Original Research
Which primary care model? A qualitative analysis of ward-based outreach teams in South Africa
Submitted: 14 July 2016 | Published: 31 May 2017
About the author(s)
Tessa S. Marcus, Department of Family Medicine, School of Medicine, University of Pretoria, South AfricaJannie Hugo, Department of Family Medicine, School of Medicine, University of Pretoria, South Africa
Champak C. Jinabhai, School of Health Sciences, University of Fort Hare, South Africa
Abstract
Aim: This 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.
Setting: Data are drawn from a rapid assessment of National Health Insurance (NHI) pilot sites in seven provinces.
Methods: The 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.
Results: Respondents 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.
Conclusion: Many 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.
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Crossref Citations
1. Awareness of the Ward Based Outreach Team and the services offered by the programme in the Tshwane health district, South Africa
T Bongongo, JV Ndimande, GA Ogunbanjo, AT Masango-Makgobela, SN Nyalunga, I Govender
South African Family Practice vol: 61 issue: 1 first page: 1 year: 2019
doi: 10.1080/20786190.2018.1501240