RHD Prelude Chapter - Health Systems Trust

• Clinic Committees – mostly in rural areas of the previous ‘homelands’
• Hospital Boards – often consisting of local business elites and little real community
representation.
A new vision for public health services was developed between 1990 and 1994. The policies
and structures for health services included governance structures to ensure community participation
and involvement in health issues.
The NW Provincial government passed the North West Health, Developmental Social Welfare
and Hospital Governance Institutions Act in 1997 (Act No. 2 of 1997) when Health and Social
Welfare were joined under one ministry in NW Province. This Act predated the establishment
of local government as a distinct sphere of government in 2000, and the passing of National
Health Act in 2003.
Early governance structures of community forums, district health committees and hospital boards
for Health and Welfare were based on the Governance Act. Nominations for membership were
made through traditional structures such as the tribal authorities, but final appointments were
made by the MEC for Health in the province. The health forum included provincial health
officials, ex officio, but no local government officials. These governance structures were seen
as a communication channel between the community and the Provincial Health and Welfare
Department, but, as they were not elected, were not fully representative of the community:
“Those governance structures were not really elected, with the result that there was, in the
beginning, I wouldn’t say friction, but there was not that close co-operation.”
(Regional Health Director)
The health forums did, however, have power to make decisions and, if necessary, refer directly
to the MEC for Health any matters that could not be solved at the local level, as explained by
a district manager:
263
They do have the power to take the decision; they also do have the power to give that
resolution directly to the MEC.
(District Health Manager)
Subsequent to the establishment of the local government sphere in 2000, new community based
structures have emerged. There is possible duplication of function between the local government
structures, such as ward committees and the health governance structures. Councilors are voted
into office by local residents. A mayor and mayoral committee are appointed from the majority
political party in the municipality, and ward committees are formed at a local level to address
local issues, including health.
Both structures, namely Ward Committees and Health Governance structures, are able to
call meetings. The ward committees, however, in terms of the legislation, have greater power
than the health governance structures in implementing recommendations made.
The apparent duplication of structures at a local level (established under different spheres of
government) leads to confusion and possible delays in implementing resolutions or bringing
problems to the notice of authorities. Some health governance structures overcome this by
following two lines of reporting – to the provincial department and to the local municipality.
This was noted by a hospital manager: