Health systems in sub-Saharan Africa have been in a state of decline since the debt crisis of the 1980s and the subsequent effects of structural adjustment programmes, chronic public under-investment and health sector reform.
Report by Itai Rusike
Presently, Zimbabwe experiences a heavy burden of preventable diseases such as HIV and Aids infection, malaria, tuberculosis and diarrheal diseases.
Nutritional deficiencies, lack of vaccine for preventable diseases and health issues affecting pregnant women and neonates are also a serious challenge.
The latest Zimbabwe Demographic and Health Survey says the number of women that have died due to maternal causes in the past seven years increased from 725 deaths for every 100 000 live births in 2009 to 960 deaths for every 100 000 live births in 2011.
It is against such a background that the concept of primary health care (PHC) has to be revived to ensure improvements in the health sector.
PHC, as outlined in the Declaration of Alma-Ata 1978, is based on practical, sound and socially acceptable methods made universally accessible to individuals and families in the community through their full participation.
It is the first level of contact of individuals, the family and community with the national health system, bringing health care as close as possible to where people live and work.
The country’s health policy commits the government in ensuring that communities are empowered to take responsibility for their own health and to manage their local health services.
Community participation can be enhanced through the establishment of health centre committees (HCCs), which are a mechanism through which communities can participate in health services.
The committees complement vital community level initiatives like community health workers, and mechanisms for public participation at all levels of the health delivery system.
Such committees were originally proposed by the Health ministry in the early 1980s to assist communities to identify their priority health problems, plan how to raise their own resources, manage them and tap such resources for development.
Three years ago, HCCs in two districts in Mashonaland East province collaborated with village health workers to mobilise expectant mothers to deliver at health facilities nearest to them, contributing to improved maternal and neonatal survival.
A community in Chikwaka in Goromonzi district has taken the lead in mobilising financial and material resources such as bricks, quarry, river sand, pit sand and labour to construct a maternity waiting home in their ward.
Despite their proved usefulness, the committees do not have a statutory instrument that specifically governs their roles and functions.
The absence of formal recognition may mean that other sectors do not act on health as it is not adequately profiled in their wider deliberations.
The 2009-2013 National Health Strategy has recognised this gap and made specific note of the importance of establishing HCCs 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”.
An assessment by Training and Research Support Centre (TARSC) and Community Working Group on Health (CWGH) in 2009 on PHC found that HCCs were functioning only in 40% of the 20 districts surveyed.
The committees were found to lack coherent integration with planning systems and were functional only in a third of sites.
Nevertheless, they were effective and this was attributed to improved understanding and morale that they built between communities and health workers.
A 2004 study by Loewenson et al, also found that HCCs were associated with improved primary health care outcomes compared to areas where they did not exist.
It found out that the committees ensured the proper planning and implementation of primary health care in coordinated efforts with other relevant sectors.
In doing this, they promoted 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.
CWGH and TARSC in partnership with the PHC taskforce have developed HCC guidelines that have been proposed as the basis for a Statutory Instrument to formally recognise the role of these structures.
Itai Rusike is the executive director for Community Working Group on Health (CWGH)