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
The Figure below (click on Figure to enlarge) illustrates the footprint of PHC
research in the Faculty and is mapped onto the PHC performance initiative
There is little research activity in the domain of System that deals with the policy architecture for primary health care in terms of governance, leadership, financing and adjustment of policy to health needs.
Global Health is interested in governance structures for PHC and Family Medicine & Primary Care has explored the views of general practitioners on the proposed National Health Insurance scheme.
There is little research activity in the domain of system Inputs for drugs and supplies, facility infrastructure, health information systems and funds.
The workforce, however, is an area of considerable interest. This area was split into two components, the one focusing on issues of education and training for the PHC workforce and the other focusing on issues of human resources for health planning.
Education and training
Family Medicine & Primary Care have a body of work looking at the training of family physicians for the district health services. Nursing and Midwifery have looked at the integration of patient safety and quality of care into pre-service training. Global Health have an interest in training of rural health professionals through their Ukwanda Centre for Rural Health. The Centre for Health Professions Education have focused on training of undergraduates and interns in the rural and distributed platform as well as the measurement of empathy in medical students. Health Sciences and Rehabilitation have looked at what curriculum is relevant for neurology in occupational therapy.
Human resources for health
Global Health have an interest in broader issues around human resources for health planning and development of new policy for South Africa. They have also looked at the role of clinical associates. Family Medicine & Primary Care have a body of work looking at the contribution of family physicians to the district health services in South Africa. Nursing and Midwifery have looked at the role played by primary care nurses in delivering PHC.
Population health management
Family Medicine and Primary Care are developing a research interest in the implementation of community-orientated primary care in the Cape Town metropole. This touches on all aspects of this sub-domain. Global Health has a variety of focus areas including community engagement around cancer issues, community health systems, the role of community health workers in surgical conditions and the contribution of undergraduates.
Facility organization and management
Ukwanda Centre for Rural Health has an interest in collaborative or multidisciplinary team-based care.
Nursing and Midwifery have an interest in nurses as PHC managers and aspects of women in leadership, cultural diversity and factors that are associated with effective leadership. Global Health also has an interest in leadership and management capability at the facility level.
Nursing and Midwifery have an interest in the use of informatics in maternal care, while Family Medicine and Primary Care are interested in the use of the International Classification of Primary Care in health information systems.
Global Health, Family Medicine & Primary Care as well as Nursing & Midwifery are interested in the development of evidence-based practice, implementation of primary care clinical guidelines and improving the quality of care. Family Medicine and Primary Care also have an interest in clinical governance and topics such as antimicrobial stewardship.
Availability of effective PHC services
Family Medicine & Primary Care as well as Nursing & Midwifery have an interest in this area. In particular the competency of primary care nurses and doctors. In terms of motivation of primary care providers there is an interest in burnout, resilience and the workplace environment. In addition Nursing and Midwifery have focused on patient safety as well as litigation of malpractice. The Department of Health Sciences and Rehabilitation have an interest in the availability of therapists.
Global Health has an interest in geographical, economic and organizational barriers to access of PHC. There is also a specific interest in access for people with disabilities and the use of mhealth to facilitate access.
High quality PHC
Family Medicine & Primary Care have an interest in assessing these components of high quality PHC through use of the Primary Care Assessment Tool. Family Medicine & Primary Care as well as Nursing & Midwifery also have an interest in evaluating the person-centredness of consultations. Nursing & Midwifery have also had a focus on coordination across transitions of care.
Effective service coverage
Nursing & Midwifery have an interest in community-based health promotion initiatives, while Family Medicine & Primary Care have an interest in behavior change counselling as a form of health promotion. Global Health have also touched on barriers to behavior change counselling.
Family Medicine & Primary Care have had an interest in disease prevention, for example, HIV, cervical cancer, TB and non-communicable diseases. Global Health have also touched on the prevention of disability.
Family Medicine & Primary Care have had an interest in aspects of maternal care and family planning. Global Health have had an interest in the First 1000 days and infant mental health. Nursing & Midwifery have an interest in adolescent health.
There is little footprint in the area of childhood illness in these Departments. A few projects from Family Medicine & Primary Care as well as Global Health have touched on this area.
Family Medicine & Primary Care have an interest in Prevention of Mother to Child Transmission for HIV and adherence to anti-retroviral medication. They are also interested in adherence to TB treatment and the emergence of TB drug resistance. Nursing & Midwifery are interested in nurse-initiated ARV treatment.
Family Medicine & Primary Care as well as Nursing & Midwifery have an interest in patient education and empowerment for self-management of NCDs. Global health have an interest in integrated models of care as well as the evidence for screening of people for NCDs.
Family Medicine & Primary Care has a focus on Mindfulness Based Interventions for stress reduction and primary mental health care. Global Health have an interest in adolescent mental health.
There is little focus on injury and trauma, although Global Health have developed an interest in the use of mhealth technology to help manage orthopaedic conditions in primary care.
Global Health have an interest in delivery of services for people with disabilities.
Global health as well as Family Medicine & Primary Care also have an interest in palliative care.
None of the departments had research that measured or investigated outcomes such as health status, responsiveness to people, equity, efficiency or resilience of the health system.
Social Determinants and Context
Health Sciences and Rehabilitation has an interest in community mobility of people with impairments and occupational factors affecting people's health. Global Health has an interest in population-level interventions to prevent the development of NCDs as well as the relevance of indigenous knowledge on health and wellness.