An investigation into the roles and functions of community health committees

Community participation has been a popular method of people centred, grassroots development in many developing countries. With an emphasis on primary health care (PHC) through the signing of the Declaration of Alma Atta in 1978, there was a renewed commitment to community participation within the health care system. In South Africa, the end of the apartheid era announced a new dedication towards the principles of a comprehensive, promotive and preventative health care in line with the principles of PHC. These changes were outlined in The White Paper on Transformation of the Health System (1997) and advocated the importance of community involvement in the health care system. These roles were formalised in the National Act Health (61 of 2003) with the provision for the establishment of the clinic and community health centre committees as statutory bodies. The initial implementation of the committees had no guidelines or policy to direct their functioning and therefore led to them being differentiated and poorly functioning. In 2009, the Eastern Cape Department of Health issued a Policy on the Establishment and Effective functioning of Clinic and Community Health Centre Committees. In 2010, the Nelson Mandela Metropolitan University’s Community Development Unit, in collaboration with the Health Department, provided a program to formally establish and train all the community health committees in the Nelson Mandela Bay Municipality in accordance with the new policy. This research aimed to investigate the community health committees (CHCs) in the Nelson Mandela Bay District, specifically the way in which they were functioning, three years on from this establishment process, with regards to the roles and functions outlined in the Policy document. This report highlights the extent to which the roles are being met, the challenges impeding the fulfilment of these roles and other factors which inhibit the effective functioning of the CHCs. A qualitative research method was used including focus group discussions and in-depth interviews with key informants to illicit the necessary data. These results were transcribed and analysed to identify recurring themes in order to draw conclusions. The CHCs were found to have varying levels of functionality but had similar challenges in fulfilling the roles. Generally there was a poor level of awareness of the policy and the roles defined within and in addition to this there was confusion over the terminology used within the Policy. The role of Advocacy was undertaken enthusiastically by the CHCs with many forms of education and health programs being promoted. However, a lack of knowledge of the PHC model was evident, which inhibited the CHCs from advocating the importance of this. Oversight was seen by the CHC members as being the most important role for them to fulfil, as the level of medical care received in the clinic was perceived to be poor. The CHC members readily monitor levels of medication, staff presence and service provision but do not feel that they have much power to improve the situation. The role of Social Mobilisation was poorly fulfilled due to a lack of outreach into the community and therefore social upliftment only takes place when community members come to the clinic to use the services. Finally, fundraising was the most unsuccessfully achieved role of the CHCs. A combination of a lack of formal recognition and misguided ideas, have resulted in little means of funding for the CHCs. Generally the major inhibiting factors that the CHCs face are; an incomplete fulfilment of the outlined membership of the committees, lack of comprehensive community representation, a lack of commitment from the Health Department and a feeling of isolation. All of these factors are reducing the motivation of the dedicated CHC members. Recommendations were made at the end of the study to help increase the impact these committees are having on their communities. It is hoped that the Provincial Health Department can work together with the CHCs and other stakeholders to implement these recommendations to help sustain the CHCs further