Re-conceptualising primary oral health of a substructure in the Cape Health Metro District
Background: The literature shows that despite the vision of PHC re-engineering (rPHC) to promote universal access to health, oral health remains a critical concern, particularly regarding the provision of primary oral health care (POHC) within the public health system. Aim: This study aimed to explore the status of primary oral health care (POHC) within the re-engineered PHC (rPHC) approach in a substructure of the Cape Metro in the Western Cape province of South Africa and to develop guidelines to better align POHC with rPHC (as applied in the Western Cape province). Method: A mixed methods approach with a case study design as the strategy of enquiry was used. The case encompassed the Klipfontein and Mitchells Plain substructure (KMPSS). The study population consisted of members of the district management team (DMT), including the Deputy PHC Deputy Director and Programme Manager, managers of community health centres (CHCs) (n=2), oral health practitioners (dentists=4, oral hygienists=4), nurse practitioners (n=19), and community health workers (CHWs) (n=149). Data collection to meet the first five objectives included: 1) interviews and focus group discussions with managers to inquire about their perceptions and implementation of PHC and POHC; 2) a scoping review to explore types of interventions by CHWs in healthcare settings that led to improved health outcomes, along with their enablers and challenges; 3) a cross-sectional survey to determine the knowledge, attitudes, and practices of CHWs in their personal and work roles; and 4) document analysis exploring how oral health and POHC are articulated in health policy documents. Qualitative data were analysed using content and thematic analysis, and descriptive and inferential statistics were generated for quantitative data. Data were triangulated to answer the first part of the aim, which was to explore the status of POHC.
Primary health care, Reengineered primary health care approach, Community health workers, Oral health practitioners, Nurse practitioners
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