Abstract
Globally, models of extending universal health coverage through primary care are influenced by country-specific systems of health care and disease management. In 2015 a rapid assessment of the ward-based outreach component of primary care reengineering was commissioned to understand implementation and rollout challenges.AimThis article aims to describe middle- and lower-level managers’ understanding of ward-based outreach teams (WBOTs) and the problems of authority, jurisdiction and practical functioning that arise from the way the model is constructed and has been operationalised.SettingData are drawn from a rapid assessment of National Health Insurance (NHI) pilot sites in seven provinces.MethodsThe study used a modified version of CASCADE. Peer-review teams of public health researchers and district/sub-district managers collected data in two sites per province between March and July 2015.ResultsRespondents unequivocally support the strategy to extend primary health care services to people in their homes and communities both because it is responsive to the family context of individual health and because it reaches marginal people. They, however, identify critical issues that arise from basing WBOTs in facilities, including unspecific team leadership, inadequate supervision, poorly constituted teams, limited community reach and serious infrastructural and material under-provision.ConclusionMany of the shortcomings of a facility-based extension model can be addressed by an independently resourced, geographic, community-based model of fully constituted teams that are clinically and organisationally supported in an integrated district health system. However, a community-oriented primary care approach will still have to grapple with overarching framework problems.
Highlights
IntroductionCommunity-based primary health care is increasingly recognised as an essential part of a strong health care delivery system.[1]
Community-based primary health care is increasingly recognised as an essential part of a strong health care delivery system.[1]It is seen as a sustainable and affordable way of achieving public health goals across all segments of society.[2]
ward-based outreach teams (WBOTs) is there to help the sister in the PHC setup to reach the patient to oversee the adherence of the patient treatment.’ (Northern Cape, SA RES2, Female; SA RES6, Female)
Summary
Community-based primary health care is increasingly recognised as an essential part of a strong health care delivery system.[1] It is seen as a sustainable and affordable way of achieving public health goals across all segments of society.[2] While efforts to achieve universal health coverage through primary care all involve community health workers (CHWs) of some description, actual intervention models around the globe vary quite considerably.[3] are they place and time specific, but they are strongly influenced by historical and contemporary country-specific practices and their embedded assumptions. In this model these and all other tiers and divisions of health care provision are to be integrated through a National Health Insurance (NHI) financing system
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