Re-imagining primary healthcare provision in South Africa

Abstract

The Bill of Rights states that equal access to healthcare is the constitutional right of all people living in South Africa (SA 1996). However, with the current healthcare model being made up of a divided public and private sector, gross inequalities in terms of access to healthcare have become a familiar occurrence in the way our society functions and as a result, the statement above is not a reality for many communities. One such community is Plastic View in Moreleta Park, Pretoria East, the research site for this dissertation. In order to rectify this situation found across South Africa, a number of proposals have been put forward from both a governmental (top down) approach and a grass roots (bottom up) approach, in order to re-engineer the current primary healthcare model. These proposals are critically analysed in later text, and the conclusion that this dissertation proposes, from a programmatic point of view, is how the bottom up preventative approach to primary healthcare may be used to support the larger top down curative primary healthcare model in order to move closer towards a Health for All (Kautzky & Tollman 2009:26). As health is defined as not only being free from disease or infirmity, but rather a state of complete physical, mental and social well-being (WHO 2003), this dissertation investigates the role that the built environment can play in spatially support the proposals being made from a top down and bottom up approach by assisting the holistic healing process of all the users of such facilities. In order to achieve this, the architectural investigation focuses on facilitating a more preventative approach to health care as opposed to a solely curative approach, and turns to the historical beginnings of healthcare facilities for informants, rather than the case studies present in our society currently. These informants include the design of monastic cloisters and Florence Nightingale's pavilion designs which were centred around the holistic well being of the user's experience.

Vervolgens die Handves van Menseregte is toegang tot basiese gesondheidsorg 'n konstitusionele reg wat elkeen in Suid-Afrika toekom (SA 1997). Huidiglik bestaan Suid-Afrika se gesondheidsdienste uit 'n verdeelde privaat- en publiekesektor. Ongelyke toegang tot gesondheidssorg is aan die orde van die dag. Baie gemeenskappe het nie toegang tot die basiese gesondheidssorg wat hulle toekom volgens die reg nie. So 'n gemeenskap is die fokusarea van hierdie verhandeling, Plastic View, in Moreleta Park. Daar word tans, en is ook al in die verlede, verskeie voorstelle gemaak om die huidige model te herstruktureer. Die voorstelle kan verdeel word in twee bre? benaderings ? die eerste stel voor dat die staat alle gesondheidsdienste verskaf en bestuur ('n sogenamende 'Top-Down- benadering) terwyl die teenoorgestelde benadering voorstel dat die gemeenskap self meer betrokke raak by die lewering van gesondheidssorg in hulle onmiddelike omgewing. Albei benaderings word later in die teks in krities geanaliseer, waarna tot die slotsom gekom word dat die twee wyses mekaar kan ondersteun wanneer dit saam geimplimenteer word. Die gemeenskap se betrokkenheid by die lewering van basiese dienste sal die druk op staatsinstellings verlig. Op hierdie wyse kan beter dienste aan almal gelewer word binne die beperkte hulpbronne tot ons beskikking. Dit is belangrik om in ag te neem dat gesondheid gedefinieer word as algehele fisiese, geestelike en sosiale welstand, eerder as slegs die afwesigheid van siekte (WHO 2003). Dus word daar in hierdie verhandeling gekyk hoe die ruimtelike omgewing bydra tot die proses van genesing by persone wat van gesondheidssentrums gebruik maak. Historiese voorbeelde, soos die ontwerp van kloosters en Florence Nightingale se pawiljoen-ontwerpe, dien as inspirasie eerder as kontempor?re gevallestudies. Die fokus van die ondersoek is die rol van argitektuur en die stedelike omgewing in die skep van 'n gesonde omgewing wat bydra tot die holistiese gesondheid van stedelike inwoners.