Background

The basis of the health system in South Africa in purported to be primary health care (PHC), as defined by the Alma Ata Declaration of 1978. This approach emphasises community involvement in all health-related activities, but it would appear that a very limited or selective PHC approach in actually being pursued in South Africa, without meaningful community participation or ownership. This study explores the involvement of exemplary medical and nursing clinical practitioners in non-clinical community-wide activities in terms of the primary health care approach, which demands a broader scope of practice than primary medical care.

Methods

The objectives of the study were to identify exemplary medical and nurse practitioners in primary health care, to document their practices and perceptions with regard to their community involvement, to analyse the common themes arising from the findings, and to present recommendations based on the findings. Seventeen primary care clinicians in KwaZulu-Natal, half of whom were professional nurses and the rest medical practitioners, were purposively selected through their district managers. A team of four medical students was trained to collect the data and interviewed the subjects in their places of work using open-ended questions. The interviews were recorded, translated where necessary, and transcribed. Content analysis was carried out as a team, with the identification of major and minor themes.

Results

The findings of this study were consistent with studies from other countries, with some interesting differences. The major themes that emerged from the data included the wide range of activities that subjects were involved in, the importance of relationships, the context of poverty, the frustrations of this kind of work, and the respondents' motivations. These are illustrated by numerous verbatim quotes from the respondents. Minor themes were the roles that the respondents play in the community, the difficulty of obtaining funding, and experiences in starting up. Significantly, the fact that the role of clinicians in the community emerged as only a minor theme rather than a major theme in this study indicates the absence of expectation and policy in this area of practice in South Africa. In the light of the supposed centrality of the primary healthcare approach in the national health system, this is a serious gap.

Conclusion

The lack of a clearly defined role in the community outside of the clinical role that deals with the individual patient who presents for care in discussed in relation to the policy of the primary health care approach. The concept of community-oriented primary care provides a framework for a more systematic approach to community engagement, and this study serves as a basis for further research into the subject.