Which primary care model? A qualitative analysis of ward-based outreach teams in South Africa
Which primary care model? A qualitative analysis of ward-based outreach teams in South Africa
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DOI：
10.4102/phcfm.v9i1.1252
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发表时间：
2017-01-01
影响因子：
2
通讯作者：
Jinabhai, Champak C.
中科院分区：
文献类型：
--
作者：
Marcus, Tessa S.;Hugo, Jannie;Jinabhai, Champak C.
在全球范围内，通过初级保健扩大全民健康覆盖的模式受到具体国家的保健和疾病管理制度的影响。2015年，委托对初级保健再造的病房外展组成部分进行快速评估，以了解实施和推出挑战。目的：本文旨在描述中层和下层管理人员对病房外展团队（WBOTs）的理解，以及该模型构建和运作方式所产生的权限、管辖权和实际运作问题。本研究以七省全民健保试点地区为研究对象，采用CASCADE量表进行快速评估。2015年3月至7月，由公共卫生研究人员和地区/街道管理人员组成的同行评议小组在每个省的两个地点收集了数据。结果：受访者明确支持将初级卫生保健服务扩展到家庭和社区的战略，因为它对个人健康的家庭背景做出了反应，并且因为它触及了边缘人群。然而，他们指出了将WBOT设在设施中所产生的关键问题，包括团队领导不明确、监督不足、团队构成不良、社区覆盖范围有限以及基础设施和物资供应严重不足。以设施为基础的推广模式的许多缺点可以通过一个独立的资源，地理，以社区为基础的模式，由在综合地区卫生系统中得到临床和组织支持的完全组成的团队组成。然而，以社区为导向的初级保健方法仍需解决总体框架问题。
Globally, models of extending universal health coverage through primary care are influenced by country-specific systems of health care and disease management. In 2015 a rapid assessment of the ward-based outreach component of primary care reengineering was commissioned to understand implementation and rollout challenges.Aim: This article aims to describe middle-and lower-level managers' understanding of ward-based outreach teams (WBOTs) and the problems of authority, jurisdiction and practical functioning that arise from the way the model is constructed and has been operationalised.Setting: Data are drawn from a rapid assessment of National Health Insurance (NHI) pilot sites in seven provinces.Methods: The study used a modified version of CASCADE. Peer-review teams of public health researchers and district/sub-district managers collected data in two sites per province between March and July 2015.Results: Respondents unequivocally support the strategy to extend primary health care services to people in their homes and communities both because it is responsive to the family context of individual health and because it reaches marginal people. They, however, identify critical issues that arise from basing WBOTs in facilities, including unspecific team leadership, inadequate supervision, poorly constituted teams, limited community reach and serious infrastructural and material under-provision.Conclusion: Many of the shortcomings of a facility-based extension model can be addressed by an independently resourced, geographic, community-based model of fully constituted teams that are clinically and organisationally supported in an integrated district health system. However, a community-oriented primary care approach will still have to grapple with overarching framework problems.