Re-imagining community participation at the district level: Lessons from the DIALHS collaboration.

In South Africa, the value of community participation as one of the central components of a primary health care approach is highlighted in legislation, policy documents and strategic plans. There is widespread acceptance that community participation strengthens community empowerment, disease prevention and access to services. Since 2010, the District Innovation and Action Learning for Health System Development collaboration has co-produced knowledge about how to strengthen district health systems. Nested within this collaboration is a series of engagements seeking to understand and strengthen community participation including a multi-stakeholder health risks and assets mapping activity; ‘Local Action Group’ initiatives; reflective meetings with service colleagues about community participation experiences; and a capacity-development initiative (community participation-related short courses and mentoring). These engagements hold a number of lessons for those interested in enhancing the population orientation of primary health care and the district health system, the first of which is the clear benefit to those interested in community roles and engagement of convening spaces for dialogue. However, it is not easy to generate and sustain these spaces. Through the application of a framework of collective capacity, this chapter aims to shed light on why this is the case, and in so doing, to highlight a second lesson, which is the perhaps unrecognised capacities of certain cadres, particularly environmental health practitioners, in the implementation of community participation. Ultimately, the chapter seeks to stimulate thinking and engagement about the ways in which dialogue and participation can enrich the South African health system.