Strengthening Inclusive, Gender-Responsive and Accountable Community Health Governance Through Health Centre Committees in Masvingo District, Zimbabwe

Background: Health Centre Committees (HCCs) are intended to strengthen community participation, social accountability and local primary health care governance, yet many remain weakly constituted and insufficiently inclusive. This paper examines programme-associated changes in HCC functionality and other outcomes following structured capacity strengthening in Masvingo District, Zimbabwe. Methods: A comparative descriptive design used programme monitoring data from 18 Pangaea Zimbabwe ZIMACE-supported focus clinics assessed at baseline in July 2024 and during post-implementation monitoring in 2025, together with 18 non-focus clinics assessed as a comparison benchmark. Indicators included HCC membership size, gender composition, women in leadership, youth and persons with disabilities (PWD) representation, availability of feedback mechanisms and HCC meeting documentation and action plans. Results: HCC membership in focus clinics increased from 156 members at baseline to 200 post-implementation, exceeding the expected minimum of 198 members across 18 clinics; non-focus clinics had 111 members. Women’s membership increased from 43.6% to 51.5% in focus clinics, compared with 42.3% in non-focus clinics. Youth and PWD representation increased from 22% to 66% in focus clinics, compared with 28% in non-focus clinics. Feedback mechanisms increased from 78% to 100% in focus clinics, compared with 72% in non-focus clinics. Women’s leadership combining chairperson and vice-chairperson representation changed modestly from 33% to 35%, indicating that leadership transformation remains incomplete. Conclusion: Structured training, advocacy, mentorship and supportive supervision were associated with rapid strengthening of HCC functionality, inclusion and accountability. However, HCC strengthening must move from representation to influence by institutionalising women’s leadership, youth and PWD participation, feedback-response loops, documentation quality and links to district decision-making.

Community participation; disability inclusion; gender-responsive governance; Health Centre Committees; primary health care; social accountability; Zimbabwe.

1. Aggarwal, R. and Ranganathan, P. (2019) ‘Study designs: Part 2 - Descriptive studies’, Perspectives in Clinical Research, 10(1), pp. 34–36. Available at: https://doi.org/10.4103/picr.PICR_154_18 [Google Scholar] [Crossref]

2. Arnstein, S.R. (1969) ‘A ladder of citizen participation’, Journal of the American Institute of Planners, 35(4), pp. 216–224. Available at: https://doi.org/10.1080/01944366908977225 [Google Scholar] [Crossref]

3. Cantrell, M.A. (2011) ‘Demystifying the research process: Understanding a descriptive comparative research design’, Pediatric Nursing, 37(4), pp. 188–189. [Google Scholar] [Crossref]

4. Chikonde, N. (2017) Training clinic health committees: A vehicle for improving community participation in health. Master’s thesis. University of Cape Town. Available at: http://hdl.handle.net/11427/27060 [Google Scholar] [Crossref]

5. Danforth, K., Ahmad, A.M., Blanchet, K., Khalid, M., Means, A.R., Memirie, S.T., Alwan, A. and Watkins, D. (2023) ‘Monitoring and evaluating the implementation of essential packages of health services’, BMJ Global Health, 8(Suppl. 1), e010726. Available at: https://doi.org/10.1136/bmjgh-2022-010726 [Google Scholar] [Crossref]

6. Denison, J.A., Pettifor, A., Mofenson, L.M. et al. (2017) ‘Youth engagement in developing an implementation science research agenda on adolescent HIV testing and care linkages in sub-Saharan Africa’, AIDS, 31(Suppl. 3), pp. S195–S201. Available at: https://doi.org/10.1097/QAD.0000000000001509 [Google Scholar] [Crossref]

7. Durrance-Bagale, A., Marzouk, M., Tung, L.S. et al. (2022) ‘Community engagement in health systems interventions and research in conflict-affected countries: A scoping review of approaches’, Global Health Action, 15(1), 2074131. Available at: https://doi.org/10.1080/16549716.2022.2074131 [Google Scholar] [Crossref]

8. Fisher, R.A. (1922) ‘On the interpretation of chi-square from contingency tables, and the calculation of P’, Journal of the Royal Statistical Society, 85(1), pp. 87–94. Available at: https://doi.org/10.2307/2340521 [Google Scholar] [Crossref]

9. Fung, A. (2006) ‘Varieties of participation in complex governance’, Public Administration Review, 66(Suppl. 1), pp. 66–75. Available at: https://doi.org/10.1111/j.1540-6210.2006.00667.x [Google Scholar] [Crossref]

