An analysis of the meaning of integrated Primary Health Care from the KwaZulu- Natal Primary Health Care context

Abstract

In South Africa, integration o f services policy was enacted in 1996 with the aim of increasing health service utilization by increasing accessibility and availability of all health care services at Primary Health Care (PHC) level. Integration of PHC services continues to be seen as a pivotal strategy towards the achievement of the national goals of transformation of health services, and the attainment of a comprehensive and seamless public health system. Although the drive behind the integration of PHC services was to improve accessibility of services to the community, the problem however, arises in the implementation of integrated PHC (IPHC) as there is no agreed upon understanding of what this phenomenon means in the South African context. To date no research studies have been reported on the meaning of the integration of PHC services. Hence, there is a need for shared views on this phenomenon in order to facilitate an effective implementation of this approach. <p>A cross-sectional study, using a qualitative approach was employed in this study in order to analyze the phenomenon, IPHC in KwaZulu-Natal and the meaning attached to it in different levels of the health system. A grounded theory was selected as it is a method known for its ability to make greatest contribution in areas where little research has been done and when new viewpoints are needed to describe the familiar phenomenon that is not clearly understood. Policy makers and co-ordinators of PHC at national, provincial and district levels as well as PHC nurses at functional level participated in the study. The data was collected by means of observations, interviews and document analysis. The sample size for interviews was comprised of 38 participants. Strauss and Corbin’s process of data analysis was used. It emerged that there were three core categories that were used by the participants as discriminatory dimensions of IPHC in South Africa. These core categories were (a) comprehensive health care, (b) supermarket approach and (c) one stop shop.</p

A practice framework to enhance the implementation of the Policy on Integration of Mental Health Care into primary health care in KwaZulu-Natal province

“…A one-stop-shop approach to care, where mental health care users are managed holistically by one nurse, was reported to take place in clinics where their PHC nurses had a qualification in psychiatric nursing. The results of this study are consistent with the findings of the study that was conducted by Sibiya and Gwele, 22 who found that IPHC was viewed by participants as the provision of services by one nurse and that the patient receives comprehensive care in one clinic. In South Africa, PHC comprehensive package indicates that clinics should provide comprehensive IPHC service through a one-stop-shop approach for a minimum number of hours.…”

“…On the contrary, a one-stop-shop approach may result in staff being overloaded with work. 23 Sibiya and Gwele 22 argue that one can never be sure if a one-stop-shop approach saves time or not and further state that it may take longer for one nurse to provide all the services.…”

Clinician perceptions and patient experiences of antiretroviral treatment integration in primary health care clinics, Tshwane, South Africa

“…Uebel et al ( 2013a :9) reported that models of integration for HIV care ‘varied on a spectrum from a fully integrated service, where patients accessed HIV care from any nurse, to a more separate delivery of care, with patients accessing care from a specific ART nurse’. Sibiya and Gwele ( 2009 :35) describe integrated comprehensive PHC services as a supermarket or one-stop approach. For the purpose of this report the NDOH's (2012b:9) definition of ‘integration’ will be used, referring to a ‘one-stop shop under one roof’ service to ensure comprehensive health care services to patients.…”

What do medical students and their trainers understand by primary health care in South Africa? A qualitative study

“…A study on students' perceptions of the applicability of the PHC approach in the South African context, revealed that students were of the view that the PHC principles could not be applied in the country, given its poor socio-economic situation primarily in the rural areas [9]. A study which came very close to our study was conducted by Sibiya and Gwele in KwaZulu Natal in 2009, who analysed the meaning of integrated PHC among policy makers and coordinators of PHC at national, provincial and district levels, including PHC nurses at healthcare facility level [10]. One of the questions the participants were asked enquired on what they understood by "integrated PHC," and the study ndings were that PHC was conceptualised as comprehensive health care, employing a "supermarket" and a "one stop shop" approach in health care delivery [10].…”