Home Community-Based Care services (HCBC) in the Western Cape

Health and Wellness (WCPP)

24 February 2023
Chairperson: Mr G Pretorius (DA)
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Meeting Summary


In a hybrid meeting, the Western Cape Health Department briefed the Committee and members of the public representing different communities and organisations who were invited to ask questions and give input on healthcare matters they experience in their communities. The presentation mainly focused on the Department’s vision towards improving access to person-centered, quality healthcare. The provincial health Minister was also in attendance.

Members noted that the Department’s goal is to provide the right care and in the right time. However, they lamented that this goal could not be achieved without happy health workers. There had been concerns about salary packages not fully taking cost of living into consideration and the minimum wage regulation. The workers are simply not paid enough for the work they do.

A Member recounted that when the Committee went to do oversight visitation, Members witnessed a challenge of transport due to the vastness of the areas the people stay in. She pleaded that the Department ensure that healthcare workers go to the rural areas and mobile clinics at least twice a week, as opposed to once a month.

In concluding her contributions to the meeting, the Minister thanked everyone – Committee Members and members of the public – for their contributions during the discussion. She urged those who also sit under the national capacity to push national health on these concerns to speed up the processes. Some ways include writing to the National Deputy Director. In addition, one can also call the unions that are part of the province and national bargaining. 

Meeting report

The Chairperson opened the hybrid meeting, welcoming everyone in attendance.

Members of the Committee all introduced themselves as per the Chairperson’s request, as they were joined by members of the public.

Minister’s Remarks

The Western Cape Minister of Health, Dr Nomafrench Mbombo, gave a brief background on the home-community-based care packages. The home-community-based care packages using community health workers (CHWs) as part of the packages during 2010 when a model from Brazil was adopted. The Western Cape made it part of the package, ensuring that there is continuation of the multi-sectoral collaboration of civil society. The province is waiting for the National Department of Health to develop the correct models. As Members may be aware, across the spectrum, community health workers (CHWs) are still not integrated, and there are still discussions. “We need to differentiate what it is about home-community-based care services, who is involved, and so forth”, she added.

Briefing by the Western Cape Department of Health: Home Community-Based Care Services

Dr Saadiq Kariem, Chief Operating Officer, Western Cape Department of Health, delivered the presentation. He said the Department’s vision is for access to person-centred quality care.

The Department’s service transformation and key priorities (according to HealthCare 2030) include:

- Reducing Infectious diseases such as HIV/TB (90/90/90 targets)

- Improving healthy lifestyles (through community behaviour change to enhance healthy choices)

- Preventing injuries and violence

- Improving maternal and child health (with focus on the First 1 000 days)

- Strengthening women’s health

- Improving mental health

[See presentation document for more details]


Mr D Plato (DA) commented on the presentation. He began by acknowledging the members of public that were present in the meeting, saying that it is important that they get involved regarding health issues within their communities.

He said that the care package had improved, which is what the communities needed – especially the disadvantaged communities, as health and social issues are more prevalent there. He was also impressed by the mental health work in those communities. Further, he mentioned it could not be solely the Department of Health’s responsibility, and encouraged integration of departments such as the Department of Social Development.

Ms R Windvogel (ANC) had questions. She asked for clarity from the Minister having mentioned that the NHI (National Health Insurance) makes provision for healthcare workers who are ward based. What does that mean? Secondly, she noted that the Department’s goal is to provide the right care and at the right time. However, one needs happy workers to get to that goal. In the negotiation of their salary packages, there is the cost of living to take note of. It does not matter if the agreement or negotiation is not finalised yet, because of the minimum wage bill that states one should not be paid below. Lastly, is there a system where NGOs will be assessed to be compliant?

Mr C Fry (DA) welcomed the presentation and had one question. The ratio of community health care workers to nurses is 10 to one. Is that going to be the same in rural areas as well? In the last cluster visit, it was identified that there was an immense need for health care facilities and primary healthcare in rural areas.

Another Member asked a question. It was said that there is a point of a closing date. Is the Department going to employ them or give the NGO geographically on the basis of race or need? The reason is that sometimes, people are paid ‘peanuts’ for something that is difficult. The Member added a request that, when checking the NGOs or NPOs, all geographical areas must be included, with Athlone and Manenberg as examples.

