Understanding the role of maps in community oriented primary care (COPC) : a case study of mapmaking in ward-based outreach teams in Mamelodi

Abstract

This study addresses an observable problem, which is that community health workers (CHWs) struggle to understand medical data maps and healthcare related statistics in community oriented primary care (COPC). COPC is a model of healthcare that was implemented in the city of Tshwane by the Department of Family Medicine (University of Pretoria), the City of Tshwane and Tshwane District Health (Gauteng Provincial Department of Health) as part of a national government drive to reform primary healthcare services in South Africa. COPC is an internationally recognised model of care that is patient-centred and focuses on bringing healthcare to the home. To address the above-mentioned problem, the purpose of the study was to explore if and how different types of participatory mapmaking projects and discussions about these maps could help healthcare team members to make sense of medical data and other healthcare related maps in a different way. The study was conducted in Mamelodi, a township located in the City of Tshwane, South Africa. Participants who took part in the study were nurses, CHWs and registrar medical doctors who deliver COPC. To gather data for the study, three participatory mapmaking projects were designed and implemented by both the researcher and those who took part in each project. In addition to the mapmaking projects, participants also took part in focus group discussions or semi-structured interviews and completed reflective writing about their mapmaking experience. The focus group discussions and interview data were transcribed, and a thematic data analysis was used to analyse both the transcriptions and participant reflective writing. Data generated led to the discovery of several themes, which were grouped under two headings: map and mapmaking and map discussions. Themes identified under the heading, map, included (a) identifying and locating information, (b) using the maps to plan healthcare interventions as well as (c) to assess and evaluate the performance of healthcare team members. Themes identified under mapmaking and map discussions were linked to more tacit qualities such as (d) learning, (e) group work, (f) idea generation and problem solving and (g) team motivation. Findings from the study reveal the value of working with both the map and mapmaking simultaneously to enable ward-based outreach teams (WBOT) to better understand both the work that they do and the area where they work. These findings have a significant value to offer in both the delivery of COPC as well as to other primary healthcare projects where maps and mapmaking can be utilised to not only improve service delivery but also to foster team building and workplace-based learning amongst healthcare service providers.