PRIMARY HEALTH CARE IN SOUTH

AFRICA
Presented by V. Ntsalu
2024
Overview of this lecture

 Public health care facilities

- Primary health care facilities

- Hospitals
 Private health care facilities

- Role of private pharmacy in PHC

 Role of pharmacist

- WHO seven star pharmacist

- Role of the pharmacist in PHC

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Primary healthcare facilities

1) HEALTH POST

A room in a house or other building in a community from which a range of elementary

primary health care services are provided.

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Primary healthcare facilities

2) MOBILE CLINIC

A temporary service from which PHC services are provided and where a mobile
van/bus/car/train provides the resources for the service
 Has fixed routes
 Stops at fixed points

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Primary healthcare facilities

3) SATELITE CLINIC

A facility that is a fixed building where one or more rooms are permanently equipped
and from which a variety of PHC services are provided.
 Open up to 8 hours a day
 Open less than 4 days a week

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Primary healthcare facilities

4) CLINIC

An appropriately permanently equipped facility that provides a range of PHC services

 Open up to 8 hours a day
 Open 5 days a week

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Primary healthcare facilities

5) DAY CENTRE

Not open 24 hours a day or 7 days a week, but offers a broad range of PHC services

 Includes accident and emergency services

 Does not include midwifery surgery under general anaesthesia

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Primary healthcare facilities

6) COMMUNITY HEALTH CENTRE

Open 24 hours a day, 7 days a week, providing a broad range of PHC services

 Includes accident and emergency services

 Includes midwifery services
 Does not include surgery under general anaesthesia

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Primary healthcare facilities

7) GATEWAY CLINIC

Clinic on the premises of a tertiary/secondary/regional hospital, providing PHC

services
 May include trauma services, but not all
 May have extended hours, but not all

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District, regional and tertiary facilities

1) DISTRICT HOSPITALS
 Small, medium and large, varying from 50 to 600 beds
 Provides care on a 24 hour basis
 Have general practitioners and clinical nurse practitioners
 Offer:
-Paediatric services
-Obstetrics and gynaecology
-Internal medicine
-General surgery
-Family physician
 Example: Zitulele Hospital, OR Tambo District Municipality
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District, regional and tertiary facilities

2) REGIONAL HOSPITALS
 Services are provided on a 24 hour basis
 Has between 20 and 800 beds
 Includes same services as a district hospital as well as:
-Trauma & emergency
-Short-term ventilation in a CCU
-At least one specialty in either orthopaedics, psychiatry, anaesthetics or diagnostic
radiology
 Example: Uitenhage Hospital, NMMM Sub district B

Dora Nginza Hospital, NMMM Sub district A

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District, regional and tertiary facilities

3) TERTIARY HOSPITALS
 Provides special level services provided by regional hospitals
 Provides sub-specialities of these services
 Intensive care under the supervision of a specialist
 May provide training for health care services
 Receives referrals from regional hospitals not limited to provincial boundaries
 Have between 400 to 800 beds
 Example: Livingstone Hospital, NMMM Sub district C

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District, regional and tertiary facilities

4) CENTRAL HOSPITALS
 Provides tertiary hospital services
 May provide services for national referral (super-specialized referrals)
 Must provide health care training
 Must conduct research
 Must be attached to a medical school
 Has a maximum of 1200 beds

Example:
Nelson Mandela Academic Hospital in the OR Tambo district municipality
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District, regional and tertiary facilities

5 ) SPECIALISED HOSPITALS
 Provides specialised services, for example:
-Tuberculosis
-Psychiatric services
-Orthopaedic services
-Eyes etc

Example:
Elizabeth Donkin Hospital, Psychiatric Hospital, NMMM Sub district C

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Facts about PHC clinics

 Generally open 8 hours a day, 5 days a week (NOT weekends)

 Any person in SA can come to the clinic
 All treatment at the clinic is free
 An ID is not required
 Provides services to children, mothers, adults and the elderly
 All emergencies are treated immediately
 Not all services are available every day
 If the clinic cannot help, the patient will be sent to the next level of care for further
treatment
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Private pharmacies and PHC

 PHC is generally associated with public clinics

 In terms of legislation, a private pharmacy can offer PHC services in one of 2 ways:

a) The pharmacist can register the pharmacy as a “clinic” and provide primary health care
services through a registered professional nurse
b) The pharmacist can complete a PCDT (primary care drug therapy) course
- Course currently offered only by Potchefstroom University
- After successful completion of the course the pharmacist registers the
qualification with the SAPC
- The pharmacist then applies to the NDOH for a Section 22A(15) license

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Private pharmacies and PHC

 However, any pharmacy can become in primary health care type services through:

- Screening
- Health promotion
- Treatment of minor complaints and illness through OTC prescribing
 The challenge though is the cost of providing these services as PHC treatment is
free through the clinics
 Pharmacies need to think about their preparedness to function in a NHI health
system

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The role of the pharmacist

 The role of the pharmacist has changed over many years from the early tradition of
“compounder and dispenser” to “drug-therapy manager” practicing “pharmaceutical care”
 The scope of pharmacy practice includes:
a) Patient-centred care
- counselling
- patient education
- providing drug information
- drug therapy monitoring
b) Technical aspects
- manufacturing, quality control, drug discovery, regulatory processes
- dispensing
- drug supply management 18
WHO 7-Star Pharmacist

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The Seven-Star Pharmacist

1) Caregiver
- Provide caring and compassionate services of the highest quality
- Be aware of cultural and social circumstances
- Maintain patient confidentiality
- Care provided by the pharmacist is integrated with the health care system as a
whole

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The Seven-Star Pharmacist

2) Decision maker
- Accurate decisions made around the appropriate, effective, safe and cost-effective
use of resources
- Such resources include personnel, medicines, chemicals, equipment, procedures,
practices
- Contribute to the setting of medicine policy at national and local levels

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The Seven-Star Pharmacist

3) Communicator
- Communication with other health care providers
- Communication with the patient
- The pharmacist is often the link between the clinician and the patient
- Ability to build a relationship of trust with the patient

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The Seven-Star Pharmacist

4) Manager
- Management of human, physical and financial resources
- Involvement in policy and procedure setting, quality standards setting and
maintenance

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The Seven-Star Pharmacist

5) Life-long learner
- Life long learning which starts at the pharmacy school
- Active participation in continuous professional development

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The Seven-Star Pharmacist

6) Teacher
- Training future generations of pharmacists and pharmacy support personnel
- Teaching patients

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The Seven-Star Pharmacist

7) Leader
- Create a vision and motivate team members to achieve this vision
- Create high-performance pharmacy practices characterised by high-quality patient
care, medicine safety and productivity
- Encourage constructive differences

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Role of the Pharmacist in PHC

 Ensure constant supply of medicines, supplies and equipment

 Ensure all equipment is functional and maintained
 Secure storage of medicines
 Supply of medicines according to appropriate protocols
 Ensure availability of hot and cold water in the dispensary
 Ensure back-up power is functional
 Supervision of dispensary personnel
 Ensure cleanliness of the dispensary
 Ensure access to the dispensary for all patients

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Role of the Pharmacist in PHC

 Monitor waiting times and make improvements where necessary

 Provide compassionate and comprehensive pharmaceutical care
 Ensure correct referral of patients
 Organise / conduct outreach services for the community served by the clinic
 Training of community health care promoters and caretakers
 Education of patients
 Accurate recording of all data and information
 Collaboration with other healthcare professionals

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