Making clinics accountable to the community (Audio)

At the tender age of 26, Zingisa Sofayiya mentors men and women twice her age.

Sofayiya is a clinic committee mentor and helps 10 of the 50 clinic committees in the Eastern Cape as part of a pilot project of the University of Cape Town. These committees are aimed at providing ordinary residents with the opportunity to give input in their health care facilities.

The committees consist of clinic staff, members of the community and in some provinces, the local ward councillor. Their aim is to increase community participation in the management of health services. They meet once or twice a month.

The clinic committee not only provides oversight and support to the clinic management but also looks at other factors that impact on the health of the community. “Say there’s a dump site in the community that causes people to get sick. The clinic committee’s role in this instance is to lobby the ward councillor to do something about the site to prevent possible disease outbreak,” Sofayiya said.

The committee also works with the health promotion team to encourage the community to use the clinic’s services and raise awareness of various health issues. In addition, they bring the community together to observe major events on the health calendar, such as World Aids Day on 1 December.

In some pilot clinics, the Soul City Institute, in support of the Department of Health’s primary health care re-engineering initiative, is implementing community-based monitoring. At these sites the committee works with community monitors to measure and track the quality of care provided at the facility. The monitoring teams interview users of clinic to reflect on their experience and rate the quality of service. The results are fed through to management who are obligated to take measures to improve the offering.

According to Soul City Institute research manager, Bongiwe Ndondo, the most important role of these health committees is accountability. “The committee must ensure that the clinic is accountable to the community,” Ndondo said.

However, funding remains a major challenge for health committees. Committee members are volunteers who are often unemployed but are expected to expend the little resources they have to do committee work. Often they do not receive a stipend for performing these functions, and in individual provinces, this is left to the discretion of the health MECs. Currently the National Health Act stipulates that each province should draft its own policy governing clinic committees, Ndondo said. In addition, members of these committees are not adequately trained and supported in executing their roles.

Sofayiya helps clinic committee members feel empowered in their role, draw up action plans and helps them come up with fundraising ideas. “They already have the skills, I just draw them out. I am often surprised to find they have completed tasks scheduled for three to four weeks later,” said Sofayiya.

The mentorship is meant to last a year but Sofayiya feels committees would benefit were it to be extended for an extra year. She also thinks the health department should train the committees on elementary understanding of primary health care such as the norms and standards and basic equipment needed for a functional clinic.

Ndondo agrees, saying government shouldn’t just draft legislation but should provide support in the form of resources and training. “Government should also ensure that there is harmonisation of policies and guidelines nationally and that the committees are capacitated to deliver on their mandate,” she said.

Article by By Zanele Sabela

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