Reorganisation of primary care services during COVID-19 in the Western Cape, South Africa: Perspectives of primary care nurses

Abstract

Background: Primary care nurses play a pivotal role in the response to disasters and pandemics. The coronavirus diseases 2019 (COVID-19) pandemic required preventative, diagnostic, and curative measures for persons presenting with symptoms of COVID-19 by healthcare providers, whilst continuing other essential services. We aimed to investigate the reorganisation of primary care services during COVID-19 from the perspectives of primary care nurses in the Western Cape province of South Africa.Methods: We administered an online survey with closed and open-ended questions to professional nurses enrolled for a Postgraduate Diploma in Primary Care Nursing at Stellenbosch University (2020) and alumni (2017–2019) working in the Western Cape. Eighty-three participants completed the questionnaire.Results: The majority of the participants (74.4%) reported that they were reorganising services using a multitude of initiatives in response to the diverse infrastructure, logistics and services of the various healthcare facilities. Despite this, 48.2% of the participants expressed concerns, which mainly related to possible non-adherence of patients with chronic conditions, the lack of promotive and preventative services, challenges with facility infrastructure, and staff time devoted to triage and screening. More than half of the participants (57.8%) indicated that other services were affected by COVID-19, whilst 44.6% indicated that these services were worse than before.Conclusion: Our findings suggest that the very necessary reorganisation of services that took place at the start of the COVID-19 pandemic in South Africa enabled effective management of patients infected with COVID-19. However, the reorganisation of services may have longer-term consequences for primary care services in terms of lack of care for patients with other conditions, as well as preventive and promotive care.

Technical-assistance arrangements in coping with the COVID-19 pandemic from the managers’ perspective

“…They state strategies for the provision of care to the vulnerable population in the PHC context, reasserting the relevance of this care level in assuming the leading role in the health systems, especially in the face of public health emergencies, with emphasis on monitoring cases with territorial responsibility (15) . A number of studies developed in South Africa address the importance of PHC in coping with COVID-19, reinforcing the urgent need for investments, especially with a focus on the workers, as it directly impacts on the most resolute and timely response to the contextualized health needs, in addition to providing strengthening of the health system, with major impacts on coping with pandemics (15)(16) .…”

Arranjos tecnoassistenciais no enfrentamento da pandemia da COVID-19 na perspectiva de gestores

“…They state strategies for the provision of care to the vulnerable population in the PHC context, reasserting the relevance of this care level in assuming the leading role in the health systems, especially in the face of public health emergencies, with emphasis on monitoring cases with territorial responsibility 15 . A number of studies developed in South Africa address the importance of PHC in coping with COVID-19, reinforcing the urgent need for investments, especially with a focus on the workers, as it directly impacts on the most resolute and timely response to the contextualized health needs, in addition to providing strengthening of the health system, with major impacts on coping with pandemics 15 - 16 .…”

“…Enunciam estratégias para oferta de cuidados à população vulnerável no contexto da APS, reafirmando a relevância deste nível de atenção em assumir o protagonismo nos sistemas de saúde, especialmente, diante de emergências em saúde pública, com ênfase no acompanhamento dos casos com responsabilidade territorial (15) . Estudos desenvolvidos na Africa do Sul abordam a importância da APS no enfrentamento da COVID-19, reforçando a necessidade urgente de investimentos, especialmente com foco nos trabalhadores, por impactar diretamente na resposta mais resolutiva e oportuna das necessidades contextualizadas de saúde, além de, proporcionar o fortalecimento do sistema de saúde, com grandes impactos no enfrentamento de pandemias (15)(16) .…”

Preparativos tecnoasistenciales para enfrentar la pandemia de COVID-19 desde la perspectiva de los gestores

“…Enuncian estrategias para brindarle atención a la población vulnerable en el contexto de la APS, lo que reafirma la relevancia que tiene este nivel de atención para asumir el protagonismo en los sistemas de salud, especialmente frente a emergencias de salud pública, fundamentalmente para el seguimiento de casos con responsabilidad territorial (15) . Estudios desarrollados en Sudáfrica abordan la importancia de la APS en la lucha contra el COVID-19, enfatizan que es necesario que se realicen inversiones de forma urgente, especialmente centradas en los trabajadores, dado que impacta directamente en una respuesta más resolutiva y oportuna a las necesidades de salud contextualizadas, además de fortalecer el sistema de salud, lo que genera grandes impactos para enfrentar las pandemias (15)(16) .…”