Primary health care in support of community development

Abstract

A community development approach has been adopted in the outreach component of the work of the Alexandra Health Centre in South Africa. The importance of local township organizations has been recognized and the Centre is seen not only as providing technical solutions but also as helping people to achieve improved living conditions. This requires clear motivation, rigorous management, purposeful action by teams of health staff, and planning in conjunction with the community.

PIP: Alexandra, a township in South Africa with 200,000 inhabitants, is 15 kilometers from Johannesburg. The Alexandra Health Center and University Clinic is the major provider of comprehensive health care in a way that empowers the community; it is a model of health care for similar communities in the Third World. The aims of outreach are to increase accessibility to health care, improve compliance with treatment for chronic diseases, and ensure the working of preventive and promotive care programs. As the services have improved, attendance from neighboring areas has increased. The outreach system ensures that the focus remains on the residents of Alexandra and the township's disadvantaged people such as squatters, the elderly, and the disabled. The services consist of: promotion of community participation, support of community organizations, outreach services, community education, and research on outreach and community services and information gathering for the establishment of a health information system. The outreach services cover maternal and neonatal health, child health, workers' health, geriatric and chronic care, and community-based rehabilitation and education. To meet these requirements, a community-based network of health extension workers could be developed who are selected, employed, and trained by the Alexandra Health Center. Training would cover primary health care, community resources, communication and education techniques, and community-based information systems. The workers would be based in health units, each covering some 2000 families, from which many outreach services could be provided. Their tasks would be home visiting, environmental supervision, and community organization and education. The Alexandra Health Center also provides assistance with financial management and offers the services of a doctor and physiotherapists for the Nokuthula Center for Mentally Handicapped Children.