Minister’s Response

Minister Mbombo said that she would not respond to all the questions in this round, as there are members of the public who may not be familiar with everything because it is not their everyday language like the Committee Members, and thus would need more information.

In response to Ms Windvogel’s question on the NHI, she clarified that she was trying to highlight that, with the South African Health system post-democracy, they were trying to realign all health services using primary healthcare. On services outside the health facility, which are home and community-based health care services, it did not take much beyond on paper. This was until they developed the NHI to strengthen the primary health system, which was phase one from 2012-2017. The current phase two of the NHI is from 2018-2022, which is the Bill, with the amendments of the legislation being underway. The last phase, phase three, running between 2022 and 2026, is about the tax, where the money will come from, and so forth.

On what is currently happening with the home and community-based care services: part of the ten issues they were driving at the time was ward-based primary healthcare teams using community health workers. Others included having school health programmes, the GPs contracting, the ideal clinic realisation, and centralisation of chronic medicine, patient registration, stock visibility, human resources and infrastructure. Of most of those ten, not much happened, according to the report.

On the issue of the workers, there was a service delivery agreement on how it should have happened but it was the first time. Unfortunately, things took a square A in this regard because, at this stage, the National Health Department has to take it back to back to the Department of Labour. This is because what was envisioned ended up being difficult to implement as part of the formal health system, because if one ends up employing them – which is the case in other provinces – it then means the principles of primary health care are being breached. As they should not form part of the formal health system, they should be “owned” by the communities. The question is how communities will be able to “own” them in this case. That is why one finds that the NPOs become the ones who are the vehicle for one to make use of them.

Lastly, on the different models used by the Western Cape Government using packages from the NPOs as service providers: the Minister gave an example from her previous experience as the MEC of Sport, Arts and Culture. She said that, in that Department, it becomes an open system when one does adverts for the NPOs and NGOs. But in the case of the Health Department, it becomes a thing of a package needing to be provided and following this kind of particular format.

In November 2022, the National Health Council returned the package to the Department. One thing that was non-negotiable and cannot be compromised is the minimum wage, which needs to be revised.

Department’s Response

Dr Kariem answered Mr Plato’s comment on mental health. He said that mental health is a key focus of the Department. They are looking to integrate and collaborate with the Departments of Social Development and Basic Education and other relevant departments. There are talks underway, and the approach will be exciting.

On the NHI question, he responded that the Department would like to pay more as they deserve it. On the matter of compliance, he said that there is checking through a small unit of about three people, making sure that the NGOs comply with the contract signed in terms of the deliverables that have been agreed upon. Geographically speaking, there are people who make sure that there is compliance.

On the ten-to-one ratio, the Department does indeed seek to expand the home and community-based care form depending on how the budget process allows. The desire is to reach a better target in terms of nursing staff and healthcare workers. There are indeed more challenges in rural areas due to distance and other socio-economic factors.

Dr Nousheena Firfirey,  Assistant Director: Mental Health and Substance, further clarified the matter of packages. She said that, even though the packages are provincialised and there are no separate packages for rural and metro, the services teams in those geographical areas were integral when developing the current service package. When the call for proposals was made and the briefing sessions were done, separate sessions were done in the rural areas. Each district had their own briefing session and metro combined one. The information shared with the NPOs was on the meticulous work done by the teams. How the CHWs and NPOs are appointed is based on the need in a particular area and the population within that area. So, for example, with CHWs, one needs to have an average of 200 –250 households and be responsible for those. Therefore, each area would have different needs based on the prevalence of the disease and the population. Each geographical area is divided into specific nodes and each node has a different need. Thus, each team and structure within the metro worked closely to determine what it would mean for their areas. This was communicated to NPOs who attended a briefing session. They were able to submit a proposal based on an area that they wanted to service. Based on the adjudication, there is a strict process where there is scoring. This makes a non-bias process, since everyone gets the same information and the same opportunity to submit a proposal and know what needs to be included.

Further discussion  

Ms N Bakubaku-Vos (ANC) emphasised the rural areas. She recounted that when the Committee went to do oversight visitation, Members witnessed a challenge of transport due to the vastness of the areas the people stay in. She pleaded that the Department ensure that healthcare workers go to the rural areas and mobile clinics at least twice a week, as opposed to once a month. She welcomed the Department’s effort and willingness to work with the community.

