Abstract:
BACKGROUND : The introduction of community-based services through community health workers
is an opportunity to redefine the approach and practice of primary health care. Based on bestpractice
community oriented primary care (COPC), a COPC planning toolkit has been developed
to model the creation of a community-based tier in an integrated district health system.
AIM : The article describes the methodologies and assumptions used to determine workforce
numbers and service costs for three scenarios and applies them to the poorest 60% of the
population in Gauteng, South Africa.
SETTING : The study derives from a Gauteng Department of Health, Family Medicine (University
of Pretoria) partnership to support information and communication technology (ICT)-enabled
COPC through community-based health teams (termed as ward-based outreach teams).
METHODS : The modelling uses national census age, gender and income data at small area
level, provincial facility and national burden of disease data. Service calculations take into
account multidimensional poverty, demand-adjusted burden of disease and available work
time adjusted for conditions of employment and geography.
RESULTS : Assuming the use of ICT for each, a health workforce of 14 819, 17 925 and 7303
is required per scenario (current practice, national norms and full-time employed COPC),
respectively. Total service costs for the respective scenarios range from R1.1 billion, through
R947 million to R783 million.
CONCLUSION : Modelling shows that delivering ICT-enabled COPC with full-time employees is
the optimal scenario. It requires the smallest workforce, is the most economical, even when
individual community health worker costs of employment are twice those of current practice, and is systemically the most effective.
