A framework for implementation of community-orientated primary care in the Metro Health Services, Cape Town, South Africa

Abstract

In South Africa, the national policy on re-engineering primary health care (PHC) supports the implementation of ward-based outreach teams with community health workers. In the Western Cape, a community-orientated primary care (COPC) approach has been adopted in provincial goals for 2030 and the key strategies for the improvement of district health services. This approach is expected to improve health and also save costs. A task team was established in the Metropolitan Health Services to develop an implementation framework for COPC. The framework was developed in an iterative process with four learning sites in the metropole over a period of 18 months. The framework consists of 10 inter-related elements: geographic delineation of PHC teams, composition of PHC teams, facility-based and community-based teamwork, partnership of government and non-government organisations, scope of practice, information system, community engagement, stakeholder engagement, training and development of PHC teams, system preparation and change management. This framework was implemented at the four learning sites and is now being taken to scale and further assessed in the metropole.

Evaluating the implementation of home delivery of medication by community health workers during the COVID-19 pandemic in Cape Town, South Africa: a convergent mixed methods study

“…Implementation was enabled by a prior commitment to community-orientated primary care [13]. The widespread geographic delineation of vulnerable communities, according to teams of CHWs linked to primary care facilities, enabled rapid implementation.…”

“…Going forward, home delivery of medication by CHWs should form part of a menu of options for patients. Such a hybrid system is necessary because home delivery should not replace the other essential activities in the CHWs' scope of practice -such as health promotion, risk assessment, physical and home-based care [13]. Many of these activities were curtailed during the pandemic, but will resume as soon as possible.…”

“…These facilities linked with a network of 2500 CHWs employed by non-profit organisations (NPO). Each team of 10-15 CHWs served a delineated geographic area and was supervised by a professional nurse (PN) [13]. Each CHW was responsible for approximately 250 households.…”

The contribution of family physicians and primary care doctors to community-orientated primary care

“…In Cape Town, for example, a 10-point framework for implementation of COPC has been adopted as shown in Figure 2 and Table 2. 12 A number of training manuals on how to implement COPC have come out of the Tshwane experience 13,14,15 as well as a special collection of research studies. 16…”

Non-communicable disease care and management in two sites of the Cape Town Metro during the first wave of COVID-19: A rapid appraisal

“…The COPC strategy entails close liaison with community outreach teams consisting of community health workers (CHWs) employed by a local non-profit organisation (NPO) as described elsewhere. 6 This primary health care (PHC) strategy was reinforced at the start of the first COVID-19 wave, at both facility and community level. 7 …”