Community Based Monitoring to Increase Access of Adolescents to Primary Health Care Services: A Soul City Case Study

This 4-page case study discusses the findings of a process evaluation of a community-based monitoring (CBM) of health services project conducted in twelve South African communities to assess and support quality health care and increase access to and participation in health care by adolescents. "CBM is a form of public oversight that uses local information to describe and track changes within the health care system. It is aimed at promoting accountability through increased involvement of users in the delivery of health care services" (see Related Summaries below for more information). The monitoring is being led by the Soul City Institute for Health and Development Communication (SCI) and funded by the Department of Health and the European Union, while the evaluation is a project sponsored by the Reducing Maternal and Child Mortality through Strengthening Primary Health Care (RMCH) Programme, which is implemented by GRM Futures Group in partnership with Health Systems Trust, Save the Children South Africa, and Social Development Direct, with funding from the United Kingdom Government.

According to the case study, "reducing child maternal mortality requires greater focus on the adolescent phase of life" as "lowering rates of adolescent pregnancy will decrease maternal mortality and increase child survival." The case study explains that despite the importance of adolescent health, this population is often the most poorly served by health services. The CBM was used to gather information that was then compiled into report cards and used to engage the community, health facility staff and management, and health officials to discuss the concerns raised and jointly seek solutions. The case study discusses a number of outcomes from the process, including increased public interest, participation and utilisation of health care services, improved efficiency and productivity, and improved staff attitudes and better patient-staff rapport, "an important factor for adolescents accessing health care services."

The case study also outlines lessons learned. These include the importance of consultation and planning. "Getting buy-in from the health care services is also an important milestone to ensure that they are not threatened by the process, but rather understand its value to improving maternal and child health outcomes amongst adolescents." Selecting good teams and early introduction to the community are cited as important, as well as ensuring visibility of both CBM teams (through a uniform of sorts) and score charts to increase wider community involvement.

The case study brief offers six recommendations resulting from the CBM process:

• expand the CBM programme to more facilities;
• develop linkages with community structures outside the clinic, such as youth organisations, citizen-based organisations (CBO)’s, and local councils;
• partner with existing ward, municipal and district AIDS councils to increase technical support and sustainability;
• research and develop evidence-based interventions to address why young people don’t access services;
• ensure that existing teams support new teams through mentorship and skills sharing;
• develop formal feedback mechanisms between the CBM teams and communities, both face-to-face and through local media, to report back on activities undertaken and what achievements or bottlenecks still exist.