Ms Windvogel wanted clarity on the signing off. Her last concern was that, as a department – be it national or provincial level – it likes to emphasise the importance of healthcare workers. But when it comes to the point when one needs to put value and money into the services, it becomes a problem. She urged people to change their thinking and ensure they get what they deserve, not ‘peanuts’.


Dr Kariem answered the question on the signing off. He said 20 February 2023 was the cut-off date for applications, and 01 March 2023 should be when the contracts are signed off after the adjudication process. The NPOs are aware of the times and processes.

The Minister made further responses to Ms Windvogel’s concerns. She said that they are part of the health system, yet they are not necessarily the employees of the health system. The national health sector did drop the ball in the beginning. The problem is that there are so many different components of community healthcare workers. From the 80s, during the HIV prevalence, they mostly came from NGOs. In the Western Cape, there were NGOs like Zibonele. Similar ones in other provinces were part of the HIV/AIDS councillors, and others would be part of the outreach programmes. They ended up being absorbed by working with the clinics within the system. Further, others have been part of home-based healthcare, and another group is with the old-aged homes that are jointly licensed and registered with the Department of Social Development. The issue becomes with the different components – some of it conflicts with the National Health Act on the definition of a healthcare professional. The different components make it difficult to establish packages and remuneration.

She concurred with Ms Windvogel’s concerns, adding that there is not much justice done to CHWs. Within the work that Western Cape Health has been trying to do for over five years, there was a workshop summit. During the summit, it was made clear that, whatever the Department does, there is evidence of being supportive of CHWs. As the health sector, the hope is that this matter is resolved before other people take over.

There was a meeting recess.


The Chairperson welcomed everyone back to the session and asked the floor if they had any further questions.

Mr Fry raised the matter of the cholera outbreak that has been trending on the news, over the past few days, particularly in the Gauteng province. Can the Department give the Members a slight brief on what measures it has put in place to prevent it from spreading in the Western Cape? How well are we prepared to face a cholera situation?

The Department responded that there is a cholera outbreak even in the sub-Saharan region in Malawi, Zimbabwe and Mozambique. Western Cape Health has a cholera alert site for cases, and there is a provincial approach in place to address it should it be detected, so that it does not spread, similar to what was done during COVID-19. The local areas on the ground are on high alert for cholera. Members would know that there had been areas in the metro in which a measles outbreak was declared, prior to the pandemic and accelerated during the pandemic. Overall, the Western Cape remains proactive regarding alerts for various infectious diseases.

Questions from members of the public

In the first round, there were four hands raised. The first person was a community member from Mitchells Plain area. They welcomed the presentation. One issue within the Muslim community in Mitchells Plain is circumcision. Currently, within the Muslim community, circumcision takes place at a very young age. The Western Cape government has made possible three circumcision facilities for males, starting from age 15. Since Muslims want to do it at a younger age prior to 15 years, they use more expensive private facilities.

The second person from the public noted that the Western Cape Department mentioned it aspires to become a department that is people-centric, trusted and equitable. That is the equity part and the people-centric approach when asking that CHWs must be absorbed into the Department. The second point is regarding the difficulty with Department of Labour. However, when calls are coming out, the job description clearly defines what a CHW must do. Tebogo felt that answer was hypocritical. The question was when the Department is going to be really people-centric and equitable to CHWs. The backtracking is not assisting, especially since, in the recent budget speech, a huge chunk went to healthcare.

The third public member had two questions. Firstly, regarding the absorption of CHWs: the challenge is that NPOs are given huge autonomy to play around with people. In reality, people were not paid their salaries by the end of the month for quite some time in previous years. It is true that this discussion has been happening for quite some time. It was said that there is a need for CHWs to be absorbed as the organisations argue that, if CHWs are absorbed, what about the organisation? This is because the director and founder were worried about their salary and not looking at the actual work and how the person is doing the job. Secondly, the timeframe states that, between 2023 and 2026, counsellors would be trained for this transition. However, the same timeline says that 20 February 2023 was the due date for the NPOs to submit the call for proposals. The proposal asked people to mention the language of the CHW and not the counsellors. This prioritises those who have been working on this programme.

