Strengthening community participation in primary health care: experiences from South Africa
This chapter draws from a case study to focus on a central, yet often neglected, pillar of primary health care: community participation. This case study emerges from the authors’ three year involvement in documenting the efforts of a university based NGO (HIVAN) to support the Entabeni Project in KwaZulu-Natal, South Africa – a project seeking to strengthen the work of health volunteers providing home-based care for people living with HIV/AIDS (PLWHA) as well as providing health advice to AIDS-affected households in a remote rural area. An overview of the achievements and challenges the project faced is provided to generate debate about challenges in implementing community participation and highlighting possible strategies to overcome these. The central aims of the project were to improve the quality of community participation in the spirit of the Alma-Ata Declaration as well as the South African government’s National Strategic Plan on HIV. These aims were actioned via three goals: firstly, skills development and confidence building of community health workers; secondly, building local community support for the community health workers; and finally, building external support for the community health workers. We suggest that strengthening community participation to achieve both target-oriented and empowerment-oriented objectives requires the development of incentives to engage in and/or support community participation.