What do medical students and their trainers understand by primary health care in South Africa? A qualitative study

Abstract

Abstract Background: The definition of Primary Health Care (PHC) issued by the World Health Organisation in 1978 indicated that it is essential health care which should be made accessible to individuals and their communities, close to where they live and work. In 2010 Starfield introduced the four pillars of PHC: the patient’s first contact with healthcare, comprehensive care, coordinated care and continuous care. This study sought to explore what undergraduate (UG) medical students and their trainers understood by PHC in four South African medical schools. Methods: A qualitative study using the phenomenological design was conducted among undergraduate medical students and their trainers. The setting were four medical schools in South Africa (Sefako Makgatho Health Sciences University, Walter Sisulu University and the University of KwaZulu-Natal and the Witwatersrand University). A total of 27 in-depth interviews were conducted among the trainers and 16 focus group discussions among the students who were in their clinical years of training (MBChB 4–6). Interviews were digitally recorded and transcribed verbatim, followed by thematic data analysis using the MAXQDA 2020 (Analytics Pro) software. Results: Six themes emerged in the understanding of PHC among students and their trainers: PHC as the patient’s first contact with the healthcare system; comprehensive care; coordination of care and continuity of care. There was agreement between students and their trainers in these four themes. However, there was a difference of opinion on whether PHC was a level or an approach to healthcare and the role of specialist trainers PHC. Conclusions: There were areas of convergence and divergence in the understanding of PHC among the students and their trainers. Since understanding should be the basis for training, there is need for trainers and their students to seek common understanding of PHC.