Countries world-wide are striving towards Universal Health Coverage (UHC). Financial resources are extremely limited in developing countries and many developing countries are in the midst of multiple interconnected social, economic, epidemiologic, demographic, technological, institutional, environmental and political transitions. According to the World Health Organization (WHO), accelerating progress towards UHC in Africa will require strong leadership. At the recent Global Conference on Primary Health Care (PHC), the Astana Declaration, the world recommitted to comprehensive Primary Health Care as a keystone of Universal Health Coverage. There is evidence that PHC works. Countries that followed the Alma Ata PHC principles have demonstrated population health outcomes and reduced inequalities at low costs as seen in Chile, Cuba, Ethiopia and Rwanda. What seems to be missing is leadership to apply and uphold these PHC principles. There is consensus that if Astana is to be realized, strong political, economic, education, health, science, institutional, and community leaders are needed to make PHC work this time around. Governments and leaders in Africa have been conveying a constant message, that those leading and managing health systems are not sufficiently prepared to succeed in leadership roles they now occupy. Africa has had different leaders with the same results for decades. Leadership development efforts made to date seem not to be producing desired results. Students taken out of Africa to be trained in leadership at western universities, seem to go back home and carry on as usual. Many students have been taken to the West for education, developed great visions and ideas of how they can transfer knowledge learnt, got home and got swallowed by the system. Pumping more money into a health system with no leadership development will not help us achieve ‘Health for All’ in sub-Saharan Africa. How can accountable leadership with a sense of consciousness for social justice be developed successfully in these contexts? If leadership is key for Universal Health Coverage to be achieved in sub-Saharan Africa, is it not high time attention is paid to leadership development approaches.

In 1978, the landmark Declaration of Alma Ata on primary healthcare (PHC) recognised that a new approach was needed to achieve 'Health for All by the year 2000' . [1] In 1994, the University of Cape Town (UCT) Faculty of Health Sciences (FHS), recognising PHC-inspired health policy developments in a democratic South Africa (SA), adopted the PHC approach as a 'lead theme' in its teaching, research and clinical service. [2] The multidisciplinary PHC Directorate was established in 2003 as a cross-cutting 'horizontal' unit to promote the PHC approach in the FHS, as well as expanding and managing the decentralised clinical teaching platform for more community-based education (CBE).The concept of social accountability, or the capacity to respond to priority health needs and health system challenges, has gained currency in the past quarter century. [3,4] It emphasises partnerships between health science faculties and key stakeholders in the health sector and communities, and the need for health sciences education to maximise its relevance and impact on people's health. [5,6] The international Training for Health Equity Network (THEnet) was founded in 2008 to promote health equity through health workforce education, research and service, based on the principles of social accountability and community engagement. THEnet has developed a practical tool with extensive indicators to help health science faculties align their training of health workers with community needs: the Framework for Socially Accountable Health Workforce Education. [7] An academic review of the PHC Directorate in October 2014 recommended, inter alia, that indicators be developed for monitoring and evaluating the PHC lead theme, which shares many principles with those of social accountability, such as equity, community partnerships and advocacy. All the authors of this article have extensive experience in teaching the PHC approach in the FHS, and most are members of the PHC Working Group, which was mandated by the FHS Deanery in June 2017 to respond to the recommendations of the academic review. The authors therefore formed an action research group to develop a set of indicators and evaluate PHC teaching and learning of final-year health and rehabilitation sciences and medical students at selected CBE sites of the FHS. The research group's objectives for the present study were therefore to identify evidence of selected PHC indicators in the documented learning outcomes, activities and assessments of final-year students, to evaluate the alignment of the Background. The comprehensive primary healthcare (PHC) approach has been a lead theme in the University of Cape Town Faculty of Health Sciences (FHS) since 1994. A 2014 institutional academic review recommended that indicators be developed for monitoring and evaluating the PHC theme. Objective. To evaluate PHC teaching and learning of final-year health and rehabilitation sciences and medical students at three community-based education (CBE) sites of the faculty, two in Cape Town and one in a distant and lar...

Background. The Faculty of Health Sciences (FHS), University of Cape Town (UCT) adopted the primary healthcare (PHC) approach as its lead theme for teaching, research and clinical service in 1994. A PHC working group was set up in 2017 to build consensus on indicators to monitor and evaluate the PHC approach in health sciences education in the FHS, UCT.Objective. To develop a set of indicators through a Delphi technique for monitoring and evaluating the PHC approach in health sciences curricula in the FHS, UCT. Methods. A national multidisciplinary Delphi panel was presented with 61 indicators of social accountability from the international Training for Health Equity Network (THEnet) for scoring in round 1. Nineteen PHC indicators, derived from a mnemonic used in the FHS, UCT for teaching core PHC principles, were added in round 2 to the 20 highest ranked THEnet indicators from round 1, on recommendation of the panel. Scoring criteria used were relevance (in both rounds), feasibility/measurability (round 1 only) and application of the PHC indicators to undergraduate and postgraduate teaching and assessment (round 2 only). Results. Of the 39 indicators presented in the second round, 11 had an overall relevance score >85% based on the responses of 16 of 20 panellists (80% response rate). These 11 indicators have been grouped by learner needs (safety of learners – 88%, teaching is appropriate to learners’ needs and context – 86%); healthcare user needs (continuity of care – 94%, holistic understanding of healthcare – 88%, respecting human rights – 88%, providing accessible care to all – 88%, providing care that is acceptable to users and their families – 87%, providing evidence-based care – 87%); and community needs (promoting health through health education – 88%, education programme reflects communities’ needs – 86%, teaching embodies social accountability – 86%). Conclusion. The selected indicators reflect priorities relevant to the FHS, UCT and are measurable and applicable to undergraduate and postgraduate curricula. They provided the basis for a case study of teaching the PHC approach to our undergraduate students.