• Chapter 1: Introduction and Background

    Community Involvement in Hospitals:
    Key Findings and Recommendations

    1.1 Hospital Strategy Project

    A central goal of the Department of Health is to develop a unified National Health System based on the Primary Health Care (PHC) approach within the district model. As a result, there is a strong commitment within the National Health System to direct more financial and human resources toward primary health care services. Despite a dramatic change in emphasis, hospitals are envisaged to play an important role in the transformed health system. According to the Department of Health, "the role of hospitals will be redefined to be consistent with primary health care principles." [2]

    The Hospital Strategy Project (HSP) was established in October 1995 to provide guidance and technical assistance to the National and Provincial Departments of Health on the transformation of hospital services and management. The Project represents a partnership between The Monitor Company, The Centre for Health Policy Research at the University of the Witwatersrand, Naledi, and International Health Partners. It is funded by the European Union.

    There are five separate modules in the Hospital Strategy Project. This module on the decentralisation of hospital management contains five focal areas: governance and accountability, hospital management structures, staffing and personnel management, procurement, and financial management. This report specifically examines the potential role of communities in the governance and accountability of hospital management. To further the work of the Project, these recommendations need to be integrated into the governance and accountability focal area and compatible with other modules of the larger project.

    1.2 Original Brief

    During the strategic planning process around the decentralisation of hospital management, several stakeholders expressed an interest in examining the potential for community involvement. Dr Johnny Broomberg of HSP approached the National Progressive Primary Health Care Network (NPPHCN) in late October 1995 to submit a proposal to research the potential role for communities within a decentralised hospital management system.

    Preliminary research and negotiations with the Hospital Strategy Project defined the terms of reference for NPPHCN. Four focal areas each with a series of related questions emerged from these discussions:

    Role of Communities in Hospital Management

    • Broadly speaking, do communities want to be involved in hospital management? If so, what are some mechanisms to meaningfully involve them? Finally, what are their goals and objectives for involvement?

    Accountability of Hospital Management to Communities

    • What are the most important issues for hospital management to report back to communities? What are the most appropriate mechanisms to facilitate this process?

    Hospital Governance Structures

    • What role do communities think that they should play in the governance of hospitals? Based on these perceptions, what should be the composition, function, and authority of Hospital Boards?

    Framework for Implementation of Community Involvement

    • How can a theoretical national framework for community involvement be put into action? Specifically, how will this framework be integrated with other efforts to decentralise management and with district health system development?

    1.3 Acknowledgements

    NPPHCN would like to acknowledge the contributions of all community members throughout the country who gave up another weekend day to participate in this consultation process. Your eagerness to participate in the transformation process is inspiring.

    NPPHCN also would like to thank Dr Louis Reynolds of Red Cross Memorial Children's Hospital, Esca Scheppers of the Media and Training Centre, and Alyssa Wigton of the Child Health Unit, who reviewed and commented on various aspects of this project. Their contributions have been invaluable. NPPHCN also appreciates the contributions of members of the Cape Metropolitan Health Forum, Red Cross Children's Hospital, the Khayelitsha Health and Welfare Forum, and the Khayelitsha Co-ordinating Committee who sacrificed their time to share their opinions with us. The contribution of the Community Agency for Social Enquiry (CASE) is also acknowledged.

    NPPHCN's PHILAW programme is funded by a grant from the Henry J. Kaiser Family Foundation, Menlo Park, California, USA.

      Back to Contents Chapter 2

    Home

    National Progressive Primary Health Care Network

    Please send comments or suggestions about this site.