The Western Cape Department of Health briefed the Standing Committee on the functioning of clinic committees and hospital boards in the Western Cape in a virtual meeting. The Department gave details of the legislation pertaining to clinic committees and hospital boards, and how they were to be constituted. The functional or non-functional status of these committees was also addressed.
The Department acknowledged the importance of having community support and buy-in when it came to health initiatives, but this support varied among communities, which displayed a general lack of interest. The Department also provided an update on its training programmes, and shared some the implementation challenges that it experienced.
Members wanted to know about councillors’ participation, and how Members of Parliament were appointed to the committees and boards. They asked whether ward committees had been approached to fill the vacant posts on the boards and committees. They also called for timelines on when training would resume.
The Chairperson said the Committee had resolved to hold the current meeting because stakeholders had raised concerns about the implementation of the Clinic Committees and Hospital Boards Act. The Committee had requested a briefing from the Department of Health (DoH) on the matter, and she had received a request from the community Cape Metro Health Forum to address the Committee.
Department of Health presentation
Dr Keith Cloete, Head of Department: Western Cape Department of Health, said community involvement in health was recognised globally and locally as a key ingredient of a ‘well-performing’ health system, and was part of the vision of Healthcare 2030. Functional statutory structures were a key enabling mechanism.
The purpose of the Act was to create boards and committees for community support in the facilities programme; ensuring responsible use of resources at the health facility level; and responsiveness of the management of health facilities to community needs.
The clinic committees were clustered, with the Minister having to take into account the geographic distance between primary care facilities, the size and distribution of the population served by these facilities, and the service volume of the facility. The Act had been passed on 5 July 2016. The regulations were published for public comment in April-May 2017.
There were three sets regulations -- financial governance, the criteria and procedure for clustering of facilities, and the process to call for nominations.
He provided the structures of a clinic committee, as well as hospital boards.
When it came to clinic committees, there were 65 that were functional, with 26 in the metro area and 39 in the rural areas. He said 13 were constituted but non-functional -- four in the metro area and nine in the rural area. 77 were neither constituted nor functional, with 15 in the metro area and 62 in the rural areas.
Dr Cloete also provided an update on the training. He said the national material had been updated to include Western Cape legislation and regulations. Pilot training had been conducted in the metro area. Two groups had gone through the training. However, all formal training was on hold due to Covid-19. An evaluation would have to be carried out before a full rollout of the training.
He said the health committees and boards could play a key role in the critical tasks needed to tackle the Covid-19 pandemic. The Practical Approach to Care Kit (PACK) would form the basis of the training. The possibility of training via webinars was being explored.
He said some implementation challenges had been experienced by the Department. Interest in volunteering varied amongst communities. There were also challenges when it came to appointing councillors. The lack of remuneration was seen as a disincentive.
He said processes within the Department required streamlining.
The Chairperson wanted to know about the process for the review of delegations. What was the Department’s role in ensuring that the non-functioning committees operated optimally? She requested a timeline for the training of the entities.
Mr R Allen (DA) asked what the Department was doing to address the lack of community involvement. He requested a breakdown of who the councillors were in the active committees.
Ms A Bans (ANC) thanked the Dr Cloete for his remark that the pandemic had ‘rocked everyone to their roots.’ She wanted to know who got to appoint Members of Parliament to the committees. How was a committee defined as functional and non-functional? She requested a training report, just to get clarity about training.
Mr G Bosman (DA) wanted to know what the specific hurdle around the appointment of councillors was. He asked if the Department had explored the option of appointing ward committee members to the clinic committees?
Ms R Windvogel (ANC) wanted to know how the advertising for the board posts was done. Were community newspapers being used? Could the Department provide clear guidelines on how they were going to tackle the issue of non-functional boards? Was it possible for the functioning committees and hospital boards to share their best practices, so these could be replicated? Lastly, she wanted to know the detail related to training and support for the structures.
