Community oriented primary care in Tshwane District, South Africa: Assessing the first phase of implementation

Abstract

BackgroundRe-engineering primary health care is a cornerstone of the health sector reform initiated nationally in South Africa in 2009. Using the concept of ward based NGO-run health posts, Tshwane District, Gauteng, began implementing community oriented primary care (COPC) through ward based outreach teams (WBOT) in seven wards during 2011.ObjectivesThis study sought to gain insight into how primary health care providers understood and perceived the first phase of implementing COPC in the Tshwane district.MethodQualitative research was performed through focus group interviews with staff of the seven health posts during September 2011 and October 2011. It explored primary health care providers’ understanding, perception and experience of COPC.ResultsParticipants raised organisational, workplace and community relationship issues in the discussions. Organisationally, these related to the process of initiating and setting up COPC and the relationship between governmental and nongovernmental organisations. Issues that arose around the workplace related to the job situation and employment status and remuneration of health post staff. Community related issues centred on the role and relationship between service providers and their communities.ConclusionCOPC touched a responsive nerve in the health care system, both nationally and locally. It was seen as an effective way to respond to South Africa's crisis of health care. Initiating the reform was inevitably a complex process. In this initial phase of implementing COPC the political commitment of governmental and nongovernmental organisations was evident. What still had to be worked through was how the collaboration would materialise in practice on the ground.

Smartphone hearing screening in mHealth assisted community-based primary care

“…A proposed solution to South Africa's access to health care difficulties relating to prevention has been to move towards community-based primary care in an attempt re-engineer the primary health care system (Kinkel, Marcus, Memon, Bam, & Hugo, 2012). A policy paper released by the National Department of Health (2011) called for a renewed emphasis on health promotion and prevention care and also indicated that services should include community health care workers (CHWs) involved in community outreach and homebased services.…”

Conceptualizing Community Oriented Primary Care (COPC) – the Tshwane, South Africa, health post model

“…This approach enables the team to work from a sound understanding of the local culture and idiom, although there is the risk of overfamiliarity and problems associated with privacy. 25 For the most part, the health post is hosted by existing community-based nonprofit organisations (NPOs). This approach to COPC was deliberately adopted because these organisations have historically established structures and links in the communities.…”

Developing generalism in the South African context

“…[7,8] Local, private general practitioners (GPs) are excited about supporting WBOTs and in the next phase GPs will work directly with these teams. In this way, the GP will be able to provide COPC to families in his/her community.…”