Primary health care changes lives

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 to 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 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. It 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.

In the past Digwamaje and other community members had to hire a car when they needed to see a doctor and the trip to the Moreteletsi Hospital is 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-tobe who are close to their birth due date but live some distance from the centre.

The mothers-to-be 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,” says 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 morality rate.

“South Africa has significantly improved its child health and reduced its infant and under five mortality rates. In 2005, it was one of only four countries globally with an under five mortality rate higher than the 1990 baseline for the MDGs.

“This rate declined by an average annual rate of 10.3 per cent between 2006 and 2011 – the fourthfastest rate of decline globally, with Rwanda being the only country in sub-Saharan Africa to achieve faster progress,” according to the Twenty Year Review.

Twenty years ago there were very few PHC facilities meeting the health needs of communities.

The democratic government then introduced a massive infrastructure programme that resulted in more than 1 500 health facility infrastructure projects being completed, the review notes.

Health Minister Aaron Motsoaledi, who described PHC as the backbone of the National Health Insurance (NHI) 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.

According to the Department of Health, 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.