Health committee participation in South Africa during the COVID-19 pandemic: a shifting picture

Background Community participation is an important component in disease outbreak management during times of systemic disruption. However, community participation was lacking in South Africa during the COVID-19 pandemic. It is known that participation at community level faces numerous barriers locally and globally, with efforts towards meaningful participation often being inadequate. The spaces (referring to invented, invited and closed spaces for participation) where participation takes place impact the level and quality of participation. Methods The aim of this chapter is to explore how participation in health committee spaces was affected during the pandemic, and how the relationship between the state (the Western Cape Department of Health (WCDoH)) and health committees evolved during this period. Health committees are linked to primary care facilities and include community representatives, facility managers, and municipal political representatives (ward councillors), functioning as a bridge between community and health facilities. This qualitative study was conducted in three phases. In phases one and three, focus group discussions were held with health committees in two economically marginalised areas in Cape Town, South Africa. Phase two involved a three-month observation of committee activities. Both inductive and deductive content analysis were used to analyse the findings. In the deductive analysis, two conceptual frameworks – Arnstein’s Ladder of Citizen Participation and Gaventa’s notion of invited and invented spaces – were used to interpret the findings. Results During the COVID-19 pandemic, health committees responded to community needs and carried out tasks that the WCDoH failed to do. The Department recognised the limits of its pandemic response and the need for collaboration with community actors. This recognition led to an opening up of previously closed spaces to include health committees in more meaningful forms of participation. While there was an opening up, barriers in these spaces hindered participation. Health committees accordingly expanded their roles and empowered members to include themselves in WCDoH spaces and invent their own spaces for participation. Conclusions The COVID-19 pandemic illustrated the critical role health committees can play in disease outbreak management. The interplay between invited and invented spaces is highlighted as an important consideration for meaningful participation. Health committees should be actively involved in decision making and implementation processes for participation in invited spaces to be meaningful.