The Status of Clinic Committees in Primary Level Public Health Sector Facilities in South Africa

In South Africa, governance structures in the form of clinic committees, hospital boards and district health councils are intended to give expression to the principle of community participation at a local and district level. Clinic committees, hospital boards and district health councils are intended to act as a link between communities and health services and to provide a conduit for the health needs and aspirations of the community to be represented at various local, district, provincial and national levels. A tiered system of representation is envisaged in which the voice of ordinary community members eventually makes its way from the local to the provincial level.

This study aimed to assess the functioning and effectiveness of health governance structures in the form of clinic committees in order to identify opportunities for strengthening their role in governance. The study sought to ascertain the number of clinic committees associated with public health facilities in all nine provinces in South Africa. In addition, the study intended to identify the factors that are perceived by clinic committee members to either facilitate or impede the effective functioning of clinic committees. The study was conducted in two phases: the first phase consisted of a cross sectional survey which was administered with the aim of collecting information on the nature, scope and extent of community participation through clinic committees at public health facilities in the nine provinces in the second phase of the study, three focus group discussions (FGDs) were undertaken with the members of three clinic committees and were directed at providing a more in-depth understanding of the information collected in phase one, as well as documenting the factors that are perceived as facilitating or impeding the effective functioning of clinic committees.

While 57% of facilities reported having clinic committees, the study found that there are a range of factors that impact on the functioning of these structures. The results also suggest that more clinic committees exist in provinces where there has been explicit political support for the creation and building the capacity of these structures. The data also suggests that most clinic committees have come into existence since the promulgation of the National Health Act, 2003. Poor socio-economic conditions and a context of poverty are important determinants of whether clinic committees flourish as the study found that a failure to attend meetings (often due to transport costs) and the lack of a stipend for clinic committee members are some of the reasons why facilities do not have clinic committees. Encouragingly, in two provinces, more than 30% of those facilities which did not have clinic committees reported being in the process of establishing committees. The low level of local councillor membership (45%) in clinic committees is cause for concern as this is a statutory requirement that is not being complied with. This has important implications for the envisaged tiered system of representation articulated in the National Health Act, 2003. The results also suggest that while most clinic committees meet on a monthly basis, the activities of the clinic committees appear to be mostly confined to problem solving between the community and the health facility, health education and volunteering their services in the facility. The issue of the roles and responsibilities of clinic committee members needs attention as the research has highlighted the gap that exists in this regard.

The results from this study indicate that while national legislation has created a political climate receptive to community participation, the lack of provincial guidelines, inadequate resource allocation, and the limited capacity of committees constrain their abilities to actively fulfill their intended roles and responsibilities.