Introduction

PRIMARY HEALTH CARE DIRECTORATE

SELF-REVIEW REPORT 1995-2014 FOR

DEPARTMENTAL ACADEMIC REVIEW

INTRODUCTION

The Primary Health Care Directorate (PHCD) is an inter-disciplinary unit with a mission to promote the Primary Health Care (PHC) approach as the “lead theme” in the Faculty of Health Sciences, in order to equip our graduates to provide equitable and holistic care at all levels of the South African health care system.

The adoption of PHC as the foundation of national health policy and practice under the newly-elected democratic government in 1994 was recognized by the Faculty as the stimulus for change, in order to ensure that our graduates are equipped to meet the changing demands of the health system.

A policy on the PHC approach was adopted by a Special Faculty Assembly in August 1994, which committed the Faculty to the following set of principles with respect to teaching, research, and clinical service, and in its engagement with communities:
1. Displaying bio-psychosocial and cultural sensitivity towards the patient.

2. Practising health promotion at individual and community levels.

3. Promoting evidence-based health care.

4. Promoting equity and human rights in health care.

5. Treating patients at the appropriate level of care.

6. Promoting multi-professional health care.

7. Promoting broad intersectoral collaboration.

8. Encouraging communities to assert their rights and interests.

9. Monitoring and evaluating the effectiveness, efficiency and equity of health services.
What is Primary Health Care?
"Primary Health Care is essential health care based on practical, scientifically sound and socially acceptable methods and technology, made universally accessible to individuals and families in the community through their full participation and at a cost that the community and the country can afford to maintain at every stage of their development in the spirit of self-reliance and self-determination" (Alma Ata Declaration on Primary Health Care, WHO-UNICEF, 1978).
PHC is therefore understood as an approach to health care that promotes the attainment by all people of a level of health that will permit them to live socially and economically productive lives. Health care using the PHC approach is essential, scientifically sound (evidence-based), ethical, accessible, equitable, affordable, and accountable to the community.
PHC is therefore not only primary medical or curative care, nor is it a package of low-cost medical interventions for the poor and marginalized. On the contrary, it calls for the integration of health services with the process of community development, a process that requires political commitment, intersectoral collaboration, and multidisciplinary teamwork for success.

THE HISTORY OF THE PHC DIRECTORATE (1995 – 2014)

A Chair and a Department of Primary Health Care were established in 1995 under the late Prof Dumo Baqwa who passed away suddenly in 2001. In 2003 the Department was renamed the PHC Directorate, a cross-disciplinary unit placed under the Dean's office with the mission of promoting the PHC Lead Theme in the Faculty of Health Sciences.

