This policy note is based on the report mapping participation mechanisms in the health sector, which addresses issues such as: the creation and/or strengthening of platforms that improve coordination, joint planning and effective links between communities and health systems, representation, participation and engagement of community actors in decision-making spaces, community-led development and review of plans, tools, resources and messages for social mobilisation, institutional capacity building and leadership development. The mapping was carried out in the provinces of Nampula and Zambézia.

Some of the recommendations presented in the policy note are:
(i) To address the poor collaboration and coordination between Health Committees and Multi-skilled Health Workers (MHWs), including the low functionality of Health Committees, MISAU and development partners must make community participation structures a priority, which could enhance the impact of other initiatives and facilitate the successful implementation of the Essential Health Care Package at community level within the framework of the Community Health Subsystem Strategy;

(ii) The Co-Management and Humanisation Committees (CCGH) face challenges related to gender imbalance, with a male predominance and a number of members far exceeding that recommended by the Terms of Reference for the establishment and operation of this mechanism. This suggests a lack of awareness of the guiding principles for the operation and composition of the CCGHs – indicating that some of these community structures may be operating on a haphazard basis. For the committees to contribute to improving the performance of the health facility, it is important that MISAU and its cooperation partners establish a training package focused on promoting good practices and raising awareness of the role of these user participation mechanisms at the community level;

(iii) Despite the apparent functionality of the User Support Offices (GAU), their activity is limited by a lack of space and a scarcity of guidance materials for their operation, a lack of certification for GAU focal points to carry out their task of monitoring user satisfaction, and little collaboration from service providers with the GAU – due to the perception that this mechanism exists to undermine the provider. MISAU should draw on the experience of Community-Led Monitoring to address challenges of this nature, thereby strengthening the partnership between the community and the health facility;

One of the conclusion emphasize that although the discourse of health sector authorities and development partners highlights the importance of community mechanisms for participation in planning and management – with the aim of improving the quality of service provision – these mechanisms, having been systematically neglected in the budgeting and financing process, are poorly structured and insufficiently prepared to provide the necessary response and deliver the expected results in the field of health promotion and the co-management of health facilities, towards the provision of quality, equitable primary health care focused on the needs of people and communities. Read more...