CORRESPONDENCE

Community paediatrics and child health

To the Editor: In 2012, the Postgraduate Education Committee of the Health Professions Council of South Africa (HPCSA) supported the accreditation of Community Paediatrics and Child Health (CPCH) as a paediatric subspecialty; however, full HPCSA approval is outstanding. Consequently, by February 2015 there had been no visible progress towards implementation. Power and Heese^[1] and Swingler et al.^[2] highlighted the benefits of CPCH, rendering further debates about CPCH accreditation unnecessary, particularly in a country where: (i) progress towards the fourth Millennium Development Goal is slow; (ii) glaring gaps exist between hospital-based and community care, and between private and public sector care;^[3] and (iii) current under- and postgraduate paediatric training emphasises clinical subspecialties (despite reduced public sector posts), yielding graduates with limited knowledge about priority child health conditions. Primary healthcare re-engineering and the establishment of district clinical specialist teams in South Africa have starkly revealed the urgency of CPCH training.^[4] CPCH locates child health within a sociocultural-economic-political-environmental-systemic paradigm.^[5] Successful community paediatricians share four characteristics:^[6](i) academic collaboration; (ii) finding evidence-based local solutions; (iii) establishing strong community-based partnerships; and (iv) addressing disease outside traditional biomedical models. This suggests that our sometimes narrow approach to under- and postgraduate training needs significant adaptation. The British Association for Community Child Health, affiliated to the Royal College of Paediatricians, is a successful model we can adapt.^[7] This custodian of community paediatrics directs traineeships, stipulates requirements and outlines the scope of the discipline.

We suggest six actions to facilitate progress:

1. Approval of CPCH as a subspecialty

2. Advocacy for CPCH and community paediatricians to create a demand at medical schools and among users in the community

3. Establishment of a pool of CPCH experts at medical schools to facilitate training in community paediatrics

4. A compulsory rotation in CPCH for all undergraduate medical students

5. Development of accredited training sites and posts for paediatricians wanting to subspecialise in CPCH

6. Revision of the paediatric registrar rotation to include a compulsory 6-month regional hospital or similar CPCH rotation.

The examples set by the University of the Witwatersrand (Community Paediatrics Division) and the University of Cape Town (School of Child and Adolescent Health, Postgraduate Diploma in Community and General Paediatrics) should inspire the launch of similar programmes in other medical schools.

Unless community paediatric training is rapidly expanded and resourced, our current health policies will remain mere statements.

Where is the block, and can we be proactive?

Ameena E Goga
Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa, and Department of Paediatrics, School of Medicine, Faculty of Health Sciences, University of Pretoria, South Africa. ameena.goga@mrc.ac.za

Ute Feucht
Department of Paediatrics, School of Medicine, Faculty of Health Sciences, University of Pretoria, South Africa, and Tshwane District Clinical Specialist Team, Gauteng Department of Health, Johannesburg, South Africa

Michael Hendricks
Anthony Westwood
School of Child and Adolescent Health, Faculty of Health Sciences, University of Cape Town, South Africa

Haroon Saloojee
Division of Community Paediatrics, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

George Swingler
School of Child and Adolescent Health, Faculty of Health Sciences, University of Cape Town, South Africa

Neil McKerrow
Department of Paediatrics and Child Health, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa, and Department of Health, KwaZulu-Natal

David Sanders
School of Child and Adolescent Health, Faculty of Health Sciences, University of Cape Town, South Africa, and School of Public Health, University of the Western Cape, Bellville, Cape Town

References

1. Power DJ, Heese HdeV The role of community paediatrics in South Africa. S Afr Med J 1978;53(3):408-410        [ Links ]

2. Swingler G, Hendricks M, Hall D, et al. Can a new paediatric sub-specialty improve child health in South Africa? S Afr Med J 2012;102(9):738-739. [http://dx.doi.org/10.7196/SAMJ.5714]        [ Links ]

3. Mayosi BM. Benatar SR. Health and health care in South Africa - 20 years after Mandela. N Engl J Med 2014;371(14):1344-1353. [http://dx.doi.org/10.1056/NEJMsr1405012]        [ Links ]

4. District Clinical Specialist Teams in South Africa: Ministerial Task Team Report to the Honourable Minister of Health, Dr Aaron Motsoaledi. http://www.rmchsa.org/wp-content/resources/resources_by_type/DistrictLevelResources/MinisterialTTReport _DCSTInSouthAfrica.pdf (accessed 20 February 2015).         [ Links ]

5. Council on Community Pediatrics. Community pediatrics: Navigating the intersection of medicine, public health, and social determinants of children's health. Pediatrics 2013:131(3):623-628. [http://dx.doi.org/10.1542/peds.2012-3933]        [ Links ]

6. Sanders L, Robinson T, Forster L, Plax K, Brosco J, Brito A. Evidence-based community pediatrics: Building a bridge from bedside to neighbourhood. Pediatrics 2005;115(4):1142-1147. [http://dx.doi.org/10.1542/peds.2004-2825H]        [ Links ]

7. British Association for Community Child Health. Community child health and the future: A BACCH discussion paper. February 2005. http://www.bacch.org.uk/downloads/briefing_papers/community_child_health_future.pdf (accessed 9 February 2015).         [ Links ]