Responsive Governance: Health Committees have impact in Asia and Africa

Mahesh Shukla

Senior Technical Advisor for Public Sector Governance

Health committees are one of the most widely implemented community level participation and accountability mechanisms in Africa and Asia. They represent multiple constituencies at community, facility, district, and provincial levels, and bring together diverse stakeholders including community members, health workers, and health managers to better understand and respond to health needs.

At the Third Global Symposium on Health Systems Research in Cape Town, over 170 concurrent and satellite sessions and 572 posters where presented on of health policy and systems research. Many of these focused on health committees and their contributions to strengthening the responsiveness of health systems. One such session, “Building collaborative and equitable governance mechanisms: Experiences strengthening health committees in diverse health systems contexts” was delivered by a panel comprising of the Kenya Medical Research Institute (KEMRI)/Wellcome Trust, Health Finance and Governance Project, Public Health Foundation of India, and the Leadership, Management &Governance (LMG) Project.

The panel presented their research on health committees from different country contexts, and discussed how effectively these governance committees broker different interests from multiple constituencies and contexts.  The panel also introduced factors that underpin effective functioning of these multi-stakeholder health committees and how they can become more effective in meeting health needs of the community.  

In Kenya, health committees including community representatives were introduced to all government health facilities in the 1980s. Recently, their roles have been expanded to include management of the Health Sector Services Fund. Panelist Evelyn Waweru of KEMRI/Wellcome Trust observed that there are opportunities for improved functioning of the health facility management committees through clear definition of their roles and responsibilities and supportive supervision.

Similarly, in Ethiopia, health centers and hospitals are now governed by boards with community representation (98% of hospitals and 92% of health centers have governing boards, and 69% hospital and 61% Health Center boards review financial and technical performance). Tiliku Yeshanew of the Health Finance and Governance Project in Ethiopia presented specific evidence on responsiveness of the health facility governing boards and concluded that the committees have helped clarify community expectations and identify gaps that were not previously recognized.

In India, over 500,000 Village Health, Sanitation and Nutrition committees include frontline health workers, local political leaders and community members, and are expected to carry out varied tasks spanning village health planning, monitoring of health facility to facilitating health promotion and access to health, nutrition, and social services. The Public Health Foundation of India’s Kerry Scott shared the initial findings of their VOICES study in India that ongoing facilitation of the work of these committees is vital to their success in meeting community health needs.

Finally, health shuras or health committees exist at provincial, district, health facility, and community levels in Afghanistan as forums for information sharing, coordination, and monitoring of health services. More than 100,000 individuals who are serving as members of these committees are performing a governing role.  I was able to share the LMG Project’s implementation research in three provinces and eleven districts of Afghanistan where consistent application of effective governing practices by the provincial and district health coordination committees showed encouraging results in terms of performance of provincial and district health systems.

Findings across these varied settings suggest that the health committees are expected to perform essentially a governing role, and have a clear opportunity to influence how the health facility or health system they govern performs. But research shows that they often lack capacity to fulfill their governance responsibilities. To realize their full potential, we must make investments in building their capacity to not only govern, but also govern well.

Photo: Dr. Mahesh Shukla (2nd from right) shares results from LMG's implementation research in Afghanistan at the Third Global Symposium on Health Systems Research. Photo Credit Sarah Lindsay