Background
Maternal and child health mortality rates in South Africa remain unacceptably high in South Africa, and community-focused efforts are crucial in addressing this situation. This DFID- funded project aimed to strengthen public accountability mechanisms at community health facilities, in order to improve maternal and child healthcare services, using a community score card methodology.
The project focussed on the Eastern Cape and KZN provinces and was implemented by the Black Sash Port Elizabeth and Durban Regional Offices. It investigated if, and how, existing accountability structures in communities and public health facilities can be strengthened and included to increase community participation to improve maternal and child health.
The project showed that strengthening the accountability function of Clinic Committees, involving service users and service providers, and other multi-stakeholders involved in Maternal, Newborn and Child Health (MNCH), has the potential to form a social compact to jointly address supply and demand challenges.
This three-year national programme, running from May 2012 until March 2015, was funded by the United Kingdom's Department for International Development.
Objectives
- Improve demand and accountability for MNCH services.
- Strengthen delivery of school health, ward-based primary health care, and obstetric & neonatal emergency services.
- Support districts in overseeing improvement of MNCH services.
- Document and disseminate new knowledge in order to remove barriers which prevent uptake and access to MNCH services.
Actions Taken
The project started out with an extensive situational analysis in 2013, resulting in a Baseline Report. It also conducted a literature review on experience in strengthening clinic committees and on possible interventions to strengthen demand and accountability for MNCH services (such as community scorecards, safe motherhood groups and participatory budgeting) as intervention methodologies.
Key Lessons
- A key lesson learnt from this project is that joint monitoring and accountability through Clinic Committees is important. To facilitate partnerships especially between facility staff and the community, exploring communication and joint problem solving between different levels of health care staff and facility management is a key recommendation.
- Using this intervention, monitoring maternal and child health outcomes (as identified in the agreed upon action plan) has to be repeated several times over a long period of time, to observe any changes and impact.
- The RMCH Action Groups in the districts have the capacity to implement the community scorecard process independently, but require adequate support and resources to do so.
- Emphasis should be placed on government providing adequate financial support to CCs so that they need not rely on project cycle funding from CSOs, which is not sustainable in an environment of reduced donor support to South Africa’s civil society sector.
