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

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dc.contributor.author Marcus, Tessa S.
dc.contributor.author Hugo, Johannes F.M.
dc.contributor.author Jinabhai, Champak C.
dc.date.accessioned 2017-11-30T09:58:12Z
dc.date.available 2017-11-30T09:58:12Z
dc.date.issued 2017-05-31
dc.description.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. en_ZA
dc.description.department Family Medicine en_ZA
dc.description.librarian am2017 en_ZA
dc.description.uri http://www.phcfm.org en_ZA
dc.identifier.citation Marcus TS, Hugo J, Jinabhai CC. Which primary care model? A qualitative analysis of ward-based outreach teams in South Africa. Afr J Prm Health Care Fam Med. 2017;9(1), a1252. https://DOI. org/ 10.4102/phcfm.v9i1.1252. en_ZA
dc.identifier.issn 2071-2928 (print)
dc.identifier.issn 2071-2936 (online)
dc.identifier.other 10.4102/phcfm.v9i1.1252
dc.identifier.uri http://hdl.handle.net/2263/63398
dc.language.iso en en_ZA
dc.publisher AOSIS Open Journals en_ZA
dc.rights © 2017. The Authors. Licensee: AOSIS. This work is licensed under the Creative Commons Attribution License. en_ZA
dc.subject Health care en_ZA
dc.subject Disease management en_ZA
dc.subject Ward-based outreach team (WBOT) en_ZA
dc.subject Authority en_ZA
dc.subject Jurisdiction en_ZA
dc.subject Practical functioning en_ZA
dc.subject National health insurance (NHI) en_ZA
dc.title Which primary care model? A qualitative analysis of ward-based outreach teams in South Africa en_ZA
dc.type Article en_ZA


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