Browsing by Author "Stuttaford, Maria"

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    Community health committees as a vehicle for participation in advancing the right to health
    (2010) Glattstein-Young, Gabriela S; London, Leslie; Stuttaford, Maria
    The principles of Primary Health Care guided health system transformation in South Africa where community health committees represent formal structures for participation in health. While there is evidence to suggest that participation can assist the progressive realization of the right to health, this link is not well established in the literature and Southern African studies underscore a serious deficit in the implementation of meaningful community participation. The present study used multiple methods to explore the relationship between participation and the right to health and to draw lessons on best practice for community participation from three health committees in South Africa's Western Cape Province.
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    Consumers' perspectives on National Health Insurance in South Africa: using a mobile health approach
    (JMIR Publications, 2014) Weimann, Edda; Stuttaford, Maria
    Background: Building an equitable health system is a cornerstone of the World Health Organization (WHO) health system building block framework. Public participation in any such reform process facilitates successful implementation. South Africa has embarked on a major reform in health policy that aims at redressing inequity and enabling all citizens to have equal access to efficient and quality health services. Objective: This research is based on a survey using Mxit as a mobile phone–based social media network. It was intended to encourage comments on the proposed National Health Insurance (NHI) and to raise awareness among South Africans about their rights to free and quality health care. Methods: Data were gathered by means of a public e-consultation, and following a qualitative approach, were then examined and grouped in a theme analysis. The WHO building blocks were used as the conceptual framework in analysis and discussion of the identified themes. Results: Major themes are the improvement of service delivery and patient-centered health care, enhanced accessibility of health care providers, and better health service surveillance. Furthermore, health care users demand stronger outcome-based rather than rule-based indicators of the health system’s governance. Intersectoral solidarity and collaboration between private and public health care providers are suggested. Respondents also propose a code of ethical values for health care professionals to address corruption in the health care system. It is noteworthy that measures for dealing with corruption or implementing ethical values are neither described in the WHO building blocks nor in the NHI. Conclusions: The policy makers of the new health system for South Africa should address the lack of trust in the health care system that this study has exposed. Furthermore, the study reveals discrepancies between the everyday lived reality of public health care consumers and the intended health policy reform.
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    Gender, participation and the right to health: health committees in Cape Town, South Africa
    (2017) Austin, Janet Sarah; Stuttaford, Maria; Müller, Alexandra
    Community participation is now widely recognized as an integral part of health systems and the right to health. Health Committees are an example of participation, influenced by multiple social factors, yet little research has covered the impact of gendered power relations in health committees themselves. Committees are also deemed to be accountability structures, aiming to bolster the efforts of an overburdened health system and aid in responding to the need for often under-resourced services relating to women's and sexual orientation and gender identity (SOGI) minorities' health and sexual reproductive health rights. Current literature affirms the social mobilisation of communities via participation structures, with all committee members needing to be empowered in their roles to provide a greater reach and platform for marginalised groups as both committee and community members. A qualitative, exploratory study was undertaken to answer the question: What is the role of gendered power relations in Health Committees in the Western Cape? Multiple methods were used during March to December 2015 that included observation of Health Committee meetings, group discussions and indepth interviews. A Gender-based Analysis using African Feminist Theory was applied, with Connell's 1987 theory of gender and power as well as considerations of community participation as a function of citizenship. Findings showed that the perception of gender equality and gender relations amongst Health Committees remains largely misunderstood and unaddressed. The Draft Western Cape Health Boards and Facilities Bill of 2015 provided an unstable political backdrop during fieldwork. Democratic group processes did not nullify manipulation of gender roles, and a disconnection between leadership positions and influential agents could be seen. This was accompanied by no notable gender bias concerning health need foci and a non-discriminatory outlook towards committee participants or service recipients, however there was no action to engender such claims, such as special training or materials to support sexual and gender minorities. Adequate representation and reinforcing accountability of Health Committees remains a challenge. Gender mainstreaming in inclusive policy needs to be operationalised at facility level, and gendersensitivity training for Health Committees is a viable approach with which to address the continuing poor policy to implementation problem. The Western Cape Health Boards and Facilities Act of 2016 shows some promise towards recognising and broadening committee governance and diversity. Women and SOGI minorities must be supported in leadership roles to strengthen scaling up efforts and enable the Health Committees to function as truly accountable and participatory instruments for public health.
