COPC is an approach to care services that begin the health engagement with people in their homes and places of work. Under the guidance of doctors, nurses or other health professionals, teams of community health workers (CHWs) engage with individuals and families in defined geographical areas. Each CHW is assigned approximately 250 families.

The COPC initiative at Daspoort Clinic follows the Department of Family Medicine at the University’s Faculty of Health Sciences’ support of the National Department of Health’s efforts to re-engineer primary health. Since 2010, the Department has worked in collaboration with the district offices of the Gauteng Department of Health, the City of Tshwane and a range of non-governmental, community and private sector organisations to develop an approach to primary care that proactively enables disease management and supports improved health. From mid-2011, several ward-based outreach teams have been set up, including in Mamelodi and Atteridgeville. These teams have started working in similar ways to those now started at Daspoort.

Daspoort Clinic was established in 1964 as a University of Pretoria’s training centre for medical students to support the local community and also to gain practical work experience. In 2005, the clinic was temporarily closed due to legal and practical issues, but was re-opened in 2007 with support from the Gauteng Department of Health. It was developed into a full-time health facility for the community.  

Dr Ellenore Meyer, one of the doctors responsible for COPC at Daspoort Clinic, described COPC as an approach that works through an integrated multidisciplinary team of doctors, nurses, CHWs, dietitians, occupational therapists, dentists and physiotherapists. She said that as a practice, the team continuously reflects on what they are doing in order to find better ways of improving individual, family and community health. Dr Meyer said that Daspoort Clinic is an academic site where the curriculum for students is driven both by their and their patients’ needs.

“We are here for the community and our guidelines are drawn up according to the needs of the community, and therefore the students are taught how to impact on the needs of the community,”  she said.

Dr Meyer said COPC was driven by a need to make a success of the government’s National Health Insurance (NHI): ‘

“The work we are doing at Daspoort Clinic will contribute to the Tshwane pilot site. At Daspoort Clinic the team will be looking for ways to use the least amount of money to provide the best health care.

 “Daspoort Clinic is unique in a sense that it has a multidisciplinary team and there are strong roots in the community. It has also established collaboration with public/private sectors and the academic preference allows the clinic to do research and partner with other institutions,” she concluded.

The Head of the Department of Family Medicine at the UP, Prof Jannie Hugo, described COPC as a “revolution” in the healthcare field. As a professional who has been involved in primary healthcare throughout his career, he said this was the first time he felt that the vision of primary healthcare as a comprehensive system was attainable.

‘For us, COPC is not a programme but a revolution in the paradigm of health service delivery. It is something different and we are proud and excited to be part of it,” he said.

Prof Hugo used the analogy of soccer to illustrate how COPC changes the game. He said that the way the system is organised now, healthcare providers are concentrated at the goal posts (hospitals, clinics, private practices) while epidemics are running amok all over the field (in communities, the place where people live and work).

The epidemics have the advantage and are able to strike indiscriminately and relentlessly when they are tackled. With COPC, the healthcare team now takes ownership of the game and drives its interventions into goalposts of the epidemics’ team. By changing the game, it is possible to control epidemic diseases more effectively while at the same time improving the general health of the population. In this approach, hospitals and clinics, as well as private GP practices, remain relevant and important, but because COPC tackles illnesses early and in the terrain where they are strongest – the community – they are able to use their expertise to manage conditions when they can’t be dealt with at primary care level. ‘

“This revolution is about placing ourselves in the communities. Although we may not understand them, if we work with community health workers and ordinary individuals and families, we can break the stranglehold of disease together,” he said.

Prof Hugo said since 2008 the Department of Family Medicine has worked with the Faculty to move undergraduate and postgraduate medical students out of lecture halls and tertiary hospitals. Initially the students went to district hospitals, then to clinics. This year, master’s students are working in communities rather than at facilities. Their impact is already being felt, as they work with community health workers and other health professionals, interacting directly with patients in their homes.

“We are going to make COPC work in the areas in which we are positioned, and we will show the country that we are part of a new health system,” he concluded. 

Prof Tessa Marcus, a sociologist in the Department of Family Medicine at the University of Pretoria, said COPC is a paradigm that brings a different perspective to “a passive, hospital and specialist-centred health system.”’.

She said COPC was built on interpersonal relationships between the people who use and need healthcare and the professionals who provide healthcare services.

“Humans need relationships. Relationships depend on trust, shared responsibility and mutual accountability. That is how you develop healthcare,” she said.

Prof Marcus said her book, Community oriented primary care L2: Primary health has been developed for the National Curriculum (Vocational) Primary Health that is presently being run with the Department of Higher Education and Training at 12 Further Education and Training colleges nationwide.

It is also being used in undergraduate and postgraduate medical and allied health education, as well as to support professional continuing education. The book sets out the principles of COPC and how they can be applied to healthcare, taking into account the place of individuals and families in time, space and place.

The book also engages the social structure of our society and the implications that age, disability, race-ethnicity-origin, sex and gender and social class have on the practice of community-oriented primary care. In this, the book is unique both in its application of sociological ideas to healthcare understanding and in its predominant focus on South and sub-Saharan Africa.

The Dean of the Faculty of Health Sciences, Prof Eric Buch, said the Faculty was committed to educating health workers to serve the society and also learning in the community. He said Daspoort Clinic is a place where new ideas which can fit into the vision of the government’s NHI can be innovated and pioneered.

Prof Buch said the new book on community-oriented healthcare by Prof Marcus has demonstrated the approach to healthcare delivery that has impacted on improving health in communities and in changing the delivery model of healthcare.

“This book sets out the principles of what makes the approach uniquely different. It is our responsibility as universities to generate and share new knowledge and ideas, and this book is part of sharing years of experience in building the COPC approach to healthcare,”
 he said.

Prof Tessa Marcus signs one of the first copies of her book,  Community Oriented Primary Care L2: Primary Health