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. 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.
Highlights
Background to the studyThe redirection of the health care sys tem towards Primary Health Care (PHC) along with the concomitant establish ment o f the District Health System (DHS) as a framework for PHC delivery and management has been the trans formation event in the public health sphere in South Africa since 1994
In the context o f this study, it emerged that there were three core categories that were used by the participants as discriminatory dimensions o f integrated PHC (IPHC) in South Africa
The following excerpts from the interviews with PHC nurses sup port this theme: “I understand IPHC as a basket o f serv ices that must be available in the clinic in order to address all the needs o f the com m unity as stated in the com pre hensive PH C package
Summary
The redirection of the health care sys tem towards Primary Health Care (PHC) along with the concomitant establish ment o f the District Health System (DHS) as a framework for PHC delivery and management has been the trans formation event in the public health sphere in South Africa since 1994. As equity and access to health care have since 1994 been considered the key principle to steer the transforma tion o f health services in South Africa, a mechanism was required to define parameters for service delivery, as well as to ensure com parability in the ren dering of services This mechanism was realized in the form comprehensive PHC service package that was intro duced by the National Department of Health in 2001. There has been a pressing need to co-ordinate local authority and pro vincial services, previously separately responsible for preventative and cura tive care respectively, and to bring to gether services offered through au thorities in the former homelands, with new provincial and national structures This type o f integration is structural and has unique organizational require ments. This inter action is further complicated by the dif ferent capacities within the different municipalities (Department o f Health, 2001 a:3)
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