Implementation of the principles of primary health care in a rural area of South Africa.

Surona Visagie,Marguerite Schneider

doi:10.4102/phcfm.v6i1.562

Abstract

BackgroundThe philosophy of primary healthcare forms the basis of South Africa's health policy and provides guidance for healthcare service delivery in South Africa. Healthcare service provision in South Africa has shown improvement in the past five years. However, it is uncertain as to whether the changes have reached rural areas and if primary healthcare is implemented successfully in these areas.ObjectivesThe aim of this article is to explore the extent to which the principles of primary healthcare are implemented in a remote, rural setting in South Africa.MethodA descriptive, qualitative design was implemented. Data were collected through interviews and case studies with 36 purposively-sampled participants, then analysed through Interpretative Phenomenological Analysis.ResultsFindings indicated challenges with regard to client-centred care, provision of health promotion and rehabilitation, the way care was organised, the role of the doctor, health-worker attitudes, referral services and the management of complex conditions.ConclusionThe principles of primary healthcare were not implemented successfully. The community was not involved in healthcare management, nor were users involved in their personal health management. The initiation of a community-health forum is recommended. Service providers, users and the community should identify and address the determinants of ill health in the community. Other recommendations include the training of service managers in the logistical management of ensuring a constant supply of drugs, using a Kombi-type vehicle to provide user transport for routine visits to secondary- and tertiary healthcare services and increasing the doctors’ hours.

Highlights

The philosophy of primary healthcare (PHC) forms the basis of South Africa’s health policy and provides guidance for healthcare service delivery in South Africa.[1]
Include equity; community participation; social and economic development; interventions focused on the determinants of poor health, health promotion, prevention, cure and rehabilitation; an integrated referral system to facilitate a continuum of care; teams of health professionals with specific and sophisticated biomedical- and social skills; adequate resources; and a client-centred approach
The case studies were chosen because, in combination, the experiences of these healthcare users represent much of the essence of what was narrated by various participants

Summary

Introduction

The philosophy of primary healthcare (PHC) forms the basis of South Africa’s health policy and provides guidance for healthcare service delivery in South Africa.[1]. These authors acknowledge specific challenges such as insufficient post-natal feeding support, an increase in non-communicable disease risk factors, high incidence of violence and accidents, race- and gender inequalities, challenges pertaining to social determinants of health such as low educational levels, poor housing and sanitation, limited public–private partnerships, as well as insufficient health surveillance and information systems.[8] In addition, Gaede and Versteeg[9] and Cooke, Couper and Versteeg[10] pointed out challenges to healthcare service provision in rural South Africa. It is uncertain as to whether the changes have reached rural areas and if primary healthcare is implemented successfully in these areas

Objectives

Results

Discussion

Conclusion