RHD Prelude Chapter - Health Systems Trust

The rural areas around Mafikeng were part of the Bophuthatswana homeland where there has
been community involvement for many years. These areas are still under some traditional
practices which are largely absent in the urban areas.
Other members of the health management team, such as the HIV/AIDS Coordinator and the
ADCHS, are generally more positive and believe that community involvement has increased
because the community are interested and do care.
“Awareness and the people will be willing to assist because they now show that they care.
They are even encouraged by politicians you know to assist here and there. But political
issues aside, really there is interest and awareness.”
(District HIV/AIDS Coordinator)
“You know the other thing that I would like to say about those community representatives;
really they would not like anything to happen in their community without their involvement
and their participation. Most of the projects have failed because they were being imposed.
So now we have learnt a lesson of involving them. For example if you want to let the mobile
visit a certain area, they don’t accept that, they will not consult, they will not go there, they
will not support that.”
(District ADCHS)
Community participation is seen by the district management team as being beneficial to clinic
managers and nurses working in the clinic.
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“They [health workers] think its [community participation] good, they like that… .things
become easier for nurses working at the clinic. Let’s say maybe the clinic is without the
security, one of the community members just volunteer to come and be a guard at the clinic.
They take the clinic as their own and their property, not the government property…Yes,
definitely it is beneficial.”
(District MCWH Coordinator)
Facility managers, however, generally see the community as passive and not interested in the
health education they offer, although they do consult them on issues:
“I am sorry to say, from the community …. They don’t have any interest. We have tried to
give them health education. … They are the ones who are having negative things. Mainly
they are using traditional medicines… So it is a very difficult thing and there are no
volunteers.”
(District Facility Managers Discussion Group)
“So we normally consult them for any view or suggestion that we have and we normally
take the decision that they are comfortable with.”
(District Facility Managers Discussion Group)
Programme managers are supportive of meetings with members of the formal governance
structures and the wider community. These meetings are opportunities to share ideas and health
issues, although there may be a ‘top-down’ approach in delivering the message.