Part of the priories is key populations. If one observes, most organisations working in communities with CHW programmes do not accommodate key populations (‘pops’). She was saying this because they have worked with most of them (key pops), and they know how they (key pops) work with the communities. There is a desire for the programmes to accommodate these key populations, like young people, by using social media platforms – where young people are mostly found. Social media helps trace them instead of visiting them at their homes, where you often do not find them.

There is also a concern about the ratio to reach 200-250 households and the quality. There needs to be a strategy such as finger scanning, for example. This is so that it can pick up if one person in the household is using the identity of another from the same household.

The Chairperson highlighted that the public does not often get such an opportunity to engage with the Committee, and pleaded that they abbreviate their questions. This is so that many members of the public can also get the opportunity to pose questions and engage with the Department.

Department’s responses to the public

The question on the Muslim circumcision for younger ages will be taken to the Department for consideration.

In response to the community health care workers being absorbed in the Department: as mentioned earlier in the presentation, it is part of the bargaining chamber of the bargaining council process and part of the national process. The provincial HOD has been part of that process with National Health, and the commitment was to await the outcome of the bargaining council process and implementation would happen from there. That being said, the Department will continue with the process it has been engaging on, which is working via the NPOs until the outcome of the bargaining council.

Regarding reaching young people, it has always been a challenge even during the covid-19 period. It was found that using social media to reach many young people is a lot more attractive to young people. The point is well taken. NPOs have been funded via different sources of funding that focus on key pops, particularly when it comes to HIV and TB services and funding received. The funding has been mainly from the Department of Health, but there has also funding from the grantees like the USA, as agreement between the Western Cape government and United States government. Premier Alan Winde had negotiated on the province’s behalf for about US$10 million over five years. Through that grant, a number of NPOs are funded to provide HIV services to young people and other key populations.

Dr Firfirey answered to the question of the counsellors. In terms of the changes of the counsellors, as communicated at the briefing sessions, from 01 April 2023 there will no longer be reference to lay counsellors. This goes in line with the recent counselling strategy that has been developed in the Department. However, the counselling experience will be acknowledged in the Department when one is looking at which NPOs can render the services needed in a particular geographic area. Therefore, they will all be CHWs with lay counselling experience and home-based care experience, with the intention of having a broader base of CHWs that have a broader skill set, at the end of the three years. The title will change but not the service and over a period of time. It would all be balanced out by the end of the three years.

On the ratio part: it depends on the population density in a particular geographic area. Each geographic area is divided into nodes, and not all areas have the same number of nodes. But it is the ways the districts are divided which differ.

The Minister made an example to supplement what the previous speaker referred to regarding district nodes. For instance, the Central Karoo might have fewer people, but when looking at the distances they have to travel. For instance, one ward would be in Nelspoort part of the Beaufort West. The Minister acknowledged that there are other contract workers from where a lot of help is received, especially in the farming communities from the farmers, which becomes an addition.

She wanted to highlight where the NHI is to the Committee Members and public members. Currently, the NHI is piloting the monopoly in rendering services. Any other stakeholder, be it a private licensed hospital, clinic or day hospital, GP or even the NGOs and NPOs, would be required to demonstrate that they can render a particular service according to the required specs. The National Department used district systems in phase one. There were 11 districts, and there were supposed to be nine in other areas. The Eastern Cape added its own. The Western Cape used Eden – which is the current Garden Route that they piloted – for some of the interventions for the NHI. Currently, the Western Cape is piloting in the Knysna Bitou, which is expanding to the Cederberg. These are efforts of the National Department of Health in trying to implement some of the other parts of strengthening primary healthcare and taking services away from government, for them to be rendered by other parties.

Follow-up discussion  

The Chairperson decided to open another round of questions and comments to the members of the public.

The first person to ask questions was Ms Ndayi [unconfirmed], who resided in Gugulethu. Regarding the NHI, she said there is acknowledgment of what the Minister shared. She wanted to know how far these processes were. This was because, when referring to services that must be rendered to communities, those NHI processes must not only be held within the NHI but must be filtered straight to communities so that progress can be tracked.

