Reframing Health Committee Effectiveness Using the Capabilities Approach in South African Health Governance
1
Public Health Medicine, University of Cape Town, Cape Town, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):A3717
ABSTRACT
INTRODUCTION:
The White Paper for the Transformation of the Health System envisioned health committees as participatory structures enabling communities to hold health services accountable. However, the National Health Act does not define specific powers for health committees, leaving these to provincial legislation1. This has resulted in significant variation in how committees are structured, supported, and empowered across provinces, often limiting their legitimacy, resources, and influence2,3. Existing research has largely focused on formal structures and procedural compliance, with limited attention to agency, representation, capabilities, and community trust that shape participation in practice.
METHODS:
This PhD proposal develops an empirically grounded analytical framework intended to inform the development of a practical assessment model for evaluating health committee effectiveness. Guided by Rifkin’s CHOICE framework and informed by Amartya Sen’s Capabilities Approach, effectiveness is conceptualised as multidimensional, encompassing agency, accountability, inclusivity, and sustainability4–6. The study will employ qualitative case studies in Klipfontein, Khayelitsha, and Nelson Mandela Bay, using focus group discussions, key informant interviews, and participatory workshops to examine how institutional arrangements, power relations, and resources enable or constrain meaningful community participation in health governance.
RESULTS:
The study anticipates demonstrating that health committee effectiveness depends not only on the existence of formal participatory structures, but on the extent to which institutional recognition, resources, and support are converted into real capabilities for participation and influence. These insights are expected to inform the development of an assessment model that identifies key determinants shaping health committee functionality across contexts.
CONCLUSIONS:
By applying the Capabilities Approach as an analytical lens rather than a theory-building exercise, this study contributes a context-sensitive assessment model for understanding and assessing health committee effectiveness. The proposed model aims to support strategies as instruments of procedural equity, empowerment, and community-centred accountability in South African health governance, particularly in contexts preparing for health system reform.
The White Paper for the Transformation of the Health System envisioned health committees as participatory structures enabling communities to hold health services accountable. However, the National Health Act does not define specific powers for health committees, leaving these to provincial legislation1. This has resulted in significant variation in how committees are structured, supported, and empowered across provinces, often limiting their legitimacy, resources, and influence2,3. Existing research has largely focused on formal structures and procedural compliance, with limited attention to agency, representation, capabilities, and community trust that shape participation in practice.
METHODS:
This PhD proposal develops an empirically grounded analytical framework intended to inform the development of a practical assessment model for evaluating health committee effectiveness. Guided by Rifkin’s CHOICE framework and informed by Amartya Sen’s Capabilities Approach, effectiveness is conceptualised as multidimensional, encompassing agency, accountability, inclusivity, and sustainability4–6. The study will employ qualitative case studies in Klipfontein, Khayelitsha, and Nelson Mandela Bay, using focus group discussions, key informant interviews, and participatory workshops to examine how institutional arrangements, power relations, and resources enable or constrain meaningful community participation in health governance.
RESULTS:
The study anticipates demonstrating that health committee effectiveness depends not only on the existence of formal participatory structures, but on the extent to which institutional recognition, resources, and support are converted into real capabilities for participation and influence. These insights are expected to inform the development of an assessment model that identifies key determinants shaping health committee functionality across contexts.
CONCLUSIONS:
By applying the Capabilities Approach as an analytical lens rather than a theory-building exercise, this study contributes a context-sensitive assessment model for understanding and assessing health committee effectiveness. The proposed model aims to support strategies as instruments of procedural equity, empowerment, and community-centred accountability in South African health governance, particularly in contexts preparing for health system reform.
| eISSN: | 2654-1459 |
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