Implementing a rights-based approach to community participation through public health law reform: A study of the Western Cape's Draft Policy Framework for Community Participation

Community participation is crucial to realizing public health goals, yet many health systems have not established the legislative frameworks necessary to promote effective participation. This study assesses the political, historical, and legal context of the health care policymaking process in South Africa's Western Province, investigating how stakeholders considered a Draft Policy Framework for Community Participation/Governance Structures in provincial legislative reforms. This research examines the development of South Africa's human rights-based commitment to participation through the evolution of post-Apartheid legislation to secure community participation in health care policy decisions. South African policymakers have worked in the past decade to codify executive and legislative measures to incorporate community participation in health systems, recognizing community participation as instrumental to realizing a constitutional commitment to the right to health. Although these policies have resulted in a system of Health Committees under the District Health System, many Health Committees have struggled to promote community participation without formal recognition under law. Through legal analysis of national and provincial legislation and a series of in-depth interviews with key stakeholders, this research explores the key facilitating and inhibiting factors for public health law reform to enable community participation. By analyzing the legal frameworks established in South Africa to advance community participation in health, this research concludes that attempts to promote participation have not adequately addressed the underlying factors crucial to achieving effective participation. Assuring the future success of participation, this study recommends that policymakers address issues of representation, roles, responsibilities, and capacity building for Health Committees under law.