Dr Cloete said the there was framework that was used when it came to delegations. The final draft of Circular H47/2020 was currently under review, and would deal with delegations.
The desired position was to have 100% functionality of the committees, as this put the community in an advantageous position when it came to matters related to health.
The goal was to use the following weeks to establish timelines in order to achieve the desired outcomes.
He emphasised that functionality needed to be looked at in the context of COVID-19. The pandemic had meant that the DoH had to rethink the modalities of training and try to replicate the training that was being given to functioning committees, with non-functioning committees.
The Department would like to know from the communities what could be done to generate more interest in serving on the committees and boards.
The breakdown of the councillors would be provided to the Committee, along with feedback on the participation by each councillor.
All manner of newspaper adverts, including community newspapers, had been run -- at great expense. He said this needed to be rethought.
Dr Krish Vallabhjee, Chief Director: Strategy and Health Support, Western Cape DoH, addressed the issue of delegations. He said that the final draft of the circular was giving effect to the regulations, in order to specify responsibility and who was responsible for what.
Pilot training had already started. Community liaison officers had been appointed in metro and rural areas. He also agreed with the idea of sharing best practices, and scaling this province-wide.
He said legislation makes provision for the appointment of Members of Parliament to clinic committees and hospital boards. His understanding was that the Minister had tendered nominations to the Committee. Invitations had been invited. The Minister was responsible for making appointments.
Ms Windvogel wanted to know if non-governmental organizations (NGOs) were being advertised to, or if this was being done internally.
Ms Bans wanted to know how the clinic committees would be monitored if the appointments were being made by the City?
Dr Cloete said the issue of ‘city vs province’ had caused delays in the process of clustering committees. Clustering in the metro had three variations -- facilities that were measured only by the province; clusters of province and city facilities; and clusters only of city facilities. The Minister still invited nominations. He added that the response of Health in the province had never been more unified.
Cape Metropolitan Health Forum
Ms Damaris Kiewitz, Chairperson: Cape Metropolitan Health Forum, said the forum had asked the Department to acknowledge the committees that had existed before 2016. Some were as old as 20 years. She said the lack of interest from interest from people was because of how people were appointed to committees. When the Department came to the Committee last year, the issue of training had been raised. The forum had the expertise to provide training, but had not had an opportunity to provide it. She said the current appointees were saying they could not be active as the forum because they did not know what to do.
Mr Graham Lindhorst, a member of the Cape Metropolitan Health Forum, said the Department was aware as to why people were not interested in serving on the committees. People did not want to be appointed by the Member of the Executive Council (MEC), but rather by the communities they would be serving. This was the issue that needed to be addressed. The Department needed to revisit what had worked in the past and go back to that. There had been no issues when the Cape Metro Health Forum was providing the training. He said the committees were established and were active.
The Chairperson acknowledged and appreciated the comments provided, and said that channel was open for further engagement with the committee.
Dr Cloete said he believed in a broad coalition, and that those involved should not be pulling in different directions.
The Chairperson said it was important for the Committee to note the importance of community structures.
Adoption of minutes and Reports
The following minutes and Reports were considered and adopted:
- 13 May 2020
- 3 June 2020
- 27 July 2020
- Report on 2019/20 financial year
- Quarterly Report (Jan-Mar 2020)
- Quarterly Report (Apr-Jun 2020)
- Committee Tracking document
The Committee resolved that Members wanted to know about councillors’ participation, and also sought clarity on the process of nominations and appointments to the clinic committees and hospital boards.
Ms Bans requested that the Minister be present to explain who was appointed, and where.
Mr Bosman asked the Department to provide the process that each municipal council followed when it came to appointing boards, and whether they had reached out to ward committees, since they were struggling to get interest from the public.
Ms Windvogel wanted to know if the Standing Committee had received notice from the Department.
The Chairperson ruled that the records be checked, and the process researched.
Ms Windvogel wanted it noted that the Committee needed information in advance of a meeting.
The meeting was adjourned.
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