Abstract
The chapter explores and describes community participation in the National Development Plan through Primary Health Care by using case studies of LGBT organizations in South Africa. Post-Apartheid and democratic South Africa has endorsed community participation as one of the fundamental pillars of the public Primary Health Care approach in its governance structures. This chapter focuses on the current major health issue in South Africa, the HIV epidemic, which is one of the leading causes of death in the country. Particular attention is paid to members of the LGBT community because of their discrimination in public healthcare facilities on grounds of their sexual orientation. The chapter relies on secondary sources of data collection from extant literature, textbooks, journal articles, and internet sources. Challenges to address LGBT community discrimination in HIV testing, prevention, treatment, care, and support were identified and solutions to uphold their human rights were proffered. These solutions are based on the principles of social justice, inclusion, diversity, and equality.
TopIntroduction
During the apartheid era in South Africa, the process of community participation was not encouraged due to bureaucracy and segregation policies. In post-apartheid South Africa however, this process has gained full support from the democratic government. Community participation is considered to be an empowerment tool in which local communities can take responsibility in identifying and addressing their own problems through collaboration with different stakeholders in the community, including local government. Community participation enables people to realise their rights to participate in problem-solving and decision-making processes regarding issues that affect their day-to-day life in the communities that they live in. It is regarded as the process of allowing citizens within a community to participate in the formulation of policies and proposals on issues that affect the community as a whole (Ngcaweni, 2016). In developing countries such as South Africa, community participation is generally accepted as a key component of good governance for implementing effective and efficient developmental processes. As a result, community participation is widely regarded as a catalyst for an efficacious developmental process. This has been the cornerstone of the South African National Development Plan (NDP) Vision 2030 in which communities are urged to actively participate in development issues to address problems such as poverty, inequality and health issues in society. The NDP Vision 2030 is a national strategic plan that was released in 2012 to outline South Africa’s developmental goals that are to be accomplished by the year 2030. The NDP Vision 2030 has specifically identified nine key challenges that face South Africa, namely:
- 1.
Too few people work.
- 2.
The quality of school education for black people is poor.
- 3.
Infrastructure is poorly located, inadequate and under-maintained.
- 4.
Spatial divides hobble inclusive development.
- 5.
The economy is unsustainably resource-intensive.
- 6.
The public health system cannot meet demand or sustain quality.
- 7.
Public services are uneven and often of poor quality.
- 8.
Corruption levels are high.
- 9.
South Africa remains a divided society.
Given this myriad of challenges facing South Africa, this chapter focuses on the current major health issue in South Africa, the HIV epidemic, which is one of the leading causes of death in the country. South Africa is also home to the largest number of people living with HIV and AIDS in the whole world. The South African National Strategic Plan on HIV and AIDS for 2017 – 2022 has identified the Lesbian, Gay, Bisexual and Transgender (LGBT) community as one of the key populations at risk of HIV infection, however, members of the LGBT community have been discriminated against in public Primary Health Care (PHC) services based on their sexual orientation (Reddy, Sandfort, & Rispel, 2009). Discrimination on the basis of one’s sexual orientation is a constitutional rights violation in South Africa. This is stipulated in Act No. 108 of 1996 Clause 9(3) of the Constitution of the Republic of South Africa which states that:
The state may not unfairly discriminate directly or indirectly against anyone on one or more grounds including race, gender, sex, pregnancy, marital status, ethnic or social origin, colour, sexual orientation, age, disability, religion, conscience, belief, culture, language and birth.
Key Terms in this Chapter
Community Participation: Is considered to be an empowerment tool in which local communities can take responsibility in identifying and addressing their own problems through collaboration with different stakeholders in the community, including local government. Community participation enables people to realize their rights to participate in problem-solving and decision-making processes regarding issues that affect their day-to-day life in the communities that they live in.
Communities: Are usually the ones who know and have experience about their health problems. In this regard, they are also the ones who are better positioned in guiding and informing PHC service providers in rendering solutions to these health problems.
Lesbian, Gay, Bisexual, and Transgender (LGBT) Community: Is one of the key populations at risk of HIV infection; however, members of the LGBT community have been discriminated against in public Primary Health Care (PHC) services based on their sexual orientation.
South African National Development Plan (NDP) Vision 2030: Is a plan in which communities are urged to actively participate in development issues to address problems such as poverty, inequality, and health issues in society. The NDP Vision 2030 is a national strategic plan that was released in 2012 to outline South Africa’s developmental goals that are to be accomplished by the year 2030.