A descriptive analysis of how primary health care services have developed in the Cape Metropolitan Area from the period: pre-1994 to post-2000 elections

[摘要] ENGLISH ABSTRACT:Primary Health Care (PHC) approach is currently receiving tremendous attentionworldwide as a mechanism to ensure effective and efficient public health services. Theconcept has evolved from the Alma Ata conference (1978). Since then many countriesbegan to reorient their health services to achieve the goals of availability, accessibilityand affordability of health care for all citizens and a number of management issues cameto the forefront. Therefore, the provision of comprehensive PHC services is the keyaspect to improving health services. A district health system has been identified as anideal model for comprehensive PHC services to all the citizens in South Africa.Public health services in the Cape Metropolitan Area are characterised by functionalfragmentation. Two public authorities render Primary Health Care services, namely the:Provincial Administration of the Western Cape through CHSO, and the Municipal HealthDepartment. The fragmented nature of the public health services, which result in poorcoordination of service delivery between the two health authorities, compromises thequality of service delivery.Historically, PHC services in the Cape Metropolitan Area - and indeed in the wholeSouth Africa - have developed in a skewed manner. This work is an attempt atconceptualising the implications and consequences of this skewed health development.South Africa is presently undergoing fundamental reform, which has brought the PHCinto disarray of fundamental change. Since the South African health care system is ahighly complex institution, attempts have been made to critically analyse those aspectsand features of inequality, inaccessibility, and inequity. Among these is the historical andpresent development of Cape Metropolitan Area health care and the structural features itassumed with the passing of time, trends and characteristics.In order to examine the theory in practice, the evolvement of PHC in the CapeMetropolitan Area will be analysed. The analysis highlights how different politicalformations have affected the development of PHC services and points out obstacles and limitations throughout the process, which had to be dealt with. Transformation of theexisting health services, based on the principles of PHC, requires the redressing theimbalances of the past. Therefore, the integration of the two health authorities into oneentity would best achieve the principles of district health system and will ensurecomprehensive PRe.

[发布机构] Stellenbosch University