Part II: Umama noSana Uthukela Community Project

 

The second aim of this project as mentioned in the previous post is to revive clinic committee (CC) programs to ensure community participation and service provider accountability. You might be wondering, what are clinic committees?

CCs are a part of SA's governance structure intended to give expression to community participation at a local and district level. They are composed of various community members and can include elders, traditional healers, community care givers (CCGs), and Sisters (the local term for nurses, who are most often female...I've asked about how to respectfully address a male nurse to which I have not gotten a definitive answer, but it has been confirmed that we don't call them Brothers :). The CCs are intended to act as a link between communities and health services, relaying the health needs and aspirations of the community to to different levels of government. They are crucial entities to improving health status of a community, and especially as related to Umama noSana, crucial to improving demand for maternal and child health services through community mobilization. 

There are four CCs we're targeting at four different sites around the Uthukela district. Our first task was to meet with the CCs and assess how functional they are, learn about their work, and find out what challenges we could help them with. The first CC meeting at Driefontain was very productive, and we met an engaged group of people. (Every clinic is identified with medical symbol and the first letters of the area.)

Working with the community is easy-peasy I thought. How naive of me to take ease of communication for granted. My perception was rather premature as things quickly went downhill after that. We arrived to a scheduled meeting with the second CC at which there were zero people in attendance. Apparently the Sister with whom we had talked to and planned the meeting with decided not to tell any CC members about it. I was flabbergasted to hear and see her blatantly deny that we had come to speak to her the week before to set it up. The story turns out that this particular Sister has been having some issues with the Sister in charge at the clinic, and she seemed to be sabotaging clinic work from the inside. Next, we had the third CC meeting to which only two members came because the remaining six to eight of them recently were employed and would not be available during the weekdays to meet. There are telephones at these clinics, but it apparently didn't occur to the CC to let us know and reschedule another time. Then there was the fourth CC that we unsuccessfully scheduled a meeting with, the failure related to the local politics of the community. There was infighting for control of the CC between the former CC chairperson and the tribal chief. We trekked all the way to the tribal court in an attempt to make some headway, but was only met with the chief's mother who told us to come back in 6 weeks to request a meeting with the chief himself when he's back in the area. We could merely only make a request in 6 weeks, not even have a meeting with the CC itself! 

These incidences of breakdown in communication were frustrating, especially since there was quite a bit of preparation for each meeting. Traveling is not a walk in the park either. These clinics are located in remote rural areas, anywhere from 30 minutes to one hour away from Ladysmith. Many of the roads to the destination are paved, but many others are still dirt. These are some of the scenes I saw out of the car window.

So what we found out was that only one of the four CCs is really functional. This may not be surprising as it reflects a national trend. In 2008, there was study assessing the status of the CCs in all of SA. It found that while 57% of facilities reported having a CC, there was a wide range of factors that impacted how functional they are. Yes, national legislation had created a political climate receptive to community participation, but 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. 

We have a lot of work to do on this part of the Umama noSana, and it's been a humbling exercise of patience so far.