Social audit of provincial health services: building the community voice into planning in South Africa.

Social audits of health services in three South African provinces (Limpopo 2001, Gauteng 2003 and Eastern Cape 2001) demonstrated a fusion of participatory research, qualitative data collection, epidemiological surveys and analysis, and socialising of evidence for action. The social audit in each province involved the community in covering eight principles of service delivery. In the particular case of Gauteng province, householders answered a questionnaire on public perceptions of government health services. In each sentinel community, the results were returned for discussion in focus groups, made up of a sample that had answered the household questionnaire. Institutional reviews of health facilities and interviews with health workers in those facilities gave the government side of the story. Five actions came from the community-based focus groups, all accepted by the provincial government. Firstly, redesigned communication strategies will aim to reach those with lower levels of education. The second set of actions involves rebuilding the culture of care. Thirdly, the public knowledge of ways to complain was closely related to levels of public satisfaction. Leadership in the health services turned out to be a fourth area for development. And finally, related to this, is the longer-term challenge of establishing and reinforcing community consultation mechanisms.