Question

"South Africa has introduced a number of health reforms to strengthen Primary Health Care and enable universal health coverage (UHC)." One of the reforms that have been implemented is Primary Health Care Reengineering. What do you think have been the barriers to successful implementation of Primary Health Care Re-engineering? The answer should give an outline of what PHC re-engineering entails: And then further discuss each stream and it’s challenges:

Answer 1

THE RE-ENGINEERING OF PRIMARY HEALTH CARE (PHC) AIMS TO INCREASE ACCESS OF HEALTH SERVICES TO THE GENERAL PUBLIC AND TO IMPROVE THE QUALITY OF HEALTH SERVICES IN GENERAL.

Health, which is defined as a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity, is a fundamental human right.

Public participation and community engagement in health care services is a critical aspect of the PHC model. The Alma Ata Declaration defines PHC as essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community. This, through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination.

It is the first level of contact of individuals, the family and community with the national health system bringing health care as close as possible to where people live and work, and constitutes the first element of a continuing health care process.

According to the National Health Act (2003) Government, health care workers and the public all have a role to play in strengthening health systems in South Africa:

• The Minister of Health, within the limits of available resources, has to protect, promote, improve and maintain the health of the population providing essential health services;
• The public health sector provides free health services to pregnant and lactating women and children below the age of six years, who are not members of medical aid schemes;
• The duties of the public include adhering to the rules of the health establishment, providing accurate information, and treating health care workers with respect and dignity;
• The rights of the public include the right to participate in decisions affecting their health, undergoing an informed consent process, and the right to refuse treatment

The National Health Council has given clear direction to the health system around PHC re-engineering, and the associated three streams.

municipal ward-based PHC outreach teams,

school health teams, and

district-based clinical specialist teams

Limitations within the current DHS are multifactorial exacerbated by poor adherence to appropriate medicine use systems, as well as weak procurement and distribution management systems often resulting in stock-outs in facilities.The National Health Insurance (NHI), a form of universal health coverage, advocates for equitable, efficient and quality health services with the DHS, a decentralised governance and management structure, focusing on a fully integrated service with extensive community outreach and home-based services. Extensive reform of the existing health service structures and management systems are under way. While undergraduate training curricula are being oriented towards PHC, current health practitioners have not been adequately trained in implementing PHC, newly qualified health professionals receive training in silos that translate poorly towards patient care, and in-service training and continuing medical education are weak.