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  • Title: Primary health care provision in terms of community need in South Africa.
    Author: Spencer IW.
    Journal: Isr J Med Sci; 1983 Aug; 19(8):703-6. PubMed ID: 6885359.
    Abstract:
    In South Africa, early lessons in primary health care were lost to sight and have been rediscovered only recently. Priorities need to be reassessed in order to better allocate resources to community needs. Developing and developed communities require different primary care services. Simple and effective epidemiological methods should be used to gather information required for planning and evaluation of services. In developing communities, where there is a shortage of doctors, trained nurses operate local clinics with the help of community workers. Community participation and the cooperation of the traditional healers are necessary. Appropriate training of personnel for an effective role in public health care is essential. In South Africa there are so called "developed" and "developing" areas and communities which require different methods of primary health care (PHC) provision. The service to be provided to any given community depends on the community diagnosis. Services for developed and developing communities cannot be the same, for problems, priorities, and resources are different. Thus, in defining catchment areas of a health center or clinic in developing communities, it is frequently more important to define the community in terms of common demographic, social, and cultural circumstances, rather than geographic or administrative boundaries. A community diagnosis must be based on sound epidemiological techniques, which may be simple and should be appropriate for use in the field. Baseline information against which to measure subsequent change is the first requirement and this is usually obtainable from sample surveys. Important basic epidemiological data in developing communities, such as incidence, prevalence, and mortality rates, are often difficult to obtain, as these communities may have had minimal contact with the health services. Thus the obtaining of numerator and denominator data frequently requires community surveys. If the community is a developed one, with the disease profiles and priorities typically found in such communities, then the traditional Western type of advanced service provision available in South Africa is appropriate, although this needs to be increasingly health centered and community oriented. The interrelationship between hospital services and peripheral PHC in developing areas in South Africa is well demonstrated by the gross patient overload in the wards and outpatient departments of King Edward 8 Hospital, which is overcrowded with patients suffering from diseases and obstetrical complications largely preventable by simple PHC services. A critcally important resource is the community itself, which is an important member of the health team. The lower the developmental level of a community, the more important community participation becomes. Entrenched medical attitudes can be changed by pressure at 2 levels--by a new generation of appropriately trained doctors qualifying at medical schools and by central health authorities geared to the needs of the times and the population. It is also important to emphasize appropriate basic training in the principles of epidemiology for nurses and other front line workers.
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