Regarding CHWs, in terms of health and social issues, there is a need to applaud the CHWs who are foot soldiers. It is painful to hear that they must do 200-250 households per month. There is concern for their safety. If other provinces can do it, what is the issue with the Western Cape absorbing CHWs? Ms Ndayi was not impressed with the way of working regarding CHWs not being absorbed and also needing a middleman.

The second person from the round to pose questions was Ms Rena Ackerman [unconfirmed], a CHW from the Manenberg Cluster. On the needs of patients in communities such as mental health: even though CHWs get referrals to see a mental health patient, where do they take it from there? There is lack of supply from health facilities. Where does help come from regarding decreasing injuries from patients? The other thing is regarding rehabilitation for people who cannot come to the facilities: rehabilitation is supposed to take place in homes too. That is where the CHWs come in, but people do not see these services. Another concern is for transport to be patient-centred. 

She also lamented that community-orientated primary care (COPC) meetings are limited and exclusive. Most of the time, it is only management that attends them. Why are CHWs not allowed to sit in those meetings, because they have personal experiences on what is going on the ground and know how to convey it to the necessary people? Ms Ackerman also raised concerns about the healthcare of CHWs such as masks, and so forth. How are CHWs health protected?

The third person from the round was Ms Amila Isaacs [unconfirmed], representing an organisation named Manenberg People Centre. Currently, as an NGO, they support NPOs rendering services in Manenberg. There is the CDU packaging which the patients collect at the centre. The organisation is not being paid a cent. Can the terms of the contract of the NPOs be made available, including information on how much it is and when it is supporting the NPO working in Manenberg? The presentation looked good on paper but not in reality for communities. It would be appreciated if it is a reality for communities.

The last person from this round of hands was named Mike. On the matter of the package of services, he noted that the Department spoke of the establishment of the wellness hubs, while there is currently lack of infrastructure facilities. If the Department wanted to expand the wellness hubs, where would that happen? The ones that are there belong to the City of Cape Town. As an organisation, they fall under the province. To make use of those facilities, the first thing they tell you is that one needs to pay. The second thing is that no one can have it. Then there is engagement done with the various councillors for arrangements. Three councillors were approached but they did not respond.

The other point is regarding CHWs – it is being debated and discussed. However, it is important to note the high-risk areas where the CHWs work, and the danger it poses to their safety. Can the dates of the bargaining council please be clarified because it is important for the people working on the ground?

Minister's Responses

The NHI is national legislation which is currently still within the national Parliament. But because the implementation involves provinces, as it was with public hearings, there will be public hearings once they are done with it in the National Council of Provinces. Thereafter, it will go to legislators and then there will be another round of public hearings driven by the MPs, including this Committee, going to different places. It is therefore out of the Committee’s hands. What the Minister was trying to highlight was the government side which is the National Department of Health. Since 2012, they have been piloting some of the interventions; they are still continuing with that, irrespective of where the Bill is. Part of the NHI they are talking about is where in the district in the communities, there also should be other service providers, even if it would be private health. It could be the NPOs, and it could be anywhere. Western Cape Health is part of those piloting that aspect of these contracted units in the Knysna and Bitou. There will be an expansion. This Committee will be able to forward everything when it is time for public hearings, as part of the National Parliament system.

On the absorption matter: the Minister indicated that she acknowledged that, as the health sector, in South Africa as a whole they did mess up by not taking the promises of the White paper further. The Western Cape is still fortunate to be using the sub-district model because the area's needs are different and cannot have a linear approach.

The National Health Department had opted not to look deeper at the components that Ms Isaacs was referring to. There are counsellors who started doing HIV/AIDS work. Till today, they are still with the Department within the health facilities, but they are still not employed. They are still not part of government yet they are treated as such. Some of them might be absorbed. For example, Gauteng province did an absorption but under the category of abnormal absorption. This was because, within the PERSAL, one has to meet certain kinds of requirements regarding the human resources for health in all categories. What happened in Mpumalanga and KZN can be taken as examples, where the system appeared to be bloated due to inflated stats – where health workers were wrongfully added. In the Western Cape, anyone can be considered to be a community healthcare worker who works under health. It is not limited to healthcare administrators, but healthcare professionals have a separate definition. Community primary healthcare in the county is a broad spectrum; it should involve all stakeholders in the community such as NGOs. It cannot be solely delivered by government. The government just helps with coordination of those stakeholders. COPCs are a vehicle of rendering primary care, which CHWs form part of. It is a must that NPOs are not left behind.

