Primary health care delivery : a case study of KwaZulu-Natal with special reference to physiotherapy.
The delivery of primary health care (PHC), as promulgated by the World Health Organization (WHO) and in South Africa, is of fundamental importance. Physiotherapy is an essential component of the health care delivery system and must promote PHC during clinical training and practice. In KwaZulu-Natal (KZN), PHC service delivery has been a problem for various reasons such as the history of the country (apartheid era pre- 1994), financial constraints, lack of human resources, physical infrastructure and time constraints. Service delivery within the health sector is reported frequently in the media as physiotherapists and radiographers embarked on a strike latter part of 2009 in KZN due to a discrepancy in the Occupation Specific Dispensation (OSD). Physiotherapists have highlighted that they were overworked, carrying the strain of vacancies, due to frequent resignations to migrate to the private sector. The aim of the research was to explore the promotion of PHC delivery in KZN. The objectives explored the empowerment of students and staff in the Health Science Disciplines to PHC service delivery. In addition, managers at provincial and local levels were included in the study. Barriers and factors that enhance the promotion of PHC were identified. The research design comprised of a survey, a quantitative and qualitative case study of KZN, using questionnaires or semi-structured interviews. The findings indicated that the physiotherapy staff lacked PHC training (p=0.000) and 48.7% of the Disciplines in Health Sciences indicated that the rural needs were not being addressed with regards to PHC service delivery (p=0.018). Each discipline operated within its own silo, without any consultation and inter-disciplinary collaboration, to the detriment of effective delivery of PHC services. Fragmentation and duplication of PHC services existed between Provincial and Local Governments as indicated by 46% of the managers, which is disconcerting post 15 years of democracy in South Africa. The main objective of the National Health Plan and Reconstruction and Development Programme (RDP) was to readdress the inequalities and fragmented health services. Numerous recommendations are made which will improve the journey towards transformation, comprehensive PHC service delivery, and the quality of life of all citizens