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.
Highlights
Municipal ward based primary health care, referred to as community oriented primary care (COPC), is a critical component of a national effort to reform the health sector in South Africa.[1,2,3,4] Received favourably on a political level, this policy reform has been taken up in the Tshwane district of Gauteng as well as elsewhere in South Africa
Prior to the focus group interviews, general information about the health post was obtained from health post managers, nongovernmental organisations (NGOs) managers and the Tshwane district COPC management team, namely, the project manager and representatives from the Tshwane district (GPDOH), the University of Pretoria, Department of Family Medicine and the Foundation for Professional Development
The idea of COPC has touched a responsive nerve in the health care system both nationally and locally
Summary
Municipal ward based primary health care, referred to as community oriented primary care (COPC), is a critical component of a national effort to reform the health sector in South Africa.[1,2,3,4] Received favourably on a political level, this policy reform has been taken up in the Tshwane district of Gauteng as well as elsewhere in South Africa. Maternal and child mortality has increased and remains persistently high, at 625 deaths per 100 000 live births (maternal mortality) and 104 deaths per 1000 live births (under 5 mortality).[7] There is extreme inequality (Gini Coefficient of income inequality = 0.70 in 2008) and widespread poverty (3 in 10 people live below $2/day 2008).[8,9] Inequality and poverty together lead to undernourishment and malnutrition and give rise to ill health and disability They are intimately linked to chronic diseases that are on the increase across all social segments of the population.[10,11,12] Many of these poor health indicators are typical of low income countries, yet South Africa is a middle income country that makes significant allocations to health care (8.5% of GDP) and has good health care coverage.[6] This situation has been described as the health paradox of South Africa.[13]
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