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Edited by Alistair McGuire and Joan Costa-Font
Chapter 2: Strengthening Community Participation in Primary Health Care: Experiences from South Africa
Andrew Gibbs and Catherine Campbell 1. INTRODUCTION The thirtieth anniversary of the Alma-Ata Declaration (WHO, 1978) generated renewed interest in the role of primary health care (PHC) in achieving universal health and reducing health inequalities (Chan, 2008; McCoy et al., 2008; WHO, 2008). However, profound challenges remain in implementing this approach, particularly in poor countries, which experience the poorest health outcomes and face numerous challenges in delivering health services. This has led to growing calls to analyse the barriers that need tackling to implement PHC more effectively to achieve Alma-Ata’s goals. In this chapter we use a case study to focus on a central pillar of PHC – the participation of communities in efforts to improve their health. This aspect of PHC has typically been poorly implemented (Lawn et al., 2008). Yet without proper community involvement, programmes have little chance of succeeding (Campbell, 2003). 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. HIVAN was invited to work in partnership with the volunteers after undertaking research into community responses to AIDS in Entabeni. The research highlighted the existence of the volunteers, as well as the difficulties they faced. HIVAN’s role was one of external change agent (ECA) – helping the community...
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