IntroductionDistrict healthcare services in South Africa face many challenges with regard to attempts to offer effective primary healthcare services. Demand for services from uninsured communities is high. There is a quadruple burden of disease characterised by human immunodeficiency virus/ acquired immune deficiency syndrome and tuberculosis; interpersonal violence and trauma, poverty-related diseases, such as diarrhoea and pneumonia; and an emerging epidemic of noncommunicable chronic diseases. The number of service providers is often inadequate to cope with the workload. Healthcare workers are inequitably distributed. For example, doctors are found in greater numbers in urban areas, the private sector and hospitals, rather than in the communities. The district health system itself is a relatively new structure and many district-, subdistrict-and facility-level managers are still being appointed. Poor leadership and governance is one of the identified challenges that faces the new health districts. 3According to the Department of Health, primary healthcare workers are expected to be caring and compassionate at the coalface, and yet becoming patient-centred and improving the quality of care in this context is a challenge: 4 "The department renders a large and complex service every day of the year, and the clinical environment is often stressful. Staff attitudes are a common source of complaints. A key issue is how greater commitment and engagement from staff can be promoted on a daily basis, moving towards a more client-centred service with a greater focus on quality improvement". Results: In total, 154 staff members completed the survey. Participants reported personal values that are congruent with a move towards more patient-centred care. The top 10 current organisational values were not sharing information, cost reduction, community involvement, confusion, control, manipulation, blame, power, results orientation, hierarchy, long hours and teamwork. Desired organisational values were open communication, shared decision-making, accountability, staff recognition, leadership development and professionalism. Organisational entropy was high at 36% of all values. Only teamwork and community involvement were found in both the current and desired culture. The organisational scorecard showed a lack of current focus on finances, evolution and patient experience. Conclusion:The organisational culture of the Metro District Health Services is currently not well aligned with the values expressed in Vision 2020, and the goal of delivering patient-centred care.Peer reviewed.

The findings indicate an association between the application of clinical audit and quality improvement in resource-limited settings. Co-interventions introduced after the baseline audit are likely to have contributed to improved outcomes. In addition, support from the relevant government health programmes and commitment of managers and frontline staff contributed to the audit's success.

Background: Non-communicable diseases (NCDs), including type-2 diabetes and hypertension, have been associated with increased morbidity and mortality rates because of coronavirus disease 2019 (COVID-19). Maintaining quality care for these conditions is important but data on the impact of COVID-19 on NCD care in South Africa are sparse.Aim: This study aimed to assess the impact of COVID-19 on facility and community-based NCD care and management during the first COVID-19 wave.Setting: Two public health sector primary care sites in the Cape Town Metro, including a Community Orientated Primary Care (COPC) learning site.Methods: A rapid appraisal with convergent mixed-methods design, including semi-structured interviews with facility and community health workers (CHWs) (n = 20) and patients living with NCDs (n = 8), was used. Interviews were conducted in English and Afrikaans by qualified interviewers. Transcripts were analysed by thematic content analysis. Quantitative data of health facility attendance, chronic dispensing unit (CDU) prescriptions and routine diabetes control were sourced from the Provincial Health Data Centre and analysed descriptively.Results: Qualitative analysis revealed three themes: disruption (cancellation of services, fear of infection, stress and anxiety), service reorganisation (communication, home delivery of medication, CHW scope of work, risk stratification and change management) and outcomes (workload and morale, stigma, appreciation and impact on NCD control). There was a drop in primary care attendance and an increase in CDU prescriptions and uncontrolled diabetes.Conclusion: This study described the service disruption together with rapid reorganisation and change management at primary care level during the first COVID-19 wave. The changes were strengthened by the COPC foundation in one of the study sites. The impact of COVID-19 on primary-level NCD care and management requires more investigation.

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