10. Gaventa, J. and Barrett, G. (2012) ‘Mapping the outcomes of citizen engagement’, World Development, 40(12), pp. 2399–2410. Available at: https://doi.org/10.1016/j.worlddev.2012.05.014 [Google Scholar] [Crossref]

11. Goodrich, D.E., Miake-Lye, I., Braganza, M.Z. et al. (2020) The QUERI Roadmap for Implementation and Quality Improvement. Department of Veterans Affairs. Available at: https://www.ncbi.nlm.nih.gov/books/NBK566228/ [Google Scholar] [Crossref]

12. Greaux, M., Moro, M.F., Kamenov, K., Russell, A.M., Barrett, D. and Cieza, A. (2023) ‘Health equity for persons with disabilities: A global scoping review on barriers and interventions in healthcare services’, International Journal for Equity in Health, 22, 236. Available at: https://doi.org/10.1186/s12939-023-02035-w [Google Scholar] [Crossref]

13. Haricharan, H.J., Stuttaford, M. and London, L. (2021a) ‘Effective and meaningful participation or limited participation? A study of South African health committee legislation’, Primary Health Care Research & Development, 22, e28. Available at: https://doi.org/10.1017/S1463423621000323 [Google Scholar] [Crossref]

14. Haricharan, H.J., Stuttaford, M. and London, L. (2021b) ‘The role of community participation in primary health care: Practices of South African health committees’, Primary Health Care Research & Development, 22, e31. Available at: https://doi.org/10.1017/S146342362100027X [Google Scholar] [Crossref]

15. Hay, K., McDougal, L., Percival, V. et al. (2019) ‘Disrupting gender norms in health systems: Making the case for change’, The Lancet, 393(10190), pp. 2535–2549. Available at: https://doi.org/10.1016/S0140-6736(19)30648-8 [Google Scholar] [Crossref]

16. Isangula, K., Pallangyo, E.S. and Ndirangu-Mugo, E. (2023) ‘The perceived benefits and effectiveness of patient feedback systems in strengthening patient-provider relationships in rural Tanzania’, BMC Health Services Research, 23, 1202. Available at: https://doi.org/10.1186/s12913-023-10198-z [Google Scholar] [Crossref]

17. Kagwanja, N., Gilson, L., Tsofa, B., Olivier, J., Leli, H. and Molyneux, S. (2024) ‘Understanding health system responsiveness to public feedback at the sub-national level: Insights from Kilifi County, Kenya’, PLOS Global Public Health, 4(12), e0002814. Available at: https://doi.org/10.1371/journal.pgph.0002814 [Google Scholar] [Crossref]

18. Karuga, R., Kok, M., Luitjens, M., Mbindyo, P., Broerse, J.E.W. and Dieleman, M. (2022) ‘Participation in primary health care through community-level health committees in Sub-Saharan Africa: A qualitative synthesis’, BMC Public Health, 22, 359. Available at: https://doi.org/10.1186/s12889-022-12730-y [Google Scholar] [Crossref]

19. Kime, N., McKenna, J. and Webster, L. (2013) ‘Young people’s participation in the development of a self-care intervention: A multi-site formative research study’, Health Education Research, 28(3), pp. 552–562. Available at: https://doi.org/10.1093/her/cys107 [Google Scholar] [Crossref]

20. Loewenson, R., Machingura, F., Kaim, B., TARSC and Rusike, I. (CWGH) (2014) Health centre committees as a vehicle for social participation in health systems in east and southern Africa. EQUINET Discussion Paper 101. Harare: TARSC, CWGH, Medico International and EQUINET. [Google Scholar] [Crossref]

21. Loewenson, R., Rusike, I. and Zulu, M. (2004) Assessing the impact of health centre committees on health system performance and health resource allocation. Harare: EQUINET. [Google Scholar] [Crossref]

22. Mackworth-Young, C.R., Dringus, S., Dauya, E. et al. (2022) ‘Putting youth at the centre: Co-design of a community-based intervention to improve HIV outcomes among youth in Zimbabwe’, Wellcome Open Research, 7, 53. Available at: https://doi.org/10.12688/wellcomeopenres.17531.2 [Google Scholar] [Crossref]

23. Malena, C., Forster, R. and Singh, J. (2004) Social accountability: An introduction to the concept and emerging practice. Social Development Paper No. 76. Washington, DC: World Bank. [Google Scholar] [Crossref]

24. Maluka, S.O. and Bukagile, G. (2016) ‘Community participation in the decentralised district health systems in Tanzania: Why do some health committees perform better than others?’, International Journal of Health Planning and Management, 31(2), pp. E86–E104. Available at: https://doi.org/10.1002/hpm.2299 [Google Scholar] [Crossref]

