Clinic Committees and their perceived roles in Governance and Community Participation in the City of Johannesburg

Abstract

Background The United Nations Sustainable Development Goals (SDGs) underscore the importance of health system governance, and the engagement and participation of communities. In South Africa, the National Health Act emphasises community participation and makes provision for the establishment of health facility committees to act as a link between communities and the health system. Study aim Explore the perceived roles of clinic committees in community participation and health governance in a selection of wards in the City of Johannesburg (CoJ). Methods This was an exploratory qualitative study of clinic committees in six wards in the CoJ, with equal representation of provincial (n=3) and local government (n=3) clinics. Following informed consent, in-depth interviews were conducted at each of the six clinics with clinic committee members and the primary health care (PHC) facility manager. The semi-structured interview scheduled focused on the establishment, composition, functioning and the knowledge, motivation and experience of clinic committee members, relationships between and among different stakeholders, perceptions on the clinic committee roles in community participation, and health governance. Thematic analysis was used. Results Eighteen in-depth interviews were conducted with 12 clinic committee members and six PHC- facility managers. At the time of the study in 2021, all six selected clinics had an established clinic committee, the number of members ranged from two to eight, and consisted mostly of middle-aged women. The interviews revealed a political, but standard and uniform clinic committee selection process. Some of the clinic committee members reported that they had neither received formal appointment letters, nor formal induction and training. The study participants reported that each clinic had a functional clinic committee, demonstrated by monthly meetings, a venue for holding the meetings, discussion of or feedback on v substantive issues related to patients, staff and/or the clinic, and keeping of minutes. Nevertheless, the clinic committee functioning was influenced by the relationships between the clinic committee members, and the PHC clinic managers and/or staff. The perspectives on the clinic committee’s role in community participation highlighted the committee as the dual voice of the community and PHC facility manager, serving as a resource or mediator, and providing feedback to the community. The clinic committees’ role in health governance was mediated by their knowledge and relative power in relation to the PHC facility manager. The committee’s governance role was seen as assisting with the smooth running of the clinic, information sharing, the management of patient complaints, and sourcing sponsorship. However, the lack of a stipend and benefits for clinic committee members, and resource constraints emerged as major challenges. Conclusion Investment in clinic committees, combined with a multi-prong approach to address the challenges identified, will enable these structures to fulfil the envisaged community participation and governance roles.