How well do we teach the primary healthcare approach? A case study of health sciences course documents, educators and students at the University of Cape Town Faculty of Health Sciences

Background. The comprehensive primary healthcare (PHC) approach has been a lead theme in the University of Cape Town Faculty of Health Sciences (FHS) since 1994. A 2014 institutional academic review recommended that indicators be developed for monitoring and evaluating the PHC theme. Objective. To evaluate PHC teaching and learning of final-year health and rehabilitation sciences and medical students at three community-based education (CBE) sites of the faculty, two in Cape Town and one in a distant and largely rural district. Methods. Course documents were analysed for evidence and alignment of nine indicators of the PHC approach in the documented learning outcomes, activities and assessments of final-year health sciences students. Clinical educators and students were interviewed to identify factors that facilitate or impede PHC teaching and learning on site. Results. Final-year health sciences disciplines engage inconsistently with PHC principles at the CBE sites. Alignment appears to be strongest between learning outcomes and teaching activities, but the available data are insufficient to judge whether there is also strong alignment between outcomes and teaching, and formal graded assessment. PHC teaching and learning at the CBE sites are facilitated by good multiprofessional teamwork, educator role-modelling and good infrastructural and logistical support. Language barriers, staff shortages and high workloads are significant and prevalent barriers. Conclusion. Strong faculty leadership is required to promote the PHC lead theme and to achieve better departmental and multiprofessional collaboration in teaching the PHC approach. This study provides evidence from well-established CBE sites to inform future work and participatory action research in promoting the PHC approach in teaching and learning in the FHS.