Since its creation in January 2003, the Directorate has worked closely with the PGWC, Cape Town Unicity Health authorities and civil society groups in the Western Cape to identify communities for designation as PHC focus areas. These communities are selected on the basis of need (major health problems and poor services) and potential for the adaptation or development of suitable facilities for teaching and learning. The sub districts of Langa, Bonteheuwel, Khayelitsha, Hanover Park, Mitchell’s Plain and Retreat, as well as the rural district of Vredenburg, were selected in 2005 and new sites since then have been proposed for integration into the teaching platform. However this progress was been delayed by the processes leading to the Multi-Lateral Agreement, which was eventually signed in 2012.

Successful PHC planning, implementation and monitoring require reliable information on the baseline health status of the local population and the current state of the existing health care delivery system. Comprehensive situation analyses have been conducted in Vanguard and Vredenburg to provide information on the health status and health needs of the population; the health research efforts that were underway, the gaps in available information on health status and/or health needs, and key socio-economic determinants of health. The findings were discussed with community representatives and local health authorities with a view to prioritizing the development of appropriate interventions to address health and social problems in the area.

Prof Reid has been responsible for assisting the Faculty with interrogating the needs and development of the clinical teaching platform, together with Frank Molteno.

The above diagram illustrates the current platform (at the top of the diagram) and the planned expansion (at the bottom of the diagram). The implementation of this has been delayed by the Multi-Lateral Agreement (MLA) process with the Provincial Government Department of Health.

The following key questions were raised in 2013 and continue to be grappled with:

• What is the right balance in teaching capacity at different levels of care?
• What teaching & learning activities are currently happening at each level/site?
• What should the size and shape of teaching at the level/site ideally be?
• What are the next steps to facilitate the establishment? Of the ideal learning site, and how could this be funded and sustained?
• Does the clinical teaching platform at community, district, secondary and tertiary level need to expand, stay the same, or decrease?
• If it does need to change, in which departments and by how much?

A number of iterations of a business plan have been put forward for the development of a campus in the George "complex" in the Eden district which includes Mossel Bay, Knysna, Oudtshoorn and Beaufort-West district hospitals. These include the placement of final year medical students in a longitudinal integrated curriculum for the whole year in the complex, which requires changes to the MBChB curriculum in order for the experience to be equivalent to that offered in Cape Town. The components of the plan are illustrated in the diagram below.