From disease-focused programmes to system strengthening, implementing Adult Primary Care in the Eastern Cape, South Africa
1
Knowledge Translation Unit, Knowledge Translation Foundation, 240 Main Road Rondebosch, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):A1770
ABSTRACT
INTRODUCTION:
the adult primary care (APC) strategy is a health systems intervention that has been successfully implemented, scaled up and sustained in south africa. Developed by the knowledge translation unit, APC has been adopted as national policy by the department of health (DOH)¹ and scaled to reach more than 300000 primary care health workers nationwide². Internationally, APC has been adapted as the practical approach to care kit and introduced in ethiopia, brazil, nigeria, and indonesia ².
METHODS:
this paper draws on eight years of implementation experience of APC across three districts in the eastern cape (EC) province, south africa. We describe how APC was implemented and sustained within a complex health system environment, with particular attention to the interaction between donor priorities and provincial and national health policy objectives.The paper outlines the implementation strategies used to embed APC within district health systems and factors influencing sustainability.
RESULTS:
APC supported a shift from donor-defined, disease-specific capacity building towards a system-oriented, comprehensive primary health care approach aligned with national policy. Over 4600 training completions by health workers were achieved, with district-based mentorship and assessment systems embedded within DOH structures. APC functioned as a mediating mechanism between donor accountability requirements and health system priorities, enabling integrated service delivery while maintaining donor reporting obligations. Capacity building was reframed as a routine health system function rather than a time-limited project output, challenging assumptions about baseline provider competence by prioritising supported practice over rapid certification. During the COVID-19 pandemic, APC was adapted through blended and online learning modalities, improving reach and system resilience. APC was sustained by the health system beyond the funding period.
CONCLUSIONS:
Policy aligned, integrated interventions such as APC can reconcile donor funding requirements with comprehensive primary health strengthening. The EC experience offers transferable lessons for institutionalising sustainable capacity-building interventions in resource-constrained health systems
the adult primary care (APC) strategy is a health systems intervention that has been successfully implemented, scaled up and sustained in south africa. Developed by the knowledge translation unit, APC has been adopted as national policy by the department of health (DOH)¹ and scaled to reach more than 300000 primary care health workers nationwide². Internationally, APC has been adapted as the practical approach to care kit and introduced in ethiopia, brazil, nigeria, and indonesia ².
METHODS:
this paper draws on eight years of implementation experience of APC across three districts in the eastern cape (EC) province, south africa. We describe how APC was implemented and sustained within a complex health system environment, with particular attention to the interaction between donor priorities and provincial and national health policy objectives.The paper outlines the implementation strategies used to embed APC within district health systems and factors influencing sustainability.
RESULTS:
APC supported a shift from donor-defined, disease-specific capacity building towards a system-oriented, comprehensive primary health care approach aligned with national policy. Over 4600 training completions by health workers were achieved, with district-based mentorship and assessment systems embedded within DOH structures. APC functioned as a mediating mechanism between donor accountability requirements and health system priorities, enabling integrated service delivery while maintaining donor reporting obligations. Capacity building was reframed as a routine health system function rather than a time-limited project output, challenging assumptions about baseline provider competence by prioritising supported practice over rapid certification. During the COVID-19 pandemic, APC was adapted through blended and online learning modalities, improving reach and system resilience. APC was sustained by the health system beyond the funding period.
CONCLUSIONS:
Policy aligned, integrated interventions such as APC can reconcile donor funding requirements with comprehensive primary health strengthening. The EC experience offers transferable lessons for institutionalising sustainable capacity-building interventions in resource-constrained health systems
| eISSN: | 2654-1459 |
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