A perspective on Primary Health Care in South Africa : Primary Health Care : in context

Abstract

Throughout much of the twentieth century, South Africa was a global leader in the conceptualisation and development of the Primary Health Care approach. Its seminal contributions include : the Pholela Health Centre model; the pioneering health system policies of the Gluckman Commission; development of the community-oriented primary care movement; the apartheid-era emigration of South Africa's leading community-oriented primary care proponents and subsequent dispersion and development of community-oriented primary care / Primary Health Care principles internationally; the development of the progressive Primary Health Care movement; and experimentation with new models of health service delivery and primary care. These achievements remained fragmented and of limited impact as a result of hostile state interventions and an egregious policy environment prior to and throughout the apartheid era. Despite over a decade of structural reform and genuine commitment to achieving 'Health for All', a series of obstacles continues to limit the full implementation of Primary Health Care today. These include : the HIV and AIDS pandemic; health worker shortages and inequities in resource distribution; shortcomings of political, public sector and medical / health leadership; and a complex and protracted health transition. While there is strong justification for a renewed commitment to, and major investment in Primary Health Care today, this effort must go beyond addressing these persisting challenges, and more broadly incorporate innovative health system designs and experimental work at scale, in order to reorient today's over-bureaucratised and often rigid primary care system.