Closing the gap between public health and primary care: strengthening health systems to ensure equity in South Africa
1
School of Pharmacy, Faculty of Natural Science, University of the Western Cape, Cape Town, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
South Africa's primary healthcare (PHC) system experiences ongoing inequities, with an escalating burden of non-communicable diseases (NCDs), demanding long-term, people-centred models of care. These inequities are deeply intertwined with social determinants of health, further exacerbating disparities in health outcomes. Individuals from lower socio-economic backgrounds have a higher prevalence of NCDs, highlighting where policy interventions must focus. Against this backdrop, large-scale interventions like the Western Cape’s Chronic Dispensing Unit (CDU) and the national COVID-19 vaccination campaign offer contrasting lessons about how public health policies translate into PHC practice. The aim was to assess the implementation of two large-scale public health interventions (CDU and COVID-19 vaccination) within South Africa’s PHC system, and to identify how the factors influencing their effectiveness, equity, sustainability and service design could be used to reduce the burden of NCDs.
METHODS:
A mixed-methods research was undertaken. (i) A qualitative evaluation of the CDU used semi-structured interviews, with purposively selected stakeholders from across primary care, operational, management, and policy-levels. Thematic analysis followed a deductive–inductive strategy. (ii) A retrospective, population-based assessment of the COVID-19 vaccination campaign examined speed, equity, uptake, and death trends using publicly-available secondary National Department of Health data.
RESULTS:
The CDU achieved substantial reach, service efficiencies, reduced waiting times and decongested facilities, while strengthening prescribing governance. Sustainability risks included fragmented data systems and non-collection of medicine, limiting the monitoring of clinical outcomes. COVID-19 vaccination coverage plateaued below national aims, with geographic and demographic inequities in uptake. Integration of vaccination into routine PHC and community outreach improved access but did not fully address hesitancy, distribution, and data integration gaps.
CONCLUSIONS:
To ensure equity is more than just an inspiration, it is essential to track progress through measurable indicators. Policy-to-practice translation in South Africa is feasible and impactful when PHC interventions are data-enabled, integrated, community-embedded, and sustainably financed.
South Africa's primary healthcare (PHC) system experiences ongoing inequities, with an escalating burden of non-communicable diseases (NCDs), demanding long-term, people-centred models of care. These inequities are deeply intertwined with social determinants of health, further exacerbating disparities in health outcomes. Individuals from lower socio-economic backgrounds have a higher prevalence of NCDs, highlighting where policy interventions must focus. Against this backdrop, large-scale interventions like the Western Cape’s Chronic Dispensing Unit (CDU) and the national COVID-19 vaccination campaign offer contrasting lessons about how public health policies translate into PHC practice. The aim was to assess the implementation of two large-scale public health interventions (CDU and COVID-19 vaccination) within South Africa’s PHC system, and to identify how the factors influencing their effectiveness, equity, sustainability and service design could be used to reduce the burden of NCDs.
METHODS:
A mixed-methods research was undertaken. (i) A qualitative evaluation of the CDU used semi-structured interviews, with purposively selected stakeholders from across primary care, operational, management, and policy-levels. Thematic analysis followed a deductive–inductive strategy. (ii) A retrospective, population-based assessment of the COVID-19 vaccination campaign examined speed, equity, uptake, and death trends using publicly-available secondary National Department of Health data.
RESULTS:
The CDU achieved substantial reach, service efficiencies, reduced waiting times and decongested facilities, while strengthening prescribing governance. Sustainability risks included fragmented data systems and non-collection of medicine, limiting the monitoring of clinical outcomes. COVID-19 vaccination coverage plateaued below national aims, with geographic and demographic inequities in uptake. Integration of vaccination into routine PHC and community outreach improved access but did not fully address hesitancy, distribution, and data integration gaps.
CONCLUSIONS:
To ensure equity is more than just an inspiration, it is essential to track progress through measurable indicators. Policy-to-practice translation in South Africa is feasible and impactful when PHC interventions are data-enabled, integrated, community-embedded, and sustainably financed.
| eISSN: | 2654-1459 |
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