Abstract
BackgroundThe introduction of community-based services through community health workers is an opportunity to redefine the approach and practice of primary health care. Based on best-practice community oriented primary care (COPC), a COPC planning toolkit has been developed to model the creation of a community-based tier in an integrated district health system.AimThe article describes the methodologies and assumptions used to determine workforce numbers and service costs for three scenarios and applies them to the poorest 60% of the population in Gauteng, South Africa.SettingThe study derives from a Gauteng Department of Health, Family Medicine (University of Pretoria) partnership to support information and communication technology (ICT)-enabled COPC through community-based health teams (termed as ward-based outreach teams).MethodsThe modelling uses national census age, gender and income data at small area level, provincial facility and national burden of disease data. Service calculations take into account multidimensional poverty, demand-adjusted burden of disease and available work time adjusted for conditions of employment and geography.ResultsAssuming the use of ICT for each, a health workforce of 14 819, 17 925 and 7303 is required per scenario (current practice, national norms and full-time employed COPC), respectively. Total service costs for the respective scenarios range from R1.1 billion, through R947 million to R783 million.ConclusionModelling shows that delivering ICT-enabled COPC with full-time employees is the optimal scenario. It requires the smallest workforce, is the most economical, even when individual community health worker costs of employment are twice those of current practice, and is systemically the most effective.
Highlights
There is renewed and significant growth in global interest in extending primary health care (PHC) services to communities through community health workers (CHWs).[1]
For the purposes of this article, the community oriented primary care (COPC) planning toolkit is applied to three scenarios, (A) current practice, (B) ICTenabled COPC with full-time employment and (C) national norms, factoring in paper-based and information and communication technology (ICT)-enabled data and performance management systems
Though we adjust working time to allow for current employment practices, we do not take into consideration known equipment and resourcing challenges or differences in work practices, productivity, down time, training levels, supervision, staff turnover or skills development
Summary
There is renewed and significant growth in global interest in extending primary health care (PHC) services to communities through community health workers (CHWs).[1] The present focus on CHWs is driven by the need to meet health service demands generated by the high burden of disease as well as by national and international public expectations of universal access to quality health care. It is driven by the inability of facility-based, specialist and specialising health services to achieve the Millennium Development Goals (MDG), let alone the more ambitious health targets set out in Sustainable Development Goal 3 (SDG 3).[2]. Based on bestpractice community oriented primary care (COPC), a COPC planning toolkit has been developed to model the creation of a community-based tier in an integrated district health system
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