainable people-centred health system at the primary care level. In recent years there has been a shift from centralised management of government structures towards more devolved models that have seen community members being empowered to contribute to the development of their communities.

More recently, the community share ownership schemes have seen community members being active in decision-making in
line with resource allocation on development issues that affect them.

Although more still needs to be done, the trend has also shifted in development partners that have over the years been dictating projects in communities, without being sensitive to community needs and priorities.

One such community empowerment initiative is the Health Centre Committee (HCCs) introduced by Government to ensure that health facilities are sensitive to the needs of communities, including contribution by community members themselves to management of these facilities at primary level.

The Primary Health Care (PHC) provides the first point of contact between the community, village health workers and the
formal health delivery system, hence becoming the most important level in the health delivery system in any country.

Zimbabwe’s National Health Policy commits the Government to ensure that communities are empowered to take responsibility for their own health and well-being, and to participate actively in the management of their local health services.

The PHC approach that was adopted by the Government in 1980 seeks to build and depends on high level of ownership and
participation by the affected communities. HCCs are a mechanism through which community participation can be effectively integrated to achieve a sustainable people-centred health system at the primary care level.

They complement vital community level initiatives like community health workers, and mechanisms for public participation at all levels of the health system.

In Zimbabwe, HCCs were originally proposed by the
Ministry of Health and Child Welfare in the early 1980s to assist
communities to identify their priority health problems, plan how to
raise their own resources, organise and manage community contributions,
and tap available resources for community development.

Community Working Group on Health defines a Health Centre Committee as a
joint community–community health service structure at the primary care
level of the system covering the catchment area of that primary care
facility (usually a clinic). It usually covers a ward, but may be more
or less than a ward and constituting 11-15 people.

Although ward
health teams exist at local government level in both urban and rural
areas, the health centre committee exists to provide for participation
in the functioning of the health centre and the PHC activities in its
catchment area, clarifies the Community Working Group on Health.

Itai Rusike, Community Working Group on Health director, indicated that
about 80 percent of health centres in the country have constituted HCCs
although many only exist on paper.

He said: “Despite setting their roles and functions as early as the 1980s,
HCCs still do not yet have a statutory instrument that specifically
governs their roles and functions.

This is a gap in the formal
provisions on how communities should organise on health and PHC at
primary care (health centre) level. While PHC is not only an issue for
the health sector, and is thus taken up by more general local government
structures, it is necessary that mechanisms exist within the health
sector to align the health system to PHC and community issues, as well
as to link and give leadership input to these more general structures.”

Ministry of Health and Child Care 2009-2013 National Health Strategy
that has now been extended to 2015 recognised this gap and made specific
note of the importance of establishing health centre committees within
the health system.

The strategy identifies that “ . . . during the
next three years, communities, through health centre committees or
community health councils, will be actively involved in the
identification of health needs, setting priorities and managing and
mobilising local resources for health.”

In 2013, according to the
Community Working Group on Health, Health Centre Committees in two
districts in Mashonaland East province collaborated with village health
workers to mobilize expectant mothers to deliver at health facilities
nearest to them, contributing to improving maternal and neonatal

Other areas where the HCCs have made a difference in
health delivery in their committees include Chikwaka community in
Goromonzi district.

According to Mr Rusike, the HCC in this
community has from 2012 until today taken the lead in mobilizing
financial and material resources – bricks, quarry, river, pit sand and
labour – to construct a maternity waiting home at a primary care
facility in their ward. The developments in these and many other
communities are crystal clear examples of how HCCs are able to organise,
identify local health problems, tap into their own available resources
and take action for community development.

Apart from improved
service delivery, a 2012 Community Working Group on Health assessment on
PHC found HCCs being associated with higher levels of satisfaction with
services, attributed to the communication, improved understanding and
support for morale that they build between communities and health

“HCCs ensure the proper planning and implementation of
primary health care in coordinated efforts with other relevant sectors.
In doing this, they promote health as an indispensable contribution to
the improvement of the quality of life of every individual, family and
community as part of overall socio-economic development,” indicated the
Community Working Group on Health.

The Community Working Group on
Health has been working with the Ministry of Health to develop and
promote the adoption of training and guidelines for HCCs. The recently
enacted constitution now includes the right to health, which gives
greater leeway to push for legal recognition of HCCs.

community participation demands much more than HCCs, institutionalising
and giving a formal mandate to HCCs is critical and key to achieving a
sustainable people-centred health system in Zimbabwe.