Primary health care in the South African context – medical students’ perspectives

Abstract

Background: Both the South African Department of Health and the University of Cape Town (UCT) have committed to the primary health care (PHC) approach, which is best captured in the Declaration of Alma Ata. If medical students are to be trained in the PHC approach, it is important that they not only have a good understanding of this approach, but are also aware of the social, economic and political context that they will be working in when they have qualified, so that they can develop realistic expectations of their careers as doctors. From research that was conducted at UCT, this article covers UCT medical students’ views of health care in South Africa, including their perceptions of the applicability and implementation of the PHC approach for South Africa, and their perceptions of how the South African government features in issues of health and the PHC approach. Methods: Mixed-methods were used, but this article will focus on the qualitative data gathered. One hundred and seventeen medical students (years one to four) were purposively selected to be involved in focus groups and interviews. These focus groups were conducted between February 2004 and March 2005. Results: Students acknowledged that the state of health care in South Africa needs to change and showed an awareness of the role that South Africa’s history of apartheid has played in the state of health care in these areas and the existence of inequity. They however did not agree on the applicability of the PHC approach to the South African situation. The PHC approach is seen not to be working in South Africa because of various obstacles to its implementation and success, such as disorganisation within the health system, and a lack of infrastructure, finances and resources. There seemed to be a general understanding amongst the students that they will have been trained in the PHC approach but then will be working within a system that has possibly not undergone similar changes. Students agreed on the important role of government in PHC, some maintaining that the government should be at the forefront of its implementation, but were generally dissatisfied with the role the South African government is currently playing in health care. Conclusion: It is encouraging that students are generally aware of the reality of health care in South Africa and of the fact that more change needs to take place. However, it may be that many students who have a limited understanding of the impact that apartheid had on health care provision in South Africa, and this could then impact on students’ perceptions of the applicability of the current PHC approach for South Africa. Students’ views that the PHC approach has not been fully implemented in South Africa are a concern, as it is these types of views that are likely to cause students to lose confidence in the PHC approach, and will most likely widen the disjuncture between theory of the approach and the reality of its implementation. Regarding the political dynamics of the PHC approach, students do need to be aware of political factors that can impact on the success of this approach. Discussion around and research into the social, economic and political context of health care and medical education has particular relevance for South Africa, and it is vital that students’ views on these issues are acknowledged so that areas for change can be identified and addressed.