Growing the voice of communities in the Western Cape health system
This speech was delivered by Dr Nomafrench Mbombo, the Western Cape Minister of Health, during the consideration of the Western Cape Health Facility Boards and Committees Bill in the Western Cape Provincial Parliament.
Cabinet Colleagues and Members of the Provincial Parliament,
Chairperson of the Standing Committee,
Our Partners at the academic Institutions, civil society and the health sector,
members of the various media,
representatives from local communities and most importantly, our consumers of healthcare,
A good evening to you all.
Upon my appointment as Minister of Health, I made several promises.
I promised that I would always maintain an appreciation for the incredible work done by the thousands of healthcare professionals throughout the province. Being a former health worker, I have lived their daily struggles.
I also promised to never lose sight of selfless efforts of everyday people in communities who work tirelessly and give of themselves as volunteers, as members health forums, clinic committees, or hospital boards.
They’re efforts are crucial to achieving a shared vision of an inclusive health sector which protects the dignity of all our people.
It is these people whom I acknowledge and speak of today.
When I was a newly minted Western Cape Minister of Health, I pledged to give communities a more prominent seat at the Department Health’s decision-making table.
I promised to put weight behind the words “Nothing about us, without us when it comes to health matters.”
Honourable Speaker, the Western Cape Facility Boards and Committees Bill (the Bill) before the house today is the fruit of that promise. It shows the Western Cape Government’s commitment to delivering good governance to the people of this province.
The Bill before house today will to bring greater community representation, participation and diversity to the governance of our health system by not only continuing to recognise traditional facility boards at primary healthcare facilities but by also demanding community participation and representation at local clinics and community health care centres.
This is a victory for communities throughout the province and is a model for transparent and inclusive governance of state facilities.
Somlomo Obekekileyo, this participation is not a nice to have. It is a Constitutional requirement under section 195(1) (e) which requires that “people’s needs must be responded to, and the public must be encouraged to participate in policy-making.”
Equally so, the National Health Act, to which we subscribe, under sections 41 and 42, places an obligation on governments to promote the consultation and participation of communities in healthcare through various structures composed of various members of each community.
Public participation within public institutions is important for deepening democratic governance.
Our society’s laws and culture hold dearly to the belief that people have the right to influence what affects them. Strengthening the public’s role and participation in state fora more often than not, is the right thing to do in a society built on democratic values.
By increasingly creating an enabling environment for public participation, we provide a platform where the public’s ideas, values and interest can be taken into account and allow for a truly responsive public service.
By working together with communities we can –
- Better identify challenges and opportunities for creating better services;
- Create a better understanding of the contextual situation of our clients;
- Build closer connections with communities that function as a supportive network; and
- Increase mutual understanding.
The spirit of these legal and constitutional imperatives is carried through to the Western Cape Provincial Healthcare Plan for 2030 which speaks extensively about patient-centred care and how we aim to realise it as a province.
Community engagement and participation are critical to delivering healthcare which directly responds to the needs of our clients whom access public health services.
We cannot build a health system which promotes the rights of our citizens and secures their wellbeing if our clients continue to be nothing more than passive recipients of healthcare services.
At the heart of this proposed legislation is the will to entrench community engagement within the health system and make the recipients of the public healthcare services a partner in the provision of healthcare.
Honourable Speaker, the strength of this Bill lies in its ability to marry the province’s vision for healthcare whilst also strengthen the provisions of the Constitution and National Health Act. This is done by creating a structure within which communities may influence the work done within the health system.
The Bill before the house is a vehicle for driving this province’s health sector closer towards our vision for patient-centred care. It empowers communities to take ownership and responsibility of health services in partnership with health workers.
Honourable Speaker, as will happen from time to time, the face of political self-interest will rear its ugly head from those who wish to centre power towards themselves.
During the drafting of the Bill one heard from certain corners that the Bill would take away communities’ powers.
Nothing could be further from the truth.
Somlomo Obekekileyo, the truth is, since the Bill was gazetted in 15 May 2015, we have studiously engaged with comments by no less than 26 stakeholders and numerous communities in all corners of the province - revising and tweaking the Bill as we went. We did this to better suit the needs of our people.
The truth, Honourable Speaker, is that rather than take away power from the people, the Bill will legally welcome the voices of communities who previously operated on the fringes of the public health system. It will finally formalise the relationship between health administrators and communities.
The Bill will create statutory bodies out of health committees so that their voices matter on the decision-making table at all our facilities.
Honourable Speaker, recognition without the provision of necessary support would be meaningless.
Section 18 of the Bill recognises the need to ensure that communities who will now be brought into the governance space are capacitated so as to play their part.
The Bill provides for this by requiring facilities to assist with secretarial and financial account support to fledgling health committees.
Honourable Speaker, added to this, health committees will no longer be seen as toothless tigers.
Indeed, section 13 grants local communities access to powers which were previously denied to them.
For the first time, the Bill will give communities the opportunity to advise and make recommendations to the Provincial Minister, the management of the primary health care facilities, the Head of Department or the municipality concerned on matters relating to the Committee’s functions.
This will finally give these committees a greater stake in the management of the health system.
Section 13 (1) paragraphs (d) and (e) empowers communities with the power of oversight, giving them insight into the performance of their facility and placing them in a better position to work with facility managers and achieve the vision of quality healthcare.
Honourable Speaker, through this Bill, all communities and the department will indeed be able to worker better together.