25. Mdaka, K., Haricharan, H.J. and London, L. (2014) The role of health committees in equitable, people-centred health systems in Southern and East African region. Cape Town: University of Cape Town. [Google Scholar] [Crossref]

26. Melles, M.O. and Ricker, C.L. (2018) ‘Youth participation in HIV and sexual and reproductive health decision-making, policies, programmes: Perspectives from the field’, International Journal of Adolescence and Youth, 23(2), pp. 159–167. Available at: https://doi.org/10.1080/02673843.2017.1317642 [Google Scholar] [Crossref]

27. Mirzoev, T., Kane, S., Al Azdi, Z., Ebenso, B., Chowdhury, A.A. and Huque, R. (2021) ‘How do patient feedback systems work in low-income and middle-income countries? Insights from a realist evaluation in Bangladesh’, BMJ Global Health, 6(2), e004357. Available at: https://doi.org/10.1136/bmjgh-2020-004357 [Google Scholar] [Crossref]

28. Mulumba, M., London, L., Nantaba, J. and Ngwena, C. (2018) ‘Using health committees to promote community participation as a social determinant of the right to health: Lessons from Uganda and South Africa’, Health and Human Rights, 20(2), pp. 11–17. [Google Scholar] [Crossref]

29. Musungwini, E., Magarira, B., Mutyasira, R.S. and Mudzingwa, S. (2026) ‘Making Health Centre Committees effective, inclusive and gender-responsive to health and HIV/AIDS access and services in Masvingo District, Zimbabwe: Implementation lessons from the Pangaea Zimbabwe ZIMACE capacity strengthening project’, unpublished conference abstract. [Google Scholar] [Crossref]

30. Newcombe, R.G. (1998) ‘Two-sided confidence intervals for the single proportion: Comparison of seven methods’, Statistics in Medicine, 17(8), pp. 857–872. [Google Scholar] [Crossref]

31. Palinkas, L.A., Horwitz, S.M., Green, C.A., Wisdom, J.P., Duan, N. and Hoagwood, K. (2015) ‘Purposeful sampling for qualitative data collection and analysis in mixed method implementation research’, Administration and Policy in Mental Health, 42(5), pp. 533–544. Available at: https://doi.org/10.1007/s10488-013-0528-y [Google Scholar] [Crossref]

32. San Sebastian, M., Maluka, S., Kamuzora, P. et al. (2023) ‘Role of health facility governing committees in strengthening social accountability to improve the health system in Tanzania: Protocol for a participatory action research study’, BMJ Open, 13(6), e067953. Available at: https://doi.org/10.1136/bmjopen-2022-067953 [Google Scholar] [Crossref]

33. Smythe, T., Mabhena, T., Murahwi, S., Kujinga, T., Kuper, H. and Rusakaniko, S. (2022) ‘A path toward disability-inclusive health in Zimbabwe Part 1: A qualitative study on access to healthcare’, African Journal of Disability, 11, a990. Available at: https://doi.org/10.4102/ajod.v11i0.990 [Google Scholar] [Crossref]

34. WHO and UNICEF (1978) Declaration of Alma-Ata: International Conference on Primary Health Care, Alma-Ata, USSR, 6–12 September 1978. Geneva: World Health Organization. [Google Scholar] [Crossref]

35. WHO Gender Equity Hub (2020) Gender, equity and leadership in the global health and social workforce: Policy brief for consultation. Geneva: World Health Organization. [Google Scholar] [Crossref]

36. Wilson, E.B. (1927) ‘Probable inference, the law of succession, and statistical inference’, Journal of the American Statistical Association, 22(158), pp. 209–212. Available at: https://doi.org/10.1080/01621459.1927.10502953 [Google Scholar] [Crossref]

37. World Health Organization (2018) Declaration of Astana. Geneva: World Health Organization. [Google Scholar] [Crossref]

38. World Health Organization (2022) Global report on health equity for persons with disabilities. Geneva: World Health Organization. [Google Scholar] [Crossref]

• Tribal Child Nutrition and Health in District of Sundargarh: A Public Health Review of ICDS Intervention
• Knowledge, Attitudes and Practices Towards Prostate Cancer Screening Amongst Men Aged 40-60 Years in The Buea Health District: A Cross-Sectional Study
• Compliance with JCI Protocols: A Focus on Employee Safety
• Influence and Involvement of Teachers in Menstrual Hygiene Management of Female Secondary School Students in Kogi State, Nigeria
• A Critical Evaluation of Ayushman Bharat Pradhan Mantri Jan Arogya Yojana in Bihar