Original Research

Which primary care model? A qualitative analysis of ward-based outreach teams in South Africa

Tessa S. Marcus, Jannie Hugo, Champak C. Jinabhai
African Journal of Primary Health Care & Family Medicine | Vol 9, No 1 | a1252 | DOI: https://doi.org/10.4102/phcfm.v9i1.1252 | © 2017 Tessa S. Marcus, Jannie Hugo, Champak C. Jinabhai | This work is licensed under CC Attribution 4.0
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 Africa
Jannie 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

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.
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.

Keywords

primary care reengineering; community oriented primary care; universal health coverage; ward based outreach teams

Metrics

Total abstract views: 6814
Total article views: 8773

 

Crossref Citations

1. The role of community health workers in palliative care in a rural subdistrict in South Africa
Elza M. van Heerden, Louis S. Jenkins
African Journal of Primary Health Care & Family Medicine  vol: 14  issue: 1  year: 2022  
doi: 10.4102/phcfm.v14i1.3657

2. Moving to a strong(er) community health system: analysing the role of community health volunteers in the new national community health strategy in Malawi
Vibian Angwenyi, Carolien Aantjes, Ketwin Kondowe, Joseph Zulu Mutchiyeni, Murphy Kajumi, Bart Criel, Jeffrey V Lazarus, Tim Quinlan, Joske Bunders-Aelen
BMJ Global Health  vol: 3  issue: Suppl 3  first page: e000996  year: 2018  
doi: 10.1136/bmjgh-2018-000996

3. Moving from community-based to health centre-based management: impact on urban community health worker performance in Ethiopia
Teralynn Ludwick, Misganu Endriyas, Alison Morgan, Sumit Kane, Barbara McPake
Health Policy and Planning  vol: 37  issue: 2  first page: 169  year: 2022  
doi: 10.1093/heapol/czab112

4. Patient- and Community-Oriented Primary Care Approaches for Health in Rural, Remote and Resource-Dependent Places: Insights for Eco-Social Praxis
Chris G. Buse, Sandra Allison, Donald C. Cole, Raina Fumerton, Margot Winifred Parkes, Robert F. Woollard
Frontiers in Public Health  vol: 10  year: 2022  
doi: 10.3389/fpubh.2022.867397

5. Provision of HIV services by community health workers should be strengthened to achieve full programme potential: a cross‐sectional analysis in rural South Africa
N. Naidoo, N. Matlakala, J. Railton, S. Khosa, G. Marincowitz, J. O. Igumbor, J. A. McIntyre, H. E. Struthers, R. P. H. Peters
Tropical Medicine & International Health  vol: 24  issue: 4  first page: 401  year: 2019  
doi: 10.1111/tmi.13204

6. Community caregivers’ perceptions: Family-centred postnatal care in KwaZulu-Natal, South Africa
Nontuthuzelo D. Nyasulu, Myra Taylor, Nelisiwe Khuzwayo
African Journal of Primary Health Care & Family Medicine  vol: 17  issue: 1  year: 2025  
doi: 10.4102/phcfm.v17i1.4817

7. Home visits for preterm/low birthweight infants in South Africa: Qualitative evidence synthesis
Sara Cooper, Idriss I. Kallon, Denny Mabetha, Amanda S. Brand, Tamara Kredo, Shakti Pillay, Gugu Kali, Willem Odendaal
African Journal of Primary Health Care & Family Medicine  vol: 16  issue: 1  year: 2024  
doi: 10.4102/phcfm.v16i1.4701

8. Effect of a brief motivational interview and text message intervention targeting tobacco smoking, alcohol use and medication adherence to improve tuberculosis treatment outcomes in adult patients with tuberculosis: a multicentre, randomised controlled trial of the ProLife programme in South Africa
Goedele Louwagie, Mona Kanaan, Neo Keitumetse Morojele, Andre Van Zyl, Andrew Stephen Moriarty, Jinshuo Li, Kamran Siddiqi, Astrid Turner, Noreen Dadirai Mdege, Olufemi Babatunde Omole, John Tumbo, Max Bachmann, Steve Parrott, Olalekan A Ayo-Yusuf
BMJ Open  vol: 12  issue: 2  first page: e056496  year: 2022  
doi: 10.1136/bmjopen-2021-056496

9. Community healthcare worker response to childhood disorders: Inadequacies and needs
Shanturi Naidoo, Deshini Naidoo, Pragashnie Govender
African Journal of Primary Health Care & Family Medicine  vol: 11  issue: 1  year: 2019  
doi: 10.4102/phcfm.v11i1.1871

10. An ICT-enabled community oriented primary care intervention in mining communities during COVID-19 (2019–2022): perceived changes in the role and place of community health workers
Tessa S. Marcus, W. Renkin, A. S. Malan, J. M. Moodie, J. Mostert, Z. Phote, J. F. M. Hugo
BMC Primary Care  vol: 25  issue: 1  year: 2024  
doi: 10.1186/s12875-024-02588-x

11. Evaluating community health worker education policy through a National Certificate (Vocational) Primary Health qualification lens
Michelle N.S. Janse van Rensburg, Tessa S. Marcus
African Journal of Primary Health Care & Family Medicine  vol: 12  issue: 1  year: 2020  
doi: 10.4102/phcfm.v12i1.2104