Regarding the issue of absorption: they have gone back to the drawing board, to the Department of Labour, where they could be able to make a determination that they will then give to the National Health sector and the way forward concerning that. However, members of the public can rest assured that the provincial government is not compromising on the fact no one should be paid below the bargaining council wage. Part of the specs is that there must be a professional nurse because data is being used. The professional nurse helps oversee that things are delivered according to the provincial Health Department’s mandate. Professional nurses need to form part of a health system and attach to a clinic. There may be instances where NPOs will want to survive through government tenders and treat it like a business where healthcare is not a commodity but a human rights issue. How these NPOs are regulated in the province is still due for a review which was paused because an outcome is awaited from Labour and the bargaining council chambers.

Department’s Response

How the community needs are determined the intention is to work with the community to determine those needs. There is also lots of data from the data centre about the disease burden in each geographic area. Those processes are combined in accessing the needs of the communities and calling for proposals in terms of responding. The Manenberg People’s Centre organisation concerns were acknowledged about not being paid, and the centre is invited to chat to the provincial substructure office to take it up further.

The date by which the bargaining outcome would have been concluded is 31 March 2025. It is also noted that, apart from NPOs, there are also health committees. There are close working relations with the health committees as well, and they have a wealth of expertise from which the Department can draw in determining the needs of the communities. On the issue of CHWs not being able to join COPCs sittings, the province is embarking on talks with government on the Indaba processes while consulting the strategy with various stakeholders. COPCs are part of those consultations. There is going to be an internal Indaba in a week’s time, where there will be a conversation with the sub-district managers. Part of that conversation will be the COPC and how communities can join that conversation and provide input.

Further questions from members of the public

Ms Neliswa Nkwali, Treatment Action Campaign, had three questions and a comment. Firstly, regarding the CHWs, she recalled a period when government adopted the Brazilian model to say it is a good model that the government can use to absorb the CHWs. That model also came up with an answer to the issue of how much money each CHW should get. The concern is that when these people do voluntary work, there is no criteria, no consultation and no issue of qualification; they just do the work, but when it is time to get paid, there is an issue of criteria. This is quite concerning. The national Department is clear regarding CHWs – the package is estimated at about R4 000 for each person. However, the exploitation these comrades get from these NPOs when they employ them is a lot; they are getting far less than that amount. For example, there is a well-known NPO here which gives CHWs R280. On top of that R280, they also must consider uniforms, which, according to the national Department, clearly states that each CHW must have R700 for uniforms. But when one goes to these NGOs that employ them, they only give them R400 for uniforms with no leave. Therefore, CHWs are already exploited by the NPOs. Why did the Western Cape Department not want to absorb them?

When talking about home-based carers, another recent example was two government hospitals in Tygerberg and Wynberg, where they have already absorbed home-based carers to work in the stretcher rooms and the trauma units. Their job is to escort patients to the bathrooms and wash them. This helps to ease the burden of work on staff nurses. Thus, the home-based carers are doing their job but in places like Khayelitsha, none of the home-based carers work there. The trolley room in Khayelitsha has 29 beds. But when one counts that according to the ratio of staff members, it is embarrassing, to say the least. What are the criteria for selecting the home-based carers that will be absorbed in hospitals? What are the criteria for selecting the hospitals?

Lastly, these community healthcare workers are working under extremely bad circumstances. They do not have phones, yet they have to track patients. The uniforms are old. There is no security yet they face muggings on a regular. For security, they rely on the community watchdogs who are also unarmed but are working. They take treatments back to their communities with their backs, as no transport is allocated to assist them. The presentation did not speak to these issues.

Ms Nkwali recalled a period towards the end of 2021 when she was among those called by the Department to a hotel next to the CTICC, where there was a good presentation plan given which spoke to the integration of CHWs and civil society adopted it. However, till today they were told that after consultation, they would get feedback. But none has been given till now. The concern is having these good implementation plans without actual implementation and accountability. The question then becomes: what are the estimated timeframes? Who will be responsible, and how?