It was Prof Baqwa’s vision as an academic physician, anti-apartheid activist and public health advocate that drove its initial development by embracing his commitment to humane, holistic health care for all through transforming the health system and educating a new generation of socially aware health professionals. During his directorship, the PHCD was comprised of academic educators from the disciplines of Public Health (Alperstein, Arendse, Weir, Olckers) and Family Medicine (Schweitzer, Bresick). The unit was situated in the Old Main Building, Groote Schuur Hospital next to the Department of Medicine and from here Prof Baqwa successfully collaborated with Professors Padayachee, Jacobs, Hirsch, Khan, Benatar, Seggie and Reynolds to formulate policies for transformation.
A particular strength of this initiative was driving multi-disciplinary reform of the medical and allied health science curricula for PHC to be integrated throughout the existing health service and into community and rural settings. In this initiative Baqwa was part of a small team including Hartman, Watson, Cooper and Duncan that began to re-design the curriculum and teaching platform. This process required the recruitment of new academic staff, including Vivian and Keikelame, to participate in the design team process that intended to develop community based education, health promotion, and medical anthropology.
During this time Family Medicine continued its teaching of 6^th year medical students in district and secondary hospitals and clinics, and the joint PHCD/Public Health teaching programme for 4^th year medical students doing research and health promotion was successfully developed and coordinated by Alperstein. The 4^th year programme maintained community teaching sites under the direction of site facilitators such as Arendse in Atlantis/Mamre and Olckers in Woodstock.
Under Baqwa’s leadership, health service partnerships in communities were firmly established through working in a multi-disciplinary context with other university units. Of note was his active hosting of workshops to develop a community based teaching platform and this brought in organizations such as the Progressive Primary Health Care Network, SACLA, and the Health Care Trust - an NGO in Browns Farm, Zibonele, Town 2. In 2002 Baqwa led a Community Partnership Workshop where partnerships and resource needs were deliberated; a committee was formed which included stakeholders from all sites; and Keikelame was appointed as a Site Development Coordinator.
In addition, the Centre for Higher Education Development (CHED) became part of the community partnership vision assisting the PHCD with the development of the Site Facilitator job descriptions; multi-disciplinary teaching was extended to Woodstock and SACLA; and good relationships were established with Utrecht and Stanford Universities which fostered additional exchange programmes for medical students.
Prof Baqwa was the warden of Forest Hills Residence and an active supporter of the Health Sciences Student Council and Rural Support Network. After his death Prof Baqwa’s legacy was memorialized in both Faculty and University memorial services and subsequently in the naming of the Jeffery Dumo Baqwa Memorial Lecture as well as the re-naming of Barnard Fuller Building, Conference Room 1 & 2 to the Dumo Baqwa Room.
Following Prof Baqwa’s death, the PHCD was absorbed for some years into the Department of Public Health under the auspices of Family Medicine. In 2003 Prof Jimmy Volmink took up the Glaxo Wellcome Chair of Primary Health Care and the Directorate was placed under the Dean’s Office.
Prof Volmink’s strength lay in research and he created a more independent unit, re-establishing it once again in Groote Schuur Hospital. The PHCD continued to drive curriculum reform and made a significant contribution to teaching. Throughout the history of the PHCD the unit has in this respect worked closely with the disciplines of Public Health and Family Medicine, and in particular with London, Hoffman, Swartz, Hellenberg, Bock, Namane, Coetzee, and other staff members from H&RS.
Given Prof Volmink’s international reputation as an outstanding academic researcher the PHCD began to develop an innovative research and publications profile, encouraged members to complete their postgraduate degrees, invited doctoral and post-doctoral students to study in the unit, and established yearly reviews and strategic planning meetings. Research and teaching intended to interrogate the PHC principles, drive transformation from tertiary care into communities, transform curricula to be PHC and patient sensitive and to extend the teaching platform. Functionally this was done in recruiting Petro and later Molteno to establish community based teaching sites. The PHCD team was led by James Irlam as acting director when Prof Volmink left in December 2005.
In 2010, Prof Steve Reid took up the post of Glaxo-Wellcome Chair of Primary Health Care and Director and has been engaged in developing this role to support UCT medical and health science graduates to become more relevant and appropriately skilled in Africa. This has included a revision of the clinical years of the medical curriculum, an extension of the clinical teaching platform from tertiary hospitals to primary and community sites, including the development of the Vredenburg platform. He has also acted as consultant to the Western Cape Department of Health (DoH) District Health Services Division on primary health care, community engagement and human resources for health.
The strategic goals of the PHCD were revised in 2010 to include the following:
OBJECTIVE 1: To integrate a primary health care approach into the FHS undergraduate and postgraduate curriculae

OBJECTIVE 2: To extend and develop the FHS clinical teaching platform in rural and primary care sites

OBJECTIVE 3: To deepen community engagement within the health service and the FHS curriculae

OBJECTIVE 4: To enhance the recruitment and support of students of rural origin in the FHS

In 2011, an additional objective was added:

OBJECTIVE 5: To increase inter-disciplinary research in health sciences

Accordingly, Prof Reid initiated the Clinical Teaching Platform Committee to advise the Dean on all matters pertaining to the development, management and monitoring of the clinical teaching platform for the Faculty; made a number of proposals to Faculty and the Provincial Government of the Western Cape (PGWC), including a business plan for the creation of a George complex; continued as national chair of The Collaboration for Health Equity through Education and Research (CHEER); initiated the MBChB Clinical Curriculum Revision Task Team (CRTT) aimed at revising the MBChB curriculum clinical years 4-6; and initiated the Rural Students Recruitment Project to increase the output of skilled rural graduates to benefit rural communities.