Health Committees as Vehicles for Democratic Governance in Health Systems: Lessons from Selected Health Unit Management Committees in Uganda

Abstract Introduction : For over forty years, community participation has been a central component of a well-functioning health system. Despite its important role there are many difficulties in defining and understanding community participation as part of governance. Through a case study of selected health unit management committees in Uganda, this paper demonstrates that these committees can be structures for community participation and vehicles for democratic governance in health systems that advance health equity. Guided by the theoretical underpinnings of deliberative democracy the paper evaluates the performance of health unit management committees as a mechanism for citizen participation in health systems. Methods : This paper uses a qualitative, case-study methodology. Through an in-depth look at the health unit management committees of Kiboga and Kyankwanzi in Uganda, the study considered these as examples of structures for democratic community participation in health system. The study undertook literature review on the theories of deliberative democracy and human rights principles, and this provided the theoretical underpinnings of the study. Findings : Our findings underscore that community participation in health systems through health unit management committees ought to be grounded in the principles of deliberative democracy. The core of deliberative democracy is considered to be authentic deliberation and consensus decision-making, which can happen in both direct and representative democracies, giving rise to the notions of populist and elitist deliberative democracy, respectively. As such, a balance needs to be struck between the competitive notions of democracy and the public health requirements of inclusive and direct participation of communities in decision making processes on matters that affect their health. Conclusions : Community participation in the health sector in Uganda hinges on health unit management committees at the lower service provision points. These HUMCs are also perceived as vehicles to strengthen health governance through realizing the right to health of the communities. However, these have been established without attention to investing in capacity building needed to enable them to exercise community voice in the health system.