Primary health care changes lives

Tuesday, March 11, 2014

 By Noluthando Mkhize

Christina Digwamaje has spent most of her life in the small village of Pella in the North West.

During that time, the 47-year-old has seen the area change from a place that offered very limited primary health care (PHC) services to one that now boasts the Pella Health Centre.

Over the past 20 years government has put a lot of focus and resources into PHC, through the building of clinics, health centres and community care workers who conduct home visits.

PHC aims to make health care more accessible and provides the means for South Africans use nearby clinics and health centres as their first entry to the health system before being referred to hospitals.

The Pella Health Centre is an example of a facility built post 1994 that has changed to the lives of the previously disadvantaged.

Officially opened in 2008, it cost about R30 million and serves 11 258 people.

Patients from nine clinics, from 15km to 110km away, are referred to the centre where they receive treatment for hypertension, diabetes, TB and HIV, among others.

The centre runs a health education and nutrition promotion and has a laboratory and pharmacy.

The centre has six trained community health workers servicing households, a resident doctor, dentist, psychiatric nurse, two midwives, a dietician, pharmacist, nine professional nurses and administrative staff.

“What I love most about this health centre is that its only two kilometres from my home. My whole family comes here when we are not well,” says Digwamaje.

Fours year ago Digwamaje also found out that she was HIV positive. “I did the test and received the results at this centre. It is also where I receive my anti-retrovirals.”

In the past Digwamaje and other community members had to hire a car when they needed to see a doctor, while the trip to the Moreteletsi Hospital was about 150km.

“When someone was in labour at night it was very hard to get to a health facility quickly.”

The Pella Health Centre is opened 24 hours a day and has a maternity waiting home for mothers-to-be who are close to their due date but live some distance from the centre.

The mothers live in the centre until they deliver the babies.

“The pregnant mothers from these neighbouring clinics are also attended to at the centre. We deliver about 12 babies in a month,” said Sister Boniswa Mekgoe, facility manager at the centre.

If there are complications obstetric ambulances transport the pregnant woman to the nearest hospital.

Interventions such as these have contributed to the decrease in the infant mortality rate.

According to the 20 Year Review report, released by the Presidency on Tuesday the infant mortality rate decreased from 63.5 deaths per 1 000 live births in 2002 to 41.7 deaths per live births in 2013.

In 1995 there were very few PHC facilities meeting the health needs of communities.

According to the report, there were only 0.8 clinics per 10 000 people.

“The democratic government introduced a massive infrastructure programme that saw more than 1 500 health facility infrastructure projects being completed. This includes building new facilities and revitalisation of existing facilities and facilitated access to healthcare within a five kilometre radius of where people lived,” it notes.

Access to PHC is measured in terms of visits to these facilities per year. In 1998 there were 67 million visits to PHC facilities and over 129 million in 2013.

“The proportion of households who reported using public-sector clinics has increased consistently, from 44.5 per cent in 2004 to 59.6 per cent in 2012.”

The proportion of people who go directly to public hospitals without a referral from a clinic decreased from 24.6 per cent in 2004 to 10 per cent in 2012. This shows increased access to and confidence in the country’s primary health care services, the review states.

Health Minister Aaron Motsoaledi, who described PHC as the backbone of the National Health Insurance has intensified the focus on PHC and introduced three streams - district specialists, school based health programme and municipal ward based PHC agents.

District specialists include a principal obstetrician, principal paediatrician, principal family physician, advanced midwife and senior primary care nurse.

These specialists train interns, community service doctors and medical officers. They are the link between the prevention and management and cure of diseases.

As of November 2012, 163 district specialists were appointed to the 46 districts in the country.

School health teams visited 1 610 poor schools between July and September 2012. They offered services to patients with eye-care, dental and hearing problems, and immunised learners.

To improve PHC, 10 000 primary health care workers were trained and assigned to municipal wards in the country.

All these efforts are improving South Africans’ access to health care. –

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