Conceptualising health services in terms of level and location of care--a view from the academic health complex.
The origin and characteristics of academic health complexes (AHCs) are briefly outlined, along with pressures for restructuring of health services towards primary levels of care within the primary health care (PHC) approach. Weaknesses and strengths of the AHCs together with imbalances in the overall health system of which they are part are discussed. The Cape Town AHC is used to exemplify a suggested framework for analysis and development of other AHCs in South Africa and their transformation in accordance with the PHC approach. A method of service mapping is employed to aid an appreciation of the complexity of AHC services. Planning for potential transformation may be facilitated by conceptualising services in two dimensions, viz. level and location of care. Two important additional dimensions of service component linkage are integration across levels of care along a vertical axis, and integration across different services at primary level along a horizontal axis (comprehensiveness). AHCs, however skewly developed in terms of level and location of care, are complex combinations of services. They encompass all levels of care provided both within and beyond the walls of multiple health care facilities which are located both centrally and peripherally. AHC services are managed by health professionals in specific academic disciplines. They include PHC functions at the interface between primary and specialist care provision, and community health functions which are principally located outside the health care facilities in the community.(ABSTRACT TRUNCATED AT 250 WORDS)
Myers
J E
JE
Department of Community Health, University of Cape Town.
Pelteret
R
R
D000046:Academic Medical Centers / Q000458:organization & administration* / Q000592:standards; D003695:Delivery of Health Care / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D011320:Primary Health Care; D013019:South Africa