Conceptualizing Community Oriented Primary Care (COPC) - the Tshwane, South Africa, health post model

Health sector reforms initiated in South Africa in 1994 adopted a primary health care approach to strengthen the health system and achieve public health outcomes through disease prevention and health promotion.1 This led to the building of many new clinics to make health services more accessible, affordable and equitable. However, the pressures of a predominantly hospitalcentric health care system and emerging epidemics prevented the successful provision of quality comprehensive, integrated primary care to millions of South Africans. Also, little attention was given to community partnerships and multi-sectoral collaboration.The authors thank the Foundation for Professional Development for the financial support.http://www.phcfm.orgam201

Risk factors for Coronavirus disease 2019 (Covid-19) death in a population cohort study from the Western Cape province, South Africa

Risk factors for coronavirus disease 2019 (COVID-19) death in sub-Saharan Africa and the effects of human immunodeficiency virus (HIV) and tuberculosis on COVID-19 outcomes are unknown. We conducted a population cohort study using linked data from adults attending public-sector health facilities in the Western Cape, South Africa. We used Cox proportional hazards models, adjusted for age, sex, location, and comorbidities, to examine the associations between HIV, tuberculosis, and COVID-19 death from 1 March to 9 June 2020 among (1) public-sector “active patients” (≥1 visit in the 3 years before March 2020); (2) laboratory-diagnosed COVID-19 cases; and (3) hospitalized COVID-19 cases. We calculated the standardized mortality ratio (SMR) for COVID-19, comparing adults living with and without HIV using modeled population estimates.Among 3 460 932 patients (16% living with HIV), 22 308 were diagnosed with COVID-19, of whom 625 died. COVID19 death was associated with male sex, increasing age, diabetes, hypertension, and chronic kidney disease. HIV was associated with COVID-19 mortality (adjusted hazard ratio [aHR], 2.14; 95% confidence interval [CI], 1.70–2.70), with similar risks across strata of viral loads and immunosuppression. Current and previous diagnoses of tuberculosis were associated with COVID-19 death (aHR, 2.70 [95% CI, 1.81–4.04] and 1.51 [95% CI, 1.18–1.93], respectively). The SMR for COVID-19 death associated with HIV was 2.39 (95% CI, 1.96–2.86); population attributable fraction 8.5% (95% CI, 6.1–11.1)

An analysis of adolescent sexuality education programmes presented in secondary schools

M.Cur. (Community Nursing)The aim of the study Is to evaluate sexuality education programmes used In secondary schools. A descriptive, non-experimental approach Is used. Institutions and/or organisations doing sexuality education programmes in these schools were Identified through a questionnaire sent to the principals of the schools. A checklist to analyse the curricula content of each Identified Institution was developed, based on a literature survey. Guidelines for a holistic curriculum to be used by community nurses presenting sexuality education in secondary schools were developed

Community health workers in Lesotho : experiences of health promotion activities

BACKGROUND : Lesotho adopted primary health care in 1979, and community health workers (CHWs) were included in the programme to focus on health promotion, particularly to reach people in underserved rural areas. Although the CHW programme has been successful, the heavy burden of disease because of HIV and/or AIDS and tuberculosis shifted resources from health promotion to home-based care. AIM : The study explored the lived experience of CHWs in conducting health promotion activities in Lesotho. SETTING : The study was conducted in four health centres in Berea district, Lesotho. METHODS : A qualitative study was conducted using an interviewer guide translated from English into Sesotho for four CHW focus group discussions, four individual interviews of key informants and four semi-structured interviews with the health centre nurses. RESULTS : The roles of CHWs in health promotion ranged from offering basic first aid and home-based care to increasing access to health care services by taking patients to the facilities and promoting behaviour change through health education. Their perceived successes included increased access to health care services and reduced mortality rates. CHW challenges involved their demotivation to carry out their work because of lack of or inconsistent financial incentives and supplies, work overload which compromises quality of their work and limited community involvement. CONCLUSION : This study concludes that CHWs are beneficial to health promotion and its various activities. They had a clear understanding of their roles and responsibilities, although they did not fully comprehend that what they were describing was, in fact, health promotion. When it came to advocacy, CHWs did not fully understand it, nor did they consider it as part of their roles, although they acknowledged its importance. Their role of increasing access to health care services by accompanying patients to the facilities has increased considerably because of changes in disease burden. This is affecting their ability to practise other health promotion activities which focus on disease prevention.http://www.phcfm.orgam2018School of Health Systems and Public Health (SHSPH

