Need a CAB? The Power of a Community Advisory Board (CAB)

November 18, 2008

Need a CAB?  The Power of a Community Advisory Board (CAB)

By Kelly N Patterson



Back in 2000, as the HIV epidemic seized South Africa, Hlabisa District (a geographical area of 3500 square kilometres in Northern Kwa Zulu Natal) was one of South Africa’s regions most observably encumbered by the virus and its debilitating effect on the development of this area.  At the time, Hlabisa District had a 41.6% HIV prevalence rate:  this means almost one in two people were living with HIV, with equally high prevalence rates of Tuberculosis (TB) and malaria.


Reasons for the advanced stage of the epidemic in the district include the high level of labor migration due to lack of local employment opportunities, limited access to treatment for sexually transmitted diseases, the low status of women, general poverty and malnutrition in the rural areas, and poor local public infrastructures.  Historically under-funded and under-resourced public services in the district made its health care services unable to cope with the growing demand for care as a result of the epidemic. 


Back in 2000, the public health facilities in Hlabisa District consisted of a central hospital (420 beds), 12 fixed community clinics, and 3 mobile clinics expected to serve as many as 250,000 primarily Zulu-speaking people.  Community Health Workers (CHW), mainly women, over the age of 30, appointed by the community, further supported community health services.  CHW were present in most areas of the district; however, they were responsible for the supervision of integrated health care (on average) of 150 households per person.  And most of these CHW worked full-time hours even though the local department of health could only afford part-time wages.


The reality of the situation, in plain terms, was that the majority of local employable adults (25 –45 years old): teachers, police officers, taxi drivers, farmers, nurses, government workers, etc., were either constantly sick, dying or already dead of AIDS-related illnesses throughout the region.  This was leaving grandmothers, with and without pension schemes, ill adults, and children with the burden of carrying all societal functions.  It was not uncommon to find teen orphans head of a household of other AIDS-related orphans.


In light of these overwhelming circumstances, on October 25, 2000, three individuals, Dr. Annemie Vanneste, Medical Researcher at Demographic Surveillance System, Africa Centre; Dr Mel Scrace, Hlabisa Hospital Doctor; and Kelly N. Patterson, development worker for Vusimpilo (a local healthcare and rural development CBO), convinced 200+ Hlabisa District community leaders, of all sectors and all levels of local and provincial public infrastructure, to attend a day-long workshop together, with the sole goal to a create a multi-sectoral, comprehensive Community Advisory Board (CAB) and plan to tackle the HIV/AIDS crisis in the Hlabisa health district. 


The workshop objectives were clearly defined:  (1) to develop, implement and supervise a comprehensive multi-media HIV/AIDS awareness and prevention campaign involving all sectors; (2) to upgrade local voluntary testing and counseling services, (3) to scale-up local mother-to-child transmission programs, and last but not least, (4) care for orphans and vulnerable children.  Workshop participants came from local and provincial governments (everyone from departments of agriculture to transportation to social services), the religious sector, the medical community, local businesses, traditional healers, teachers and principals, CHW, the civil society sector, women’s and youth groups, and most importantly, people living with HIV/AIDS (PLWHA). 


As a result of this landmark workshop, a Community Advisory Board (CAB) was formed; representatives were elected from all sectors.  Participants agreed to refer to the work of the CAB as the “Hlabisa Community Based Care and Support” (CBC&S) program.    The intention of the Hlabisa CBC&S program was to assure healthcare and support coverage of all parts of the district, as well as to make the most optimal use of already existing human and other resources, in order to avoid unnecessary overlap, competition and gaps in healthcare and development programs and services throughout the district.  


The first CAB assignment, issued from the community, was to conduct a comprehensive needs assessment of the current community care-giving services and current patients in need of home-based care.  Therefore, the CAB decided to create a total of three databases, using local human resources and networks to collect the data: 


(1)   A database for all those patients in need of current care; all people infected with HIV/AIDS, chronically disabled, and the terminally ill.  (The CAB defined “patients in need of current care” as people who are dying, as well as people who need constant 24 hour care by a caregiver.)

(2)   A database for all current, active caregivers throughout Hlabisa district. 

(3)   A database of orphans and vulnerable children.


Individuals from the local community, from various sectors, were identified and assigned, by the CAB, to collect the data for these databases.  This way individuals were held accountable for their roles in the Hlabisa CBC&S program, not entire institutions or organizations (like the department of health). 


Now, it is 2008, and the Hlabisa CAB and CBC&S programs are still operating.  Since its conception, in 2000, the CAB has promoted partnership among all sectors and community members.   Community educators, appointed by the CAB, have been employed to raise awareness of HIV/AIDS among young people, encourage appropriate treatment for sexually-transmitted diseases, provide support for people living with HIV/AIDS, prepare the community for participation in vaccine and microbicide trials, and inform the community of research findings.  Programs for home-based and pediatric AIDS care have been scaled-up with more human and other resources. 


With this example in mind, we can determine a CAB can be an accessible, manageable, responsible, and economic tool for communities to overcome HIV/AIDS.  A sustainable, effective CAB should represent all sectors, and most importantly, must maintain regular input, monitoring and feedback from people living with HIV/AIDS as well as the community in general. The CAB debates, designs, implements, and supervises all programs and services agreed upon by the community.  A CAB is a powerful tool for overcoming HIV/AIDS because all community programs and services are made for, implemented, and judged by the very people who use and perform the services directly. 








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