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A Model for the Integration of Primary Healthcare Services in KwaZulu-Natal, South Africa

Author(s): M. N. Sibiya*1
Affiliation(s): 1Nursing, Child and Youth and Environmental Health, Durban University of Technology, Durban, South Africa
Keywords: Primary healthcare, integration, district health system, South Africa, grounded theory approach

The redirection of the healthcare system towards Primary Health Care (PHC) along with the concomitant establishment of the District Health System (DHS)as a framework for PHC delivery and management has been the transformation event in the public health sphere in South Africa since 1994. On the other side, this move towards transforming the healthcare system has been met with numerous impediments, flaws and failures, many of which have not yet been mastered, solved or ironed out. As equity and access to healthcare have since 1994 been considered the key principle to steer the transformation of health services in South Africa, a mechanism was required to define parameters for service delivery, as well as to ensure comparability in the rendering of services. This mechanism realized in the form comprehensive PHC service package that was introduced by the National Department of Health in 2001. Whereas in the past in the South Africa, the model of PHC delivery was strongly based on a vertical approach, the PHC package envisages an organization of services that allows for a one-stop approach. The comprehensive PHC service package is aimed at defining services per level of facility as a way to maximize the integration of services. Nevertheless, integration of PHC services continues to be seen as a pivotal strategy towards the achievement of the national goals of transformation of health services, and the attainment of a comprehensive and seamless public health system. The problem, however, arises in the implementation of integrated PHC as there is no agreed upon understanding of what this phenomenon mean in the South African context. To date no re- search studies have been reported on the meaning of the integration of PHC services. Hence, there is a need for shared views on this phenomenon in order to facilitate an effective implementation of this approach.


The purpose of the study was to analyse the integrated PHC (IPHC) within a DHS in South Africa and thus the shared meaning of the phenomenon. Ultimately the aim is to develop a model for the integration of PHC programmes in KwaZulu-Natal.


Grounded theory approach was used to guide the research process. Theoretical selection of clinics located within four health districts in KwaZulu-Natal was done. Data were collected by means of observation, interviews and document analysis. The results indicated that the majority of the clinics offered most of the services that are listed on the comprehensive PHC core package although the process of implementing the integration of PHC services was done differently in all the clinics where observations were done. All participants interviewed understood the IPHC services as provision of all services in the clinic as stated in the comprehensive PHC core package. However, they expressed different views regarding the process of provision of these services. From the data sources, it emerged that the need for the integration of PHC services in South Africa arose as a response to health needs of the community, the shortage of staff and limited infrastructure and the fragmentation of PHC services. The results also indicated that IPHC resulted in improved accessibility of services. However, on the contrary the unintended consequences of integration were reported to be overcrowding in the clinics thus resulting in deteriorating quality of patient care.

Lessons learned:

These are the preliminary results of the study. The researcher is still in the process of identifying the emerging categories that she will use in developing a model. Supermarket approach, one stop shop and comprehensive services emerged as conceptual categories for understanding integration of PHC services from the data analysis process. The researcher noted that the interviewees used the terms ‘supermarket approach and one stop shop’ interchangeably.

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