Community Voices in Health Governance - Participation into Practice in Pluralistic Health System India, Brazil and South Africa are countries with public health care systems with forms of citizen participation in health care institutionalised in different ways (for example health committees). These systems are pluralistic when relying on combining public and private provision of services. This proposal addresses the implications of both, community participation and pluralistic health systems, for the goals of improving population health and wellbeing. We assume that citizen participation helps to align bureaucracies, politicians and health professionals around these goals. Therefore, this research program aims to enhance understanding of a) How citizen participation is working in these systems; b) How is it adapting to ongoing changes; c) What is needed in term of resources, institutional design, community involvement and training of public officials to fulfil its potential contribution.
Since the 2000’s, cities in these countries began to expand access to health care through private provision. Preliminary evidence suggests that models of purchasing public health care involving private and philanthropic providers hired to manage public facilities and deliver public services can, under certain conditions, help expand and improve access to care quickly in marginalised communities in urban areas. At the same time, there is much resistance to this development because it is seen to introduce a private logic in the public system. Moreover, if officials lack the skills or experience to negotiate contracts with private providers, there is a risk of fraud and dysfunction in the health system. Pluralistic models of public service provision may help improve the agility of systems but may simultaneously impact negatively population health interests given the influence of private interests.
We propose a multi country study focused on mapping and improving the state of community participation mechanisms in selected districts in the cities of Mumbai, Bengaluru, São Paulo, Fortaleza, Gqebhera and Cape Town, where pluralistic models of managing and providing services are either in place or in the making. This research seeks to understand the crucial role community participation can play in pluralistic health systems and how it could strengthen and enhance Universal Health System, helping to create an accountable health system with democratic governance. It seeks to identify a model for effective and meaningful participation within the pluralistic health system. The overarching research question is “How can community participation, framed as a human right, facilitate the promotion of population health and wellbeing in pluralistic health systems?”
Objectives:
1. Identify and characterise the existing international evidence on the extent of community participation mechanisms, processes and structures under plural health systems and reasons for success or failure;
2. Map the current national and provincial policy context for urban health committees in three countries;
3. Characterise the extent to which states are able to extend their human rights obligations to ensure meaningful social participation in health, to non-state providers
4. Describe the contexts and identify the mechanisms that impede or facilitate intensified community engagement in pluralized health systems aimed at UHSs.
5. Explore how communities’ views, needs and perceptions of health service adequacy are and/or could be more adequately incorporated into contracting arrangements under pluralized health systems
6. Co-develop, test, and implement participatory approaches pilots to empower community voice in the policy cycle.
7. Evaluation of capacity building and implemented participation pilots
8. Compare and synthesize findings across different sites with a view to dissemination.