Abstract
BackgroundIntegrated care through community-oriented primary care (COPC) deployed through municipal teams of community health workers (CHWs) has been part of health reform in South Africa since 2011. The role of COPC and integration of information and communication technology (ICT) information to improve patient health and access to care, require a better understanding of patient social behaviour.AimThe study sought to understand how COPC with CHWs visiting households offering health education can support antenatal follow-up and what the barriers for access to care would be.MethodA mixed methodological approach was followed. Quantitative patient data were recorded on an electronic health record-keeping system. Qualitative data collection was performed through interviews of the COPC teams at seven health posts in Mamelodi and telephonic patient interviews. Interviews were analysed according to themes and summarised as barriers to access care from a social and community perspective.ResultsAn integrated COPC approach increased the number of traceable pregnant women followed up at home from 2016 – 2017. Wrong addresses or personal identification were given at the clinic because of fear of being denied care. Allocating patients correctly to a ward-based outreach team (WBOT) proved to be a challenge as many patients did not know their street address.ConclusionPatient health data available to a health worker on a smartphone as part of COPC improve patient traceability and follow-up at home making timely referral possible. Health system developments that support patient care on community level could strengthen patient health access and overall health.
Highlights
Over the last decade, the South African Health Department has prepared for major health reforms to address the inefficiencies of a two-tiered system where the private sector spends equal amounts on health care in comparison with the public sector, but less than 20% of the population is able to access private care.[1]
The re-engineering of primary care led to the adoption of community-oriented primary care (COPC), a municipal ward health system, implemented in 2011, and the employment of teams of community health workers (CHWs) each assigned 150 – 200 households in a municipal ward.[5,6]
Pregnant women seen at the Stanza Bopape health care facility for antenatal care (ANC) were registered electronically and their addresses used to assign a ward-based outreach team (WBOT) and a CHW to follow up the patients at home to support the ANC throughout the pregnancy
Summary
The South African Health Department has prepared for major health reforms to address the inefficiencies of a two-tiered system where the private sector spends equal amounts on health care in comparison with the public sector, but less than 20% of the population is able to access private care.[1] In its efforts to address inequality and issues with access to care, especially for people in informal settlements with low access to care, the Department of Health (DoH) proposed that it would incrementally work towards a National Health Insurance and implement major changes in health care delivery, starting with primary care.[2] In 2010, the South African Government revised its strategic framework goals over the medium term and set 12 outcomes to achieve this.[3] The DoH took responsibility for Objective 2: ‘a long and healthy life for all South Africans’.4. Integrated care through community-oriented primary care (COPC) deployed through municipal teams of community health workers (CHWs) has been part of health reform in South Africa since 2011. The role of COPC and integration of information and communication technology (ICT) information to improve patient health and access to care, require a better understanding of patient social behaviour
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