Online Reporter
Enock Musungwini
According to the World Health Organisation, primary health care is strongest when communities are not treated as passive recipients of services, but as active partners in shaping, monitoring and improving the health system.
This is the spirit of the 1978 Alma-Ata Declaration and the 2018 Astana Declaration, both of which placed community participation at the centre of effective and people-centred primary health care.
In Zimbabwe, health centre committees (HCCs) are legally recognised community health governance structures under Section 17 of the Public Health Act and are one of the most important vehicles for community participation. These committees are intended to link communities, health workers and district health authorities.
When they function well, they provide a platform for community voice, service feedback, health rights awareness, local problem-solving and accountability at clinic level.
Yet, in many places, HCCs remain underutilised and incapacitated.
Some are not properly constituted.
Others meet irregularly, lack clear documentation, have weak feedback systems or do not adequately represent women, young people, persons with disabilities and other groups that face barriers in accessing health services.
This is a missed opportunity.
HCCs should not be viewed as ceremonial structures.
They are practical local governance platforms that can help clinics become more responsive to the needs of the people they serve.
They can support health education, mobilise communities for outreach services, identify barriers to care, encourage respectful patient-provider relationships, engage in local resource mobilisation and strengthen trust between communities and the formal health system.
This is particularly important in rural and underserved communities, where clinics are often the first and most accessible point of care.
Issues such as long waiting times, privacy concerns, poor communication, limited disability access, weak referral follow-up, maternal health barriers, adolescent health needs, HIV-related stigma and gaps in community feedback can be better identified when communities have a structured voice.
Proper composition of HCCs is, therefore, critical. A committee that does not reflect the community cannot fully represent that group of people.
Women must be adequately represented, including in the HCC leadership, because they are among the most frequent users of primary health care services, especially for maternal health, child health, sexual and reproductive health, and family health needs.
Young people must be included because they experience unique barriers around HIV prevention, adolescent health, mental health, substance use, sexual and reproductive health information and youth-friendly services.
In line with the disability-inclusive development concept, persons with disabilities must be represented in HCCs because they understand the practical barriers that others may overlook, in areas such as access to buildings, communication, stigma and respectful care.
Zimbabwe has already recognised the importance of HCCs within its public health governance framework. However, legal recognition alone is not enough.
HCCs need capacity, clarity, tools and support. Members must understand their roles, how to conduct meetings, how to document issues, how to follow up action points, how to manage feedback, how to engage communities and how to work constructively with nurses-in-charge, local leaders and district health executives.
The experience of Pangaea Zimbabwe through the ZIMACE Project in Masvingo district offers useful lessons.
The project worked with 18 focus clinics to strengthen HCC composition, inclusivity, documentation, feedback mechanisms and accountability. The approach combined structured training, mentorship, supportive supervision, advocacy for inclusive membership and practical follow-up with clinic and community stakeholders.
The results were encouraging.
HCC membership in the supported clinics increased from 156 members at baseline to 200 after implementation, exceeding the expected minimum membership level across the 18 clinics. Women’s representation improved from 43,6 percent to 51,5 percent.
Representation of youths and persons with disabilities increased from 22 percent to 66 percent of clinics.
Feedback mechanisms improved from 78 percent to 100 percent. This means all supported clinics had at least one documented channel for community feedback after the intervention.
The availability of HCC minutes also improved from 89 percent to 100 percent.
These figures matter because they show that HCCs can be strengthened when deliberate investment is made in training, inclusion, mentorship and accountability.
They also show that underperformance is not inevitable.
With the right support, HCCs can become more active, more representative and more useful to both communities and health workers.
However, the Masvingo experience also highlights an important caution.
Increasing women’s general membership does not automatically translate into women’s leadership. In the supported clinics, women’s representation in combined chairperson and vice-chairperson roles improved only modestly.
This shows that gender responsiveness must go beyond numbers.
Women must not only be present in HCCs; they must also influence agendas, decisions and follow-up actions. The same applies to youth and disability inclusion. It is not enough to simply add a young person or a person with disability to a committee list.
Their participation must be meaningful.
Meeting times, venues, language, documentation and discussion processes must allow them to contribute. Their views must be recorded and acted upon.
Going forward, Zimbabwe needs a more systematic national approach to revitalising HCCs.
First, every clinic should have a properly constituted HCC with clear representation of women, youths, persons with disabilities, local leaders and other relevant community stakeholders.
Second, HCCs should receive standardised induction and refresher training.
This training should cover roles and responsibilities, primary health care, health rights, gender-responsive governance, disability inclusion, youth participation, safeguarding, meeting management, documentation, resource mobilisation and social accountability.
Third, feedback mechanisms must be strengthened.
Suggestion boxes, community meetings and community health rights champions only work when there is a clear feedback-response loop.
Communities must know where to report concerns, who opens the feedback channels, how issues are documented, how decisions are made and how responses are communicated back. Feedback without response can actually weaken trust.
Fourth, HCC data should become part of routine district health monitoring.
District health executives should track whether HCCs exist, whether they meet, whether minutes are available, whether action plans are followed, whether traditional leaders, women and marginalised groups are represented and whether feedback is acted upon.
What gets monitored is more likely to be sustained.
Fifth, HCC strengthening should be linked to broader primary health care priorities, including maternal health, HIV, adolescent health, mental health, disability inclusion, climate-related health risks, antimicrobial resistance awareness and emergency preparedness.
Communities are often the first to notice changes in disease patterns, service gaps and social barriers.
Strong HCCs can, therefore, support both routine health service delivery and public health preparedness.
The Ministry of Health and Child Care, local authorities, development partners, civil society organisations and communities should treat HCC revitalisation as a strategic investment in universal health coverage.
It is not a peripheral activity.
It is central to building a health system that listens, learns and responds.
Pangaea Zimbabwe’s work in Masvingo demonstrates that progress is possible.
The next step is to institutionalise such models, adapt them across districts and ensure that HCCs become functional platforms for community voice, gender equity, inclusion and accountability.
A clinic is not just a building where services are delivered.
It is part of a community.
If we want stronger primary health care, we must strengthen the structures that connect clinics to the people they serve.
Revitalising HCCs is one practical and urgent place to start.
* Enock Musungwini is a public health practitioner, health advocate and development practitioner with interests in public health, health policy, health systems strengthening, primary health care governance and social determinants of health. He is a PhD in Public Health candidate with UNICAF University.
