Developing a Wits locus for ‘African Community Practice’
The concept of Community-oriented Primary Care (COPC) started in the 1940s with a
young doctor couple from Wits University – Drs. Sidney and Emily Kark - setting up the
Pholela Community Health Centre in Bulwer, Natal. Their efforts led to the
development of a network of CHCs and new National Health Service for all South
Africans. Unfortunately this was all cut short by the onset of apartheid in 1948. Their
ideas, however, spread across the world, including Cuba and recently Brazil (Longlett,
Kruse, & Wesley, 2001; Tollman, 1991). The South African government has clearly
been inspired by Brazilian achievements. They have acknowledged this in the Green
Paper on National Health Insurance and have modeled the policies of Primary Health
Care (PHC) Re-engineering and PHC Outreach Teams on Brazilian experience. It is
unfortunate that the Karks (and Wits) contribution is not completely understood nor
being acknowledged, let alone celebrated (National Department of Health, 2011).
The team from HURAPRIM, a research project linked to the Wits Department of
Family Medicine, has been evaluating PHC Outreach Teams and attempting to
implement COPC, as the Karks did. We have set up a Community Practice (as we
term it) in a small part of the Chiawelo Community Health Centre, Soweto, as a reallife model suitable for South Africa and Africa. Whilst it is in line with national policy it is
taking it further, based on family medicine principles and best practice. It is being
modeled for the context of National Health Insurance (especially considering private
general practitioners-led teams).
The Chiawelo Community Practice (CCP) is modeled on a basic framework, emerging
from the Karks work and the worldwide work on COPC since:
1. Community health workers, as active part of the team, strengthening daily
interaction with the community
2. Practice organization of teamwork around person, family and community,
especially with strong problem-oriented record systems
3. Strong structured collaboration in the health system, inter-sectorally and with
community stakeholders
4. Health promotion, including innovative communication
The objective has been to build CCP as a Wits-Jhb Centre of Excellence. Our
partnerships, innovations (including in information technology) and academic freedom
are allowing us to engage socially and to contribute to important research (see
addendum) and teaching (with undergraduates and postgraduates already moving
through CCP). The Community-based Health Sciences Education Committee
(COBHSE) at Wits Medical School is very supportive. CCP is already achieving
international visibility as the first African member of the International Federation of
CHCs. We are busy developing the African Organisation of Community Practice with a
website www.AfroCP.org.za. We believe that CCP will grow in influence as a site for
the university and nationally. We feel it already offers many opportunities for
groundbreaking research in primary health care with potential for raising funds.
We are defining African Community Practice as: a community-oriented primary
care strategy that delivers holistic quality primary health care that is oriented to person,
family and community, with inter-professional and multidisciplinary teamwork. It
includes taking responsibility for a defined population, public health approaches, intersectoral cooperation and community engagement. African Community Practice is
committed to equity, social inclusion and universal health coverage. This is strongly
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aligned to objectives of the International Federation of CHCs (www.ifchc2013.org/)
We believe that Health (and community) should be in ALL policies and informed by
more than medicine, and so we have been keen to take this further with engagement
across the university, in ALL faculties. The university has many parts trying to reach
out into communities and be applicable in the real world. The pity is that it is often
fragmented and struggling. It is all too easy for the university to feel besieged by the
‘mess out there’ and retreat to behind the ‘walls’ of the university, and safe spaces like
hospitals and laboratories. We feel that “African Community Practice” can focus
interest from across the university to help its graduates experience practice IN the
community – appropriately in learning and as real world leaders. The University of
Witwatersrand has important values, social engagement and responsiveness, that
need nurturing across the various faculties in an integrated and purposeful manner.
These values and process can become demonstrable, by exploring service delivery of
‘health’ (with all its community, inter-sectoral and social determinant permutations) IN
the community especially where health reforms are possibly creating a new, major and
abiding social institution, like the United Kingdom’s National Health Service.
We feel that Chiawelo Community Practice and possibly other such Community
Practices, provide a platform to explore service delivery deep in the community. We
are proposing an ‘African Community Practice’ Project as a Wits locus for this.
Draft aim: Service development, Teaching, Research and Advocacy for inter-sectoral
and multi-disciplinary professional practice in the community.
Draft motto: Practice in the Community…. Changing paradigms
Possible future programme
 Research
 Service Development
 Professional community-based service learning / teaching;
 Advocacy of Community Practice
 Support (South) African organization of Community Practice
We believe that this project can evolve, possibly becoming a Centre. Whilst funding is
viewed as a critical Wits factor in setting up a Centre, we believe that process and
people are more important. Nonetheless the team, based on the Jozi Family Medicine
Syndicate, has funding till February 2015 and is actively seeking out further funding.
We may know the result of an NIH Grant application by August.
We would really like to brainstorm these ideas with key people at Wits interested in
the work being done in Chiawelo Community Practice.
Shabir Moosa, Stephen Pentz and Shehnaz Munshi
Department of Family Medicine
Longlett, S. K., Kruse, J. E., & Wesley, R. M. (2001). Community-oriented primary care: historical perspective. The
Journal of the American Board of Family Practice, 14(1), 54–63.
National Department of Health. (2011). PHC Re-engineering.
Tollman, S. (1991). Community Oriented Primary Care: origins, evolution, applications. Social Science & Medicine,
32(6), 633–642.
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