Dr Nomafrench Mbombo, Dedicated Provincial Minister of Health, Western Cape

Making Sure No One Gets Left Behind

By Fiona Wakelin

We asked Dr Nomafrench Mbombo to share her story with us – and the journey which led to becoming the provincial Minister of Health for Western Cape.

My journey as a politician started 10 years ago as an extension of my activism. Prior to that, I had a diverse and impactful career as both a clinician, academic and an activist. Over the course of 17 years I served as an Associate Professor focusing on Sexual and Reproductive Health & Rights. Before my academic career, I dedicated myself to public health service working as both a professional nurse and a midwife. This experience laid the foundation for my successful career in the healthcare sector.

You have been Minister of Health and Wellness since 2015. What have been some of your most memorable achievements in the last 8 years?

During my tenure as Minister, I have had the opportunity to make a real impact through various achievements:

• The only health department in the country to have received five consecutive clean audits.

• Implemented the hospital and emergency centre tracking information system (HECTIS), which is a web-based patient management system for emergency centres and is the first and only one of its kind in South Africa.

• Established the Violence Prevention Unit. Based on the Cardiff Violence Prevention Model, it uses the data in our healthcare facilities to identify and design unique interventions in our communities across the Western Cape.

• First province to develop an information and technology (E-vision) strategy, which led to health innovation initiatives that include: unique patient identifier number system, which has streamlined patient information and care across the entire public health care platform, the hospital and emergency centre tracking information system (HECTIS) and electronic pharmaceutical prescribing. Additionally, we launched the Catch and Match initiative which allows Community Health Workers (CHWs) to capture patients through their mobile phones instead of manually processing them. This forms part of the larger commitment to digital health and technology.

• Disaster preparedness and management plans that allowed us to prepare for the management of water shortages during droughts, blackouts and loadshedding.

• First province to have accredited nursing and paramedic colleges as higher education institutions to offer bachelor degrees.

• Multilateral and bilateral agreements with the four public universities in the Western Cape, where the respective vice chancellors and I joint-chair sessions.

These are but a few of the many successes over the years.

The change of the name of your department to Health and Wellness signals your focus on preventative care –please describe the key programmes you are running which focus on wellness

The change of the Department’s name to that of Health and Wellness signifies an important shift in how public healthcare approaches health, as it moves it away from the traditional hospicentric approach.

COVID-19 was a big game-changer in the healthcare sector. This was a time when healthcare had to act without delay. For example, the Western Cape housed the biggest COVID Field Hospital in South Africa that accommodated 863 beds.

While it resulted in delays for a variety of programmes and meant we had to recover our services following the pandemic, it provided us with a point of inflection to do things differently. It led us to creating the Reset Agenda where we offer the right healthcare at the right place, right time and right price. This all contributes towards our goal of achieving universal health coverage (UHC).

That is why we are focusing on the upstream factors that affect health and this focus is a cross-cutting initiative impacting all of our services. This is mostly seen in our Community Oriented Primary Care (COPC) approach, which aims to promote community health by involving local residents in the planning and decision-making processes. As we implement this, it will allow for tailored healthcare services to the specific needs of the community that focuses on disease prevention and health promotion.

With an overarching interest in community empowerment as a conduit to reclaim the voices of the population at risk such as young women and girls, rural women, the LGBTQIA+ community and the marginalised, what have been some of the success stories in this regard?

Previously, I have contributed immensely as a human rights activist and academic in this regard. But, from a governance point of view, a key intervention has been the establishment of the Violence Prevention Unit (VPU), as previously mentioned.

The rationale behind this is rather simple. Imagine you are a vulnerable woman who has been abused and is in need of medical attention. Your first instinct is to go to the nearest healthcare facility, as you know you will be better assisted there than at a police station where the wheels of justice turn slowly. This means that many of the incidents not recorded in the quarterly crime statistics, are recorded in our emergency centres (ECs).

