In the first phase of Black Sash's RMCH project (Strengthening Public Accountability Mechanisms to Improve Maternal and Child Health) we undertook a baseline study of accountability mechanisms in our two focus districts of OR Tambo (Eastern Cape) and uMgungundlovu (KwaZulu-Natal) at the end of 2013.
The objectives of the baseline study included:
• assessing the functionality and effectiveness of existing Clinic /Community Health Centre Committees (CCs/CHCCs), and their focus on RMCH services
• identifying and mapping existing civil society organisations and forums, and their focus on RMCH services
• determining whether there is currently any engagement between CCs/CHCCs and civil society organisations and forums, and what potential exists for building institutional linkages between them to strengthen and improve capacity
• determining whether CCs/CHCCs or civil society organisations/forums are currently using any accountability tools which could be replicated or improved upon; such as community monitoring, social audits, public hearings, budget tracking or community scorecards.
Black Sash's fieldwork teams conducted several interviews and focus group discussions with key stakeholders in each health sub-district in the focus areas. These included: service users of the health facilities, district and provincial department of health officials, clinic and community health centre managers and nurses, community health workers and care givers, clinic and community health centre committee members, ward councillors and committee members, NGOs/CBOs, Imbizos, etc.
Black Sash found key barriers to accessing RMCH services (as expressed by service users) in two areas: factors affecting service use at the individual, household & community level and factors affecting service delivery at the health system level. The study also found that there are several factors undermining the functioning of clinic and community health centre committees which the Black Sash intervention will need to respond to.
We also found evidence of some committees which are functioning comparatively well and where much has been achieved through the hard work and commitment of those serving their community on the committee, and this was inspiring. These cases illustrate what can be achieved when people participate meaningfully in decision-making the health of their communities.
The baseline report documents all the key findings from this fieldwork and will be used to guide the development of interventions, tools and training to strengthen CCs/CHCCs and their engagement with civil society organisations and forums, with the intention of improving RMCH services.