In the blog Dr Olico-Okui shared with us in April this year, he discussed the conditions needed for true and active community engagement and participation [1]. We share his point of view, which is also supported by a study conducted in Burundi, in the province of Makamba and Bubanza [2].   Indeed, one wonders how the community can be engaged with such limited literacy skills, limited education in general, both compounded by poverty. Other factors determining community engagement into health and social actions are the existence of mechanisms that can help to express community opinions and needs and on another hand, the inner system ‘s ability to meet those needs and to take into account the views expressed.

Community engagement is deeper if the community is also involved in the project design. This is a string point. When designing projects or development programs, the community must be involved in setting the projects’ goals, participate in projects’ development, planning and implementation.

Involving people into designing and planning is one thing, but the system must also allow providers to report to the community and exercice this right. That is to say, to make providers and public representatives accountable.

This implies that there are social accountability mechanisms established and adapted. Unfortunately, this is not often the case.  A survey that we have just completed in Kayanza province in northern Burundi shows that certain accountability mechanisms are in place in the health sector. They essentially facilitate vertical accountability, with providers only reporting to their hierarchy through technical, financial reports, and statistics. Providers do not seem to be aware that they are also accountable to the community. In Kayanza, the community quickly realized that it was not considered and lost its interest in participating.

Health committees (COSA) are bodies that encourage social accountability and therefore community involvement. They are bodies entitled to convey the views of the community. The National Health Development Plan of Burundi showed several barriers to achieving the accountability mission for instance ; caregivers resistance to collaborate with members of the COSA; limited decision-making power of COSA; misunderstanding between the elected committees and grassroots community, following the lack of community monitoring and capacity-building; the lack of interest from the population; the lack of a legal status of health committees. [3].

Health committees’ capacities have to be strengthened to effectively contribute to accountability mechanisms and improve the performance of the health system. Given the obstacles mentioned above (illiteracy, low level of education, poverty), this reinforcement must be multifaceted. Among other actions, it should include the aspects of meeting managements. The quality of meetings reflects the quality and efficiency of a committee.

Health Committees must be trained on how to organize  a working meeting. They must be trained on how to identify a problem, how to set priorities, based on practice and interactive teaching methods. Health committees should learn some accountability principles. They should also feel integrated and accepted in the health system if they are to take pride in it.

Communities should have the right to express their opinions on the selection of health committee members and the members must come from the communities they represent. Training should be based on the experiences and practices of the communities  to which the committee belong. Like all other bodies of the State, the health committees should receive logistical support of various forms, even the provision of a working space.

What is your point of view?

References

1. Olico-Okui. Community Governance: Who governs?  [Consulted August 9, 2015 URL: http://ktnetafrica.net/blog/community-governance-who-governs-olico-okui-dr
2. Niyongabo P; Douwes R; Irambona F;  Mategeko J;  Nsengiyumva G; Dieleman M;  De Cock B T. Community members’ voice to improve the quality of maternal health care provision in Burundi : Anexploratory study. Manuscript
3. Ministère de la santé Publique et de la lutte contre le SIDA du Burundi. Plan National de Développement Sanitaire. Bujumbura, 2011.