By using this information, the VPU is strengthening the Western Cape Government’s approach to evidence-based decision making for crime fighting and crime prevention. As this unit is further capacitated, it will provide our safety stakeholders both in government and civil society with these proposed interventions. This is however a very recent development.

Throughout my tenure, we have always looked after the vulnerable:

• During COVID-19, we were the first to vaccinate the homeless when nobody else wanted to

• We have rendered healthcare services to sex workers on the streets even when their business is still considered illegal

• We have looked out for drug users by offering needle exchanges to prevent the spread of HIV and other diseases

• One of the only provinces that renders services to the trans community, with the only public healthcare facility (i.e. Groote Schuur) to have a dedicated transgender clinic

What do you enjoy most about your role as Minister of Health?

Having worked across the health sector during my life, my position as Minister of Health and Wellness in the Western Cape allows me to take all the expertise and experience that I have gathered over the years to improve the lives of all residents.

As an executive member of the provincial government, I have the ability to influence how government renders its services and, over almost 9 years, I believe I have contributed to the evolution of the Department for the better. As we stand, the Western Cape public healthcare system is regarded as the best in the country.

It is extremely rewarding knowing that I have left a legacy behind in the health system since assuming this position back in 2015. A legacy that shows how the Western Cape has been focused on reducing HIV levels, violence in our communities, using innovation and digital technologies in our service delivery, and one of clean and effective governance.

In addition, my position as Minister allows me to engage all stakeholders in the private health sector and political society like councillors (even when municipal health is not their competency). By engaging all stakeholders, we are able to take health services to the people and beyond our facilities, like our hospitals without wheels initiatives at taxi ranks and churches.

How closely does your department work with other government departments? Please elaborate

Apart from collaboration that is prescribed by law, such as working with other provincial health departments and with Social Development specifically in relation to the referral of cases, the Western Cape Government has embarked on a whole of government and whole-of-society approach.

In the Western Cape, multiple departments work together in ensuring that their respective programmes work in unison to ensure that the provincial priorities are advanced. For example, Health and Wellness closely works with Social Development, Education, Police Oversight and Community Safety, Cultural Affairs and Sport – this is however done in conjunction with departments in economic clusters.

Additionally, the department has established relationships with civil society and community-based organisations. For any government intervention to be beneficial, it requires the buy-in from communities. One way we work with communities is through our Hospital Boards and Clinic Committees, which are lawful bodies made up of residents who play a key oversight role over our healthcare facilities.

What have been some of your biggest challenges and how did you overcome them?

As a black female, one of my first challenges was growing up in Mdantsane township in the Eastern Cape during the Apartheid years. Like many of my peers, I could have easily given up and accepted my situation noting the prejudice I faced from a racist and unjust government. Despite these very humble beginnings, I forced my way up the ladder and achieved the goals I set for myself. There were many obstacles in the way, whether it be patriarchy or discrimination or people simply doubting my abilities. But I kept doing what I do best: I kept on working.

How would you describe your leadership style?

My leadership style is one of collaboration and empowerment. Throughout my time in government, I have made an effort in including all stakeholders in our programmes and decision-making so that all voices are heard through every step of the way. This is specifically in relation to ensuring that civil society is heard as they are often the first point of contact for our residents. By doing this, we ensure that we leave no one behind.

What are you looking forward to in the coming year?

As I approach the end of the second term as Minister of Health and Wellness, I am excited for the new journeys that await me. I have been fortunate to work throughout the healthcare system, whether it be in different settings or in different levels of government. The past 9 years have given me even more experience which I will continue to use to make a greater impact for others.

Do you have a message of inspiration for our readers?

While we find ourselves in a difficult period as a country, let us all continue to show dedication for the work we do to the people of South Africa. Many have lost faith in our country and its potential, so let us not lose focus now. Let us be the inspiration for those who have forgotten what it feels like to be inspired.