12. "They are our eyes outside there in the community": Implementing enhanced training, management and monitoring of South Africa’s ward-based primary healthcare outreach teams
Joanne E. Mantell, Tsitsi B. Masvawure, Jennifer M. Zech, William Reidy, Martin Msukwa, Mary Glenshaw, Jonathan Grund, Daniel Williams, Blanche Pitt, Miriam Rabkin, Elizabeth S. Mayne
PLOS ONE  vol: 17  issue: 8  first page: e0266445  year: 2022  
doi: 10.1371/journal.pone.0266445

13. The supervisory relationships of community health workers in primary health care: social network analysis of ward-based outreach teams in Ngaka Modiri Molema District, South Africa
Tumelo Assegaai, Helen Schneider
BMJ Global Health  vol: 4  issue: 6  first page: e001839  year: 2019  
doi: 10.1136/bmjgh-2019-001839

14. Scaling community-based services in Gauteng, South Africa: A comparison of three workforce-planning scenarios
Rod Bennett, Tessa S. Marcus, Geoff Abbott, Jannie F Hugo
African Journal of Primary Health Care & Family Medicine  vol: 10  issue: 1  year: 2018  
doi: 10.4102/phcfm.v10i1.1748

15. Implementing active surveillance for tuberculosis: A quality improvement project
Febisola I. Ajudua, Robert Mash
South African Family Practice  vol: 67  issue: 1  year: 2025  
doi: 10.4102/safp.v67i1.6106

16. Community-orientated primary care: a scoping review of different models, and their effectiveness and feasibility in sub-Saharan Africa
Bob Mash, Sunanda Ray, Akye Essuman, Edu Burgueño
BMJ Global Health  vol: 4  issue: Suppl 8  first page: e001489  year: 2019  
doi: 10.1136/bmjgh-2019-001489

17. Professional experiences in the transition of Cuban-trained South African medical graduates
Munirah Motala, Jacqueline M. van Wyk
South African Family Practice  vol: 63  issue: 1  year: 2021  
doi: 10.4102/safp.v63i1.5390

18. A stroke rehabilitation training program for community-based primary health care, South Africa
Elsje Scheffler, Robert Mash
African Journal of Disability  vol: 12  year: 2023  
doi: 10.4102/ajod.v12i0.1135

19. An analysis of the services provided by community health workers within an urban district in South Africa: a key contribution towards universal access to care
L. S. Thomas, E. Buch, Y. Pillay
Human Resources for Health  vol: 19  issue: 1  year: 2021  
doi: 10.1186/s12960-021-00565-4

20. Integrating community health workers into the formal health system to improve performance: a qualitative study on the role of on-site supervision in the South African programme
Yu-hwei Tseng, Frances Griffiths, Julia de Kadt, Nonhlanhla Nxumalo, Teurai Rwafa, Hlologelo Malatji, Jane Goudge
BMJ Open  vol: 9  issue: 2  first page: e022186  year: 2019  
doi: 10.1136/bmjopen-2018-022186

21. The three-stage assessment to support hospital–home care coordination in Tshwane, South Africa
Jannie F.M. Hugo, Tshegofatso C.R. Maimela, Michelle N.S. Janse van Rensburg, Jan Heese, Chitalu E. Nakazwa, Tessa S. Marcus
African Journal of Primary Health Care & Family Medicine  vol: 12  issue: 1  year: 2020  
doi: 10.4102/phcfm.v12i1.2385

22. The Wellbeing of Healthcare Workers during COVID-19 Era in Public Primary Health Facilities in Johannesburg, South Africa
Glory Makhado, Busisiwe Ntuli, Lindiwe Zungu, Ntevhe Thovhogi, Peter Modupi Mphekgwana, Sogolo Lucky Lebelo, Sphiwe Madiba, Perpetua Modjadji
International Journal of Environmental Research and Public Health  vol: 21  issue: 3  first page: 372  year: 2024  
doi: 10.3390/ijerph21030372

23. 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

24. Peer-learning reviews to improve Gauteng community-oriented primary care: Findings from AitaHealth™-enabled ward-based outreach teams
Tessa S. Marcus, Elizabeth Reji, Sanele Ngcobo
African Journal of Primary Health Care & Family Medicine  vol: 12  issue: 1  year: 2020  
doi: 10.4102/phcfm.v12i1.2155

25. Community-Oriented Primary Care (COPC) in the City of Tshwane (South Africa) — A Web Map Application in Support of Responsive and Dynamic Health Care
Lilija Friesen, Gertrud Schaab, Serena Coetzee, Victoria Rautenbach, Tessa Marcus, Jannie Hugo
KN - Journal of Cartography and Geographic Information  vol: 68  issue: 4  first page: 173  year: 2018  
doi: 10.1007/BF03545359

26. Exploring primary healthcare practitioners’ experiences regarding the coronavirus disease 2019 (COVID-19) pandemic in KwaZulu-Natal, South Africa
Gugu Gladness Mchunu, Orlando Harris, Celenkosini Thembelenkosini Nxumalo
Primary Health Care Research & Development  vol: 23  year: 2022  
doi: 10.1017/S1463423622000536