The implementation of community-oriented primary care in the Cape Metro Health District: A programme evaluation

An implementation framework for community-oriented primary care (COPC) was developed in the Cape Metro, Western Cape Province, South Africa. In 2018, four learning sites were identified to experiment with the framework. A study was undertaken to explore the implementation of this framework.

To explore the process and progress of implementation, as well as the perceptions of the barriers and enablers of implementation.

A programmatic process evaluation with a descriptive exploratory qualitative study design was used. A logic model was developed, and defined inputs, outputs and the sources of evidence for the implementation process.

The understanding of COPC and its underlying philosophy contrasted with the traditional model of care, and the paradigm shift was challenging. Strong leadership was identified as a facilitator for change. Community and stakeholder engagement were the most challenging issues. COPC requires a wide range of skills and expertise supported by appropriate training and clear role definition. The use of electronic devices in the community was both an advantage and a barrier.

Implementation of COPC needs to be understood as a reform of the model of care, and not as an additional project or service. The findings can guide policy, further scale-up and implementation of COPC.