PACSA facilitates a conversation by Health Care Monitors

Category : PACSA news

In conversation

On the 19th February 2016 PACSA, supported by Oxfam Australia, facilitated a monitoring exchange conversation between four different organisations actively involved in monitoring public health clinics. The organisations included: The AIDS Legal Network (Cape Town), Project Empower (Durban), The National Health Insurance Research Team (Pietermaritzburg), and Hilton Valley Health and Development Organisation (Howick).The objective of the exchange was to create a space for monitors actively involved and experienced in monitoring to talk to one another directly about their work, how they do it, what they are observing in the clinics and how they use the outputs of these observations for advocacy. The idea was that together, through these conversations we could look at how to strengthen our advocacy and explore possibilities of further joint learning, support, solidarity and possible collaboration. From a methodological perspective, PACSA also hoped to deepen our learning on how to organise a space where those with experience speak to others with experience- to optimise the value around the work they do and how to improve it.   The exchange conversation opened up the space to broaden understanding around the work that each of the organisations do and the different modes of observation. Similarities existed in what groups were noticing in the clinics and provided space to start questioning the structural nature of public health care in South Africa. It was however in the methodologies employed in collecting data, how the data was documented, reflected upon and how the data was used for advocacy as well as the mode of advocacy that became, for PACSA and the NHI Research Team, the most instructive. We noticed that the separation of data collection from advocacy in the clinics was important for credibility of data; and that careful documentation provided a stronger foundation for quality advocacy. We noticed that careful reflection on the data provided possibilities for theory making and seeing the ‘bigger picture’. Additionally, regarding how groups ‘did advocacy’, we noticed that most groups advocated directly in the clinics e.g. confronting dignity or rights violations where they happened or holding meetings with clinic matrons to resolve matters. Here it was questioned whether these practices were useful in events where matrons and nurses did not actually have power to resolve problems on site; hence such advocacy could compromise relationships and further frustrate and exacerbate challenges. In this regard, it was found that advocacy might be more effective if more work was done in identifying who holds power to change the situation and that thereafter advocacy is targeted with more nuance – whether at clinic level or higher up at District Management. A final observation was the burden placed on monitors to do their work – that the health and wellbeing of monitors was critical; and that more attention needed to be placed on the psychosocial and health impact of the actual work on the bodies and minds of monitors.   The experience of creating a space for monitors to talk directly to monitors provided numerous lessons on how to organise such a focused conversation. Critically we found that the selection process of who becomes involved and how/and who speaks in these spaces provides the foundation for a valuable conversation. We found that we have to work harder to protect these spaces for people on the ground – whose voice talks directly to experience; to have their own spaces to reflect on their work. In conclusion, we found that exchange conversations with various organisations actively working in the same area provides enormous opportunities for learning and strengthening individual work; whilst opening up possibilities for future solidarity.

In Conversation
Participants at the conversation copy

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