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    Improving health care provider - health committee working relationships for responsive, people-centred health systems
    (2016) Zwama, Gimenne; Stuttaford, Maria; Haricharan, Hanne J
    As community-based governance structures in the service delivery of primary health care, health committees can promote the quality, accessibility and responsiveness of service delivery. More specifically, health committees provide a platform for community members to advocate for their health needs and meaningfully participate in decision-making, oversight and monitoring of service delivery. Hence, health committees provide a bottom-up strategy to realise the right to health and a people-centred health system. Previous research has found that Health Committees in the Cape Metropole of South Africa face similar challenges as their counterparts globally. In South Africa health committees' role and mandate often seem to be unclear and weak policy frameworks have resulted in wide variations in health committee functionality. Health care providers, particularly health facility managers, have been identified to play a key role in creating a supportive environment for health committees' genuine and effective participation. Particularly, health care providers' misunderstandings of health committees' roles and responsibilities as well as their lack of engagement with health committees can form barriers to health committee's functioning. A gap in understanding exists on the impact training of health care providers could have on health committees' meaningful participation. While many health committee members in the Cape Metropole of the Western Cape Province were already trained, health care providers had not been trained until May 2015. Present realist evaluation sought to describe and explore the immediate and short-term impact of this pilot training on health care providers' responsiveness towards health committees. Pre- and post-training questionnaires, direct observations and semi-structured interviews were employed as research methods. The training evaluation was enriched by participants' diverse professional positions and work environments as well as their various experiences and relationships with health committees. The study reveals that the training played a role in increasing health care providers' responsiveness towards health committees' roles and functions. Health care providers demonstrated understandings and intentions towards building effective working relationships with health committees. However, training is recommended to be followed up on and to be continuous to ensure intentions are translated into practice and to account for the dynamic nature of health facilities, health committees and the health system in which they reside. In this manner, health care providers can increasingly contribute to building sustainable relationships with health committees to promote meaningful and effective community participation, the strengthening of people-centred health systems and the progressive realisation of the right to health.
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    The National Health Insurance (NHI) in South Africa : scaling up health care provision: the consumers' perspectives.
    (2013) Weimann, Edda; London, Leslie; Stuttaford, Maria
    Globally, there are major shifts taking place in health care provision to achieve universal health coverage. In 2011, the South African Department of Health released a Green Paper outlining its vision for implementing a National Health Insurance (NHI). The NHI wants to improve the service provision and promote equity and efficiency to ensure that all South Africans have access to affordable quality health care services. Public participation is important to raise public awareness, consult the public and promote major programs of change. This research aims to analyze the gaps between the everyday lived reality of publicly provided health care consumers and intended health policy reform.
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    Training clinic health committees: a vehicle for improving community participation in health
    (2017) Chikonde, Nkandu; Stuttaford, Maria; Haricharan, Hanne Jensen
    Objectives: In South Africa, and globally, community participation has become a key feature in the health system. In order for meaningful participation to occur within the health system several mechanisms have been identified as critical and this includes formation of health committees (HCs) at health facility level. Previous research indicates that health committees are imperative in both actualizing community participation and realisation of right to health. However, few studies have been undertaken to understand the impact training health committees has on community participation and right to health. This study sought to evaluate the impact training clinic health committees in community participation, health and human rights has on participation and right to health. The training been evaluated was led by Learning Network on Health and Human Rights and targeted four clinics in Cape Town Metropole of Western Cape, South Africa. The Learning Network is a grouping of five civil society organisations (CSOs) in Western Cape, South Africa at four universities which was launched in 2008 after the recognition of a gap in documented knowledge that CSOs had on health and human rights. The study explored health committees' changes in knowledge, perceived competencies, documented member's understanding of roles and HCs sustainability as well as the trainings impact on relationship between HCs and health service providers. Methods: The study was a multiple case study with multiple qualitative methods for data collection. Narrative data was collected through twelve in-depth interviews with health committee members, one facility manager, two focus group discussions and three physical observations across four health facilities. Health facilities were purposively selected from a list of health facilities trained by the Learning Network in 2014. Inclusion criteria also included English speaking health facilities and those in close proximity to each other. 2 Results: The study revealed that training HCs contributed to improved competencies, awareness and knowledge of community participation and the right to health. After the training, HC members were perceived to be more aware and responsive to their roles and responsibilities at the health facility. It was also noted that the training aided improved HCs perspectives on sustainability and roles, improved interpersonal skills and self-esteem. Conversely, the study revealed that despite the training improving participation and right to health, power imbalances between HC members and facility staff/managers who hold authority has a bearing on when and how participation occurs. Conclusion: The study demonstrates that training health committees contributed to improving the levels of community participation such as planning, consultation and advise [Arnstein, Rifkin and Loewenson] in the realisation of right to health. It is recommended for wider community participation that trainings of such magnitude are conducted together with facility managers/staff.