Primary health care research
Strengthening primary health care (PHC) is a global priority as recently reiterated in the inter-governmental Astana Declaration. There is also an urgent need to improve PHC in sub-Saharan Africa. South Africa is committed to a health system with quality PHC as its foundation. Our intention to introduce national health insurance in South Africa is also dependent on effective and equitable PHC.
Primary health care research can make an important contribution to strengthening PHC as a system as well as the quality of clinical processes within that system. The key components of the system have been defined in the Primary Health Care Performance Initiative. Clinical processes are across the burden of disease (HIV, TB, non-communicable diseases, trauma and violence, maternal and child health), throughout the lifecycle and from health promotion, disease prevention, treatment to rehabilitation and palliative care. Community orientated primary care, integrated health service management, clinical specialist teams and the ideal clinic initiative are important aspects of South Africa's national PHC policy.
Research may focus on primary care within facilities or a broader PHC approach that engages with communities, social and environmental determinants of health as well as different sectors of society. Departments, Divisions and Centres that have a particular engagement with PHC research include:
- Department of Family and Emergency Medicine
- Division of Family Medicine and Primary Care
- Division of Emergency Medicine
- Department of Global Health
- Division of Health Systems and Public Health
- Centre for Evidence-based Health Care
- Division of Human Nutrition
- Ukwanda Centre for Rural Health
- Centre for Rehabilitation Studies
- Department of Nursing and Midwifery
- Department of Health and Rehabilitation Sciences
- Centre for Health Professions Education
PHC research in the Faculty has typically focused on the following areas:
Research that investigates the tools needed to do primary care research.
The Division of Family Medicine and Primary Care has been active in validating and piloting tools such as the Family Physician Impact Assessment Tool, Assessment of Brief Behaviour Change Counselling Tool and the Primary Care Assessment Tool. The Ukwanda Centre for Rural Health is piloting tools for collaborative care, both for education and service.
Research that is related to clinical care and the recognition, diagnosis and management of conditions in a primary care context.
The Division of Family Medicine and Primary Care has focused on improving the management of non-communicable chronic diseases such as diabetes, hypertension, asthma and COPD. In particular there is a focus on patient education and counselling through group empowerment as well as individual brief behavior change counselling. Much of the work is derived from the principles of motivational interviewing and performed in collaboration with the Chronic Disease Initiative for Africa and linked to the ichange4health campaign. Currently the Division is busy investigating an integrated approach to comprehensive patient education and counselling for chronic conditions in primary care and is also going to scale nationally with group diabetes education in collaboration with the National Department of Health.
The Division of Family Medicine and Primary Care has also launched the Stellenbosch University Family Physician Research Network to support family physicians in the forefront of clinical service delivery in identifying and addressing key research questions.
The Ukwanda Centre for Rural Health has a particular focus on child and family health, including work related to early child development and the first 1000 days, HIV transmission and exposure in infants, foetal alcohol spectrum disorders, couple relationships and inter-personal violence. This includes social determinants of child and family health. A developing field is to support clinicians to examine issues related to the burden of disease in rural communities, the determinants of this burden of disease and the effectiveness of health care strategies to address this.
The Centre for Evidence based Health Care conducts evidence synthesis and promotes the use of best evidence in PHC policy and practice.
The research conducted in the Department of Health and Rehabilitation Sciences focuses on the rehabilitation of people with mild to severe disability. This research incorporate a wide range of approaches that are mostly conducted in PHC since the ultimate aim is to optimally reintegrate individuals into their usual life-roles.
Health Services Research
Research that looks at the cross-cutting elements of quality primary care such as accessibility, coordination, continuity and comprehensiveness of care. The Ukwanda Centre for Rural Health is engaged in looking at the impact of collaborative care (interprofessional service and engagement with community health workers and families) at primary care level. The Centre for Evidence-based Health Care promotes the use of best evidence while taking account of patient preferences, health care experiences and expertise that play a key role in shaping quality primary care.
Health Systems Research
Research that looks at the structural issues related to policy and inputs into primary health care such as governance, finances and the primary care workforce.
The Division of Family Medicine and Primary Care has participated in the development of a new global primary care research consortium to identify and address key research questions. In collaboration with the Primafamed network the Division has identified key questions in sub-Saharan Africa related to community orientated primary care, the measurement of PHC and the role of the family physician in the health system.
The Ukwanda Centre for Rural Health has an overarching focus on human resources for rural health as the most critical ingredient for a successful rural healthcare system.
The Centre for Evidence based Health Care conducts research, and builds capacity of various stakeholders, on the development and implementation of evidence informed clinical practice guidelines.
Research that looks at development of the primary care workforce.
The Division of Family Medicine and Primary Care has had a particular interest in defining the contribution of family physicians to the health system and evaluating the impact of this new specialty in the South African context.
The Division of Family Medicine and Primary Care has a twenty-year track record of developing and researching training in the health professions in distributed or decentralised settings such as community-based training, training for rural practice, and training in the primary health care context. Stellenbosch University Collaborative Capacity Enhancement for Engagement with Districts (SUCCEED) has developed new understandings of this through an internationally published scoping review, twelve tips for distributed training, and the development of a framework for training health professions students on a distributed platform.
The Ukwanda Centre for Rural Health is engaged in Rural Health Professions Education research, including evaluation of components of rural training models applied across different programmes in the rural clinical school and tracking of graduates.
The Centre for Health Professions Education conducts a range of inquiries related to the learning and teaching of students in the health professions. Specific research currently ongoing relates to the renewal of curricula at undergraduate level that are responsive to the needs of South African society.