Lessons from community participation in primary health care and water resource governance in South Africa: a narrative review

Jennifer Hove* (Corresponding Author), Lucia D'Ambruoso, Kathleen Kahn, Sophie Witter, Maria Van Der Merwe, Denny Mabetha, Kingsley Tembo, Rhian Twine

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

8 Citations (Scopus)
23 Downloads (Pure)


Background: In South Africa, community participation has been embraced through the development of progressive policies to address past inequities. However, limited information is available to understand community involvement in priority setting, planning and decision- making in the development and implementation of public services.
Objective: This narrative review aims to provide evidence on forms, extents, contexts and dynamics of community participation in primary health care (PHC) and water governance in South Africa and draw cross-cutting lessons. This paper focuses on health and water govern- ance structures, such as health committees, Catchment Management Agencies (CMA), Water User Associations (WUAs), Irrigation Boards (IBs) and Community Management Forums (CMFs).
Methods: Articles were sourced from Medline (Ovid), EMBASE, Google Scholar, Web of Science, WHO Global Health Library, Global Health and Science Citation Index between 1994 and 2020 reporting on community participation in health and water governance in South Africa. Databases were searched using key terms to identify relevant research articles and grey literature. Twenty-one articles were included and analysed thematically.
Results: There is limited evidence on how health committees are functioning in all provinces in South Africa. Existing evidence shows that health committees are not functioning effec- tively due to lack of clarity on roles, autonomy, power, support, and capacity. There was slow progress in establishment of water governance structures, although these are autonomous and have mechanisms for democratic control, unlike health committees. Participation in CMAs/WUAs/IBs/CMFs is also not effective due to manipulation of spaces by elites, lack of capacity of previously disadvantaged individuals, inadequate incentives, and low commit- ment to the process by stakeholders.
Conclusion: Power and authority in decision-making, resources and accountability are key for effective community participation of marginalized people. Practical guidance is urgently required on how mandated participatory governance structures can be sustained and linked to wider governance systems to improve service delivery.
Original languageEnglish
Article number2004730
Number of pages18
JournalGlobal Health Action
Issue number1
Publication statusPublished - 7 Jan 2022

Bibliographical note

Funding information
This review was funded by the Joint Health Systems Research Initiative from Department for International Development/MRC/Welcome Trust/Economic and Social Research Council [MR/N005597/1 and MR/P014844/1].


  • Community participation
  • primary health care
  • water governance
  • health committees
  • catchment management agencies


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