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

Robert Mash,Hassan Mahomed,Steve Reid,Gio Perez,Derek Hellenberg,Charlyn Goliath

doi:10.4102/phcfm.v12i1.2632

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.

Highlights

The National Department of Health in South Africa included ward-based outreach teams as one of the key strategies to re-engineer primary health care (PHC).[1]
The district health services (DHS) strategy document stated that: Healthcare 2030 directs the Province to implement a population orientated community based DHS platform built on teams linked to PHC facilities which provide comprehensive outreach care based on a nurse driven service
The community orientated primary care (COPC) approach based on asset based thinking, utilising existing good practice models will inform the development of this aspect of the reform process.[4]

Summary

Introduction

To engage with other stakeholders that can contribute to the work of the PHC teams or provide services to people referred by CHWs: private practitioners; alternative, complementary and traditional practitioners; other NPOs or governmental organisations (e.g. department of social development, education). Networking, building relationships and collaboration needs to happen at many levels from the local PHC team, the NPO and primary care facility to the sub-structure and the MHS. Clinical staff at the facility need to be re-orientated and upskilled for a COPC approach, including training and mentoring CHWs, analysing and interpreting information from the CHW teams and community-level activities. Appropriate postgraduate courses and diplomas that support the development of the PHC team should be identified and made available The supervisory staff, such as the CHW team leader and professional nurse, will need specific training for their roles. Once decisions have been reached, these should be clearly communicated, consulted and effectively implemented in partnership with affected persons as part of the change process

Conclusion

Data availability statement

District health system strategy for the Western Cape Government