Next to ask questions was Mr Sylvester from the Heideveld Cluster. He said there is concern about CHWs who are not trained to render services to the community while not belonging to an NPO. Secondly, how and where do they fit in the package of care? Going forward, the service for the communities should be done to perfection. Government must take charge and regulate NPOs to ensure everything goes smoothly.

Another contributor from the public said it is not only Manenberg People’s Center that renders services but the churches and other community stakeholders. Can those other stakeholders rendering these services be invited to the meeting with the substructure? Secondly, patients needing care services and cannot physically go to hospitals: how can we access doctors and get them to come to the house to assess the patient?

Deidre, from Touch Community Services, also had questions. In the demarcation and service nodes that carers are working in, how is the number of carers working in a node determined, because some nodes do not have enough carers?

The other member of the public, who is the chairperson of the Gugulethu Clinic – a clinic in cluster with three other city clinics – spoke on the matter of rendering services. There is intervention needed because there is difficulty in using the community halls when community members need to fetch medication. One cannot be paying to use their own halls and going through lots of contracts and red tape to use a facility that is supposed to benefit the community.

Minister further responses

The Minister said that the process of doing anything related to the CHWs within the province had been put on pause while the national Health Department is engaging with the Department of Labour and Employment on the way forward. This does not prevent the Standing Committee should it desire to call the national Health Department to present the timeframes and when it will be finalised. This is in consideration that the national Department is busy piloting some of the NHI's components. Part of it is about using primary care packages of contracting units, which is mostly done by the same NPOs.

Department’s Further Responses

On the issue of the implementation plans: those are often done at a local level through substructures. There is support for the motion to invite other stakeholders to the COPC sittings. Regarding patients who cannot get to the hospitals, the CHW system is designed for those cases. Most workers are already paid above the minimum wage. The service nodes are localised based on that area’s needs. All other points would be taken forward to the Department.

Final round of questions

A member of the public, who is also a CHW, asked why CHWs are not supplied with equipment like mobile blood pressure machines. It is sometimes hard to get the patient to the hospital or for the worker to get the service to the patient to do things like blood pressure measures. This would make it possible for people to be checked regularly and treated earlier.

Another member of the public emphasised that following up on the NPOs is extremely important, and such organisations should attend the MDT meetings. NPOs should be held fully accountable even before signing any contract.

The Minister thanked everyone for their contributions to various solutions. She urged those who also sit under the national capacity to push national health on these concerns to speed up the processes. Some ways include writing to the National Deputy Director. In addition, one can also call the unions that are part of the province and national bargaining.

The Chairperson thanked the members of the public for joining the meeting and thanked them for the contributions and energy they gave. He also thanked the Minister for her great leadership and the Department delegation for its work.

Committee Resolutions

The Chairperson asked Members if there were any resolutions in terms of the presentation.

Ms Windvogel mentioned that it was earlier proposed that they should invite national government on the negotiations processes.

Mr Plato added that one matter that was clear from the meeting was implementation of what was discussed. There needs to be caution around it, as there is no budget for some things. The officials need to check in other provinces on what is happening with CHWs, and use that to measure and compare with the Western Cape.

Another Member of the Committee mentioned the matter of the NPOs that were raised by the public, and safety concerns CHWs. This matter needs a gathering like an Imbizo where everyone joins – including the NPOs themselves– to have discussions and make resolutions. Further, there needs to be an assessment done on the Western Cape, comparing it with other provinces – bearing in mind that all is done according to the country’s Constitution.

Ms Windvogel added that the oversight must be done on these NGOs.

The resolutions were concluded and adopted.

Committee programme and meeting minutes

The minutes of a previous meeting were considered and adopted.

The secretariat advised the Committee that the meeting scheduled for 03 March 2023 would be postponed until further notice.

The Committee then went over its programme.

Ms Windvogel mentioned a place at which the Committee must conduct oversight.

Mr Plato mentioned that Members do not have to go all on that day to conduct oversight.

Mr T Klass (EFF) added that the Committee could go to two clinics instead of one.

The Chairperson thanked everyone for attending and contributing to the meeting.

The meeting was adjourned. 


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