1. RAPID APPRAISAL OF HEALTH COMMITTEE POLICIES Hanne Jensen Haricharan, Sep. 2014
Hanne Jensen Haricharan, September 2014
Introduction: preliminary results of rapid appraisal of health committee policies. WE do not have policies from all provinces so if anybody present would like these.

2. Background: Legislative framework
White Paper on Transformation of the Health System (1997): Participation in planning and provision of health services. Ensure accountability.
National Health Act (2003) provides for establishment of health committees:
a) Each clinic should have a health committee composed of: Facility manager, ward councillor, community members.
b) Provincial legislation should stipulate role and function.
Western Cape Context: no policy.
National Draft Policy and Health Governance Structures (2013).
I could expand on White Paper

3. Background: Study in Cape Town: Key Challenges for Health Committees:
Limited reach
(55 %) Below national average, below target in NHA.
How representative are HCs? Overrepresentation of middle-aged/elderly/ female.
Formation of HCs unclear
Issues of legitimacy
Sustainability and functionality
Huge variations. Irregularity of meetings, poor attendance, cycle of disbandment and revival, communities struggle to establish committees.
Limited Role
Limited (participatory) role with limited decision-making and power.

4. Background: Limited Participation

5. Factors impacting on HCs
Lack of clarity on role
Policy vacuum in WC
Lack of consensus on vision
Low participation by facility managers and ward councillors
Limited skills and capacity for participatory role
No/limited Funding
Institutional support lacking
HCs’ self-identified role:’representing’ clinic
Stress lack of clairy and policy vacuum.

6. Why a Rapid Appraisal? Impact of policy vacuum on HCs in Western Cape.
Discrepancy between Draft Policy and practice.
Limited knowledge on other provincial policies.
Rapid Appraisal objectives:
Assess policy situation nationally.
Assess content, particular role and function, composition, and formation of health committees.
To get an overview of implementation of policies (pending)
Explain
Rapid appraisal of provincial health committees policies
Practice and policy
n policy.

7. Policies on HC’s in SA’s provinces
Policy/guidelines exist
Form
Year
Eastern Cape
Yes
Policy
2009
KwaZulu-Natal
In Provincial Health Act
Free State
Mpumalanga
Guidelines
Gauteng
Draft guidelines
Western Cape No
Draft guidelines (2008) not implemented. Amendment of Health Facility Boards Act.
Limpopo
We have been told policy exist
NorthWest ?
Northern Cape
2013

8. Roles of health committees
Explanation
Which provinces?
GOVERNANCE
Policy, strategy, planning, identify health needs, advice
All
GOVERNANCE, OVERSIGHT
Monitoring, complaints management
NETWORKING/STAKEHOLDER MANAGEMENT
Strengthen ties with communities, liaise with stakeholders
ADVOCACY
‘Represent facility’, advocate for using services
Eastern Cape, Mpumalanga
FUNDRAISING
Raise funds for facility,
Health Committee,
PHC activities
Mpumalanga, Gauteng, Eastern Cape
SOCIAL MOBILISATION
Getting community involved in health
Eastern Cape
SUPPORT FOR FACILITY
Gauteng
Policies vary greatly in length, content and detail. Only one provincial policy talk about hc’s as governance structure: Northern Cape.

9. Role of HCs, cont.
Trend towards seeing HC’s as governance structures. In line with National Draft Policy.
BUT: Disjuncture between policy and practice in Western Cape (and Eastern Cape?).
Example: little mention of HC’s as providing ‘practical support’ YET many HC’s primarily provide practical support.

10. Formation of health committees
Formation process
Provinces
Appointed by MEC
Free state, Mpumalanga, Kwazulu-Natal, Northern Cape
Elected
Eastern Cape
Unclear
Gauteng
(elected/appointment)
How does the nomination process happen? Who nominates? What role does facility managers play in nomination process?
How does this link with representivity

11. Formation, continued
Critical issues: Majority of provinces: MEC nominates
Should community participation structures be
appointed by provincial ministers – top-down
approach?
How does the nomination process happen? Who nominates? What role does facility managers play in nomination process? Implications?
Mpumalanga: The MEC will invite nomintaions from interested and qualifying individuals to sit on the committee.
KZN: MEC most establish committee.
Free State: MEC must, after consultation with District Health Council, establish a committee.
Gauteng: Members to be elected by the local community Once election completed these nominees will be appointed by the MEC.
The MEC will invite nominations from interested and qualifying councillor. The MEC will appoint the committee after receiving nominations from stakeholders.

12. Composition of health committees
Composed as outlined in NHA
Composed of ‘sector’ representatives
Mpumalanga, Gauteng, KwaZulu-Natal, Northern Cape
Free State: disability, business, traditional health practitioners, health experts.
Eastern Cape: traditional healers, organised labour, community based organisation, religious community, women’s group, youth, NGO, disabled.

13. Composition continued
Critical issues:
Which sectors should be represented and why?
Sectors not represented: health workers, environmental health officers, other ‘marginalised’ groups such as refugees, LGBT.
Both the question of elected or appointed and composition speaks to how these health committees are conceptualised and how we understand participation.

14. Financial support No support Reimbursement for expenses
Allowances and Fees
Free State, Eastern Cape
KwaZulu-Natal
Mpumalanga: MEC to determine fees and allowances.
Gauteng: fees, allowances for travel and incidental expenses.
Research suggest that financial support is crucial.

15. Support for Health Committees
Type of Support
Province
No Support
KwaZulu-Natal, Free State
Secretariat support
Mpumalanga, Gauteng, Eastern Cape
Office + equipment
Gauteng
Venue
Eastern Cape
Logistical support

16. Training and Capacity Building
Only EASTERN CAPE makes provision for training and induction.
‘put in place processes and systems to ensure ‘empower community members’.

17. Critical Issues Clarity on role of function.
Formation of Health Committees: Elected or appointed?
Composition of Health Committees: ‘sector approach’ or NHA-approach.
Minimal capacitation for participation (limited support, training, financial support).
Gaps: No linkages to other community participation structures.
No up-stream influence.

18. Thank You! More information: www.learningnetwork.weebly.com
This research was funded by the EU