Article Text
Abstract
Introduction Community-orientated primary care (COPC) is an approach to primary healthcare (PHC) that originated in South Africa and contributed to the formulation of the Declaration of Alma-Ata 40 years ago. Despite this, PHC remains poorly developed in sub-Saharan African countries. There has been a resurgence of interest in strengthening PHC systems in the last few years and identifying key knowledge gaps. COPC has been an effective strategy elsewhere, most notably Brazil. This scoping review investigated COPC in the sub-Saharan African context and looked for evidence of different models, effectiveness and feasibility.
Methods Databases were systematically searched using a comprehensive search strategy to identify studies from the last 10 years. A methodological guideline for conducting scoping reviews was followed. A standardised template was used to extract data and compare study characteristics and findings. Studies were grouped into five categories: historical analysis, models, implementation, educational studies and effectiveness.
Results A total of 1997 publications were identified and 39 included in the review. Most publications were from the last 5 years (n = 32), research (n = 27), from South Africa (n = 27), focused on implementation (n = 25) and involving case studies (n = 9), programme evaluation (n = 6) or qualitative methods (n = 10). Nine principles of COPC were identified from different models. Factors related to the implementation of COPC were identified in terms of governance, finances, community health workers, primary care facilities, community participation, health information and training. There was very little evidence of effectiveness of COPC.
Conclusions There is a need for further research to describe models of COPC in Africa, investigate the appropriate skills mix to integrate public health and primary care in these models, evaluate the effectiveness of COPC and whether it is included in training of healthcare workers and government policy.
- primary care
- primary healthcare
- community health workers
- africa
- community-oriented primary care
- community participation
- organisation and administration
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Footnotes
Handling editor Valery Ridde
Contributors RM conceptualised the study with input from SR, AE and EB. All authors participated in the searching for and selection of included studies as well as data extraction. RM synthesised the extracted data. All authors analysed the data in a workshop and RM wrote the initial draft, which was further revised by all authors. All authors approved the final manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. Stellenbosch University provided funding for the 3-day workshop and Ariadne Labs provided funding for the publication.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval As this was a scoping review of published articles no formal ethical approval was required from Stellenbosch University.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement A summary of the included studies and references to them are included in the article.