Community health workers in Lesotho: Experiences of health promotion activities

Background: Lesotho adopted primary health care in 1979, and community health workers (CHWs) were included in the programme to focus on health promotion, particularly to reach people in underserved rural areas. Although the CHW programme has been successful, the heavy burden of disease because of HIV and/or AIDS and tuberculosis shifted resources from health promotion to home-based care. Aim: The study explored the lived experience of CHWs in conducting health promotion activities in Lesotho. Setting: The study was conducted in four health centres in Berea district, Lesotho. Methods: A qualitative study was conducted using an interviewer guide translated from English into Sesotho for four CHW focus group discussions, four individual interviews of key informants and four semi-structured interviews with the health centre nurses. Results: The roles of CHWs in health promotion ranged from offering basic first aid and home-based care to increasing access to health care services by taking patients to the facilities and promoting behaviour change through health education. Their perceived successes included increased access to health care services and reduced mortality rates. CHW challenges involved their demotivation to carry out their work because of lack of or inconsistent financial incentives and supplies, work overload which compromises quality of their work and limited community involvement. Conclusion: This study concludes that CHWs are beneficial to health promotion and its various activities. They had a clear understanding of their roles and responsibilities, although they did not fully comprehend that what they were describing was, in fact, health promotion. When it came to advocacy, CHWs did not fully understand it, nor did they consider it as part of their roles, although they acknowledged its importance. Their role of increasing access to health care services by accompanying patients to the facilities has increased considerably because of changes in disease burden. This is affecting their ability to practise other health promotion activities which focus on disease prevention

Communauté des soins axés primaire dans le district de Tshwane, Afrique du Sud : évaluation de la première phase de mise en oeuvre

Re-engineering primary health care is a cornerstone of the health sector reform initiated nationally in South Africa in 2009. Using the concept of ward based NGO-run health posts, Tshwane District, Gauteng, began implementing community oriented primary care (COPC) through ward based outreach teams (WBOT) in seven wards during 2011. OBJECTIVES: This study sought to gain insight into how primary health care providers understood and perceived the first phase of implementing COPC in the Tshwane district. METHOD: Qualitative research was performed through focus group interviews with staff of the seven health posts during September 2011 and October 2011. It explored primary health care providers’ understanding, perception and experience of COPC. RESULTS: Participants raised organisational, workplace and community relationship issues in the discussions. Organisationally, these related to the process of initiating and setting up COPC and the relationship between governmental and nongovernmental organisations. Issues that arose around the workplace related to the job situation and employment status and remuneration of health post staff. Community related issues centred on the role and relationship between service providers and their communities. CONCLUSION: COPC touched a responsive nerve in the health care system, both nationally and locally. It was seen as an effective way to respond to South Africa’s crisis of health care. Initiating the reform was inevitably a complex process. In this initial phase of implementing COPC the political commitment of governmental and nongovernmental organisations was evident. What still had to be worked through was how the collaboration would materialise in practice on the ground.La restructuration des soins de santé primaire a constitué une étape clé de la réforme du secteur de la santé initiée en Afrique du Sud au niveau national en 2009. Utilisant le concept de postes de santé gérés par des ONG et basés dans les quartiers, le district de Tshwane, dans la province du Gauteng, a commence à mettre en oeuvre des soins de santé primaire communautaires (COPC, Community oriented primary care) dans sept quartiers au cours de l’année 2011. OBJECTIFS: L’objectif de cette étude était d’obtenir des informations sur la manière dont les fournisseurs de soins de santé primaire comprenaient et percevaient la première phase de mise en oeuvre des COPC dans le district de Tshwane. METHODE: Une étude qualitative a été réalisée par le biais de groupes de discussion avec le personnel de sept postes de santé au cours des mois de septembre et d’octobre 2011. Celle-ci a permis d’étudier la compréhension, la perception et l’expérience qu’avaient les fournisseurs de soins de santé des COPC. RESULTATS: Au cours des discussions, les participants ont soulevé des questions d’ordre organisationnel, relatives au lieu de travail et aux relations communautaires. Sur le plan organisationnel, ces questions se rapportaient au processus d’initiation et de mise en place des COPC et à la relation entre les organisations gouvernementales et non gouvernementales. Les questions associées au lieu de travail se rapportaient à la situation professionnelle et au statut professionnel et à la rémunération du personnel des postes de santé. Les questions associées à la communauté étaient centrées sur le rôle et la relation entre les prestataires de services et leurs communautés. CONCLUSION: Les COPC on permis de toucher un point sensible du système de santé, tant au niveau national que local. Ils étaient perçus comme un moyen efficace de répondre à la crise des services de santé à laquelle l’Afrique du Sud était confrontée. Au cours de cette première phase de mise en oeuvre des COPC, l’engagement politique des organisations gouvernementales et non gouvernementales est apparu de manière évidente.http://www.phcfm.orgam201