Can the re-engineering of PHC and/ or the introduction of community paediatricians be the solution?
|Article Type:||Letter to the editor|
Primary health care
(Forecasts and trends)
Community health services (Forecasts and trends)
|Publication:||Name: South African Medical Journal Publisher: South African Medical Association Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2012 South African Medical Association ISSN: 0256-9574|
|Issue:||Date: Nov, 2012 Source Volume: 102 Source Issue: 11|
|Topic:||Event Code: 010 Forecasts, trends, outlooks; 360 Services information Computer Subject: Market trend/market analysis|
|Product:||SIC Code: 8399 Social services, not elsewhere classified|
|Geographic:||Geographic Scope: South Africa Geographic Code: 6SOUT South Africa|
To the Editor: The recent article about the new paediatric
sub-specialty to improve child health in South Africa quotes grim child
health statistics to illustrate the need to look for new strategies to
improve child health. (1) Can the re-engineering of primary healthcare
(PHC) and/or the introduction of community paediatricians be the
I would like to share my experience. We were also confronted with bad child health conditions and statistics, but achieved great improvement in one decade (Table 1). (2-4)
The improvement in maternal and child health was achieved by the vigorous implementation of PHC in the whole catchment area of the Gelukspan Community Hospital. The factors contributing to this achievement included a change from curative hospital-based medicine to PHC; a determined effort to reach every child and pregnant woman in the community; comprehensive and integrated approach by the health services as a whole and no fragmentation; building a health team with strong reliance on nurses and allied health workers; and re-allocation of staff and resources to community-based services so that all villages had a clinic or visits by a mobile clinic.
During this time a visit to the hospital by the late Professor John Hansen during his sabbatical had a profound impact on the development of the services as a result of his enthusiasm and encouragement. However, the work was done by the PHC team without any specialist doctors or nurses, and with involvement of the mothers as 'the most important health workers'.
A similar remarkable improvement in maternal and child health recently reported from India was achieved by a nurse-driven programme and strong focus on community involvement. (5) Maternal mortality decreased by 75% and infant mortality by nearly 50% to 43/1 000 within a few years.
The potential impact of the re-discovery and implementation of PHC is considerable, and there is no reason to delay starting. The involvement of (community) paediatricians can contribute to the process, but cannot substitute for a focused approach by the whole health team and the involvement of the community.
Department of Family Medicine
University of Pretoria
(13.) Bac M. Evaluation of child health services at the Gelukspan Community Hospital, Radithuso, Bophuthatswana, 1976-1084. S Afr Med J 1986;70:277-280.
(14.) Bac M. Progress towards Health for All in the Gelukspan Health Ward--1985. MD thesis, Medical University of Southern Africa, 1987.
(15.) Van Oord DJ. Fertility transition in a rural African community. MD thesis, Medical University of Southern Africa, 1996.
(16.) Alehagen SA, Finnstrom O, Hermansson GV, et al. Nurse-based antenatal and child health care in rural India, implementation and effects--an Indian-Swedish collaboration. Rural and Remote Health 2012;12:2140. http://www.rrh.org.au (accessed 8 October 2012).
S Afr Med J 2012;102(11):815. DOI:10.7196/SAMJ.6368
Table 1. Health status indicators, Gelukspan Health Ward 1978-1989 Indicator 1978 1985 1989 No. of children <5 years 9 000 13 500 Perinatal mortality rate 60/1 000 78/1 000 39/1 000 Infant mortality rate >200/1 000 41/1 000 24/1 000 <5 mortality rate 105/1 000 17/1 000 6/1 000 No. of paediatric deaths in 144 * 63 33 hospital No. of visits to UFC/child <1/year 7/year Total No. of visits to UFC 3 000 95 000 76 709 Home deliveries 75% 29% 15% ANC visits 2 077 15 375 19 679 Supervised deliveries 684 2 554 2 981 Maternal mortality rate ? 180/100 000 50/100 000 Family planning visits 1 000 17 746 Health care worker/ 1/7 000 1/1 000 population Doctor/population 1/30 000 1/10 000 Midwife/population 1/12 000 1/2 500 * In 1979. UFC = under-5 clinic; ANC = antenatal clinic.
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