Abstract:

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. 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. Purposive, stratified sampling was used to select health care staff, managers or students that complied with set inclusion criteria, and were willing to participate in the study. The sample (N=180) included various strata or subgroups from a range of professions namely, Physiotherapy, Optometry, Occupational Therapy, Nursing, Medicine, Social Work. The validity and reliability of the questionnaire was rigorously tested by pre-pilot as well as pilot studies. Excel spreadsheet and SPSS statistical package were used to assist in data capture and quantitative analysis. Data analysis included the Cronbach's Alpha, Chi-Square, Fisher;s Exact, Mann Whitney, ANOVA and the Kriskal Walis test. Qualitative data in the form of open-ended questions in the survey was captured using coding or content analysis by identifying similar and different responses to enable interpretation of the raw data. The analysis/ interpretation of results by triangulating quantitative and qualitative data enabled the presentation of the findings.

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 16 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. The plethora of recommendations that emanated should improve the journey towards transformation; a comprehensive PHC service delivery; and in the improvement of the quality of life for all South Africans.

Keywords:

Primary Health Care Delivery, Physiotherapy, Clinical training, Practice.