Abstract:
BACKGROUND : Integrated care through community-oriented primary care (COPC) deployed
through municipal teams of community health workers (CHWs) has been part of health reform
in South Africa since 2011. The role of COPC and integration of information and communication
technology (ICT) information to improve patient health and access to care, require a better
understanding of patient social behaviour.
AIM : The study sought to understand how COPC with CHWs visiting households offering
health education can support antenatal follow-up and what the barriers for access to care
would be.
METHOD : A mixed methodological approach was followed. Quantitative patient data were
recorded on an electronic health record-keeping system. Qualitative data collection was
performed through interviews of the COPC teams at seven health posts in Mamelodi and
telephonic patient interviews. Interviews were analysed according to themes and summarised
as barriers to access care from a social and community perspective.
RESULTS : An integrated COPC approach increased the number of traceable pregnant women
followed up at home from 2016 – 2017. Wrong addresses or personal identification were given
at the clinic because of fear of being denied care. Allocating patients correctly to a ward-based
outreach team (WBOT) proved to be a challenge as many patients did not know their street
address.
CONCLUSION : Patient health data available to a health worker on a smartphone as part of COPC
improve patient traceability and follow-up at home making timely referral possible. Health
system developments that support patient care on community level could strengthen patient
health access and overall health.
