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Title:Foundations Without a House? Why We Learn the 'What' of PHC Long Before the 'How'

Introduction: A Curriculum of Two Halves

“Knowing is not enough; we must apply. Willing is not enough; we must do"(Goethe, as cited in Eliot, 1870, p. 78).

In my third week of fourth year, I sat in a community theory lecture and finally learned about community development models, asset-based approaches, and participatory rural appraisal. I scribbled notes furiously, but a nagging feeling interrupted my focus: Why am I learning this now?

We have been going into communities since first year. We learned the role of Occupational Therapy (OT) in Primary Health Care (PHC) back in Fundamentals (second year) (UKZN Discipline of Occupational Therapy, 2025). But the theories of how to actually work with communities, not just in them arrived four years later. This blog reflects on the pros and cons of UKZN's OT curriculum in preparing students for community and PHC practice. It is a reflection of gratitude, frustration, and hope.

Personal & Professional Growth: The Disruption

Let me be honest. When I was in first year, standing in a community clinic under the guidance of fourth years, I felt competent. We ran a craft group for mothers. We did a fine motor screening at a crèche. I checked boxes.

But now, looking back, I realise I did not know how to do a community needs assessment. I did not understand power dynamics between us (university students) and community members. According to Freire (1970), without critical reflection, community engagement risks becoming a "banking" model where professionals deposit knowledge rather than co-create it.

The disruption came in fourth year when the question asked: “Did you build on community assets or just deliver your own programme?” I had no answer. That question exposed the gap between knowing OT's PHC role (learned in Fundamentals) and knowing how to practise it without a manual.

Curriculum Pros: The Good Bones

UKZN's Bachelor of Occupational Therapy curriculum has genuine strengths for community preparation (UKZN School of Health Sciences, 2025):

1. Early community exposure: From Level 1, students are in real contexts weekly. Research suggests that early fieldwork experiences reduce anxiety and increase professional self-efficacy (Dancza et al., 2017).

2. Foundational PHC knowledge early: In Level 2 Fundamentals, we were taught the role of OT in PHC, prevention, promotion, and rehabilitation (UKZN Discipline of Occupational Therapy, 2025). I remember writing an assignment on the Ottawa Charter (WHO, 1986). So, what came early.

3. Longitudinal fieldwork: By Level 4, students complete a full community block. Extended immersion in under-resourced settings has been shown to better prepare graduates for community service in South Africa (Ned et al., 2020).

4. Decentralised placements: Many of us work in rural clinics, townships, and schools. This mirrors the reality of PHC, where occupational therapists must practise with limited resources (Watson, 2020).

These are real strengths, and I do not dismiss them.

Curriculum Cons: The Missing Scaffolding

However, the curriculum has a structural flaw: theory-practice mismatch. While learning the roleof OT in PHC early is valuable, role knowledge without methodological tools is insufficient (Kronenberg et al., 2011).

| What we learned | When | Gap |

Role of OT in PHC (Fundamentals) - Level 2 -No practice tools to implement it

Community theories (community block) - Level 4 -Students practised for 3 years without them

What happens? Students default to activity-based OT such as groups, crafts, screenings because that is what is observed and modelled. We do not learn community organising, participatory methods, inter-sectoral collaboration, or programme evaluation until near graduation.

Research confirms this challenge. Galvaan and Peters (2019) argue that many South African OT curricula prioritise individual clinical reasoning over collective, community-centred approaches. Similarly, Morville and Erlandsson (2013) found that without explicit teaching of community participation frameworks, students revert to individual rehabilitation models even in PHC settings.

 Reflection: What Do We Value?

This reveals a hidden value in the curriculum. If community theories are placed in final year, what message is sent? That community practice is an advanced skill, not a foundational one? Yet PHC is South Africa's reality. The National Department of Health (2018) explicitly positions occupational therapists as key PHC providers.

Kronenberg et al. (2011) argue that occupational therapy education must embrace a "political" and "socially responsive" orientation, not just a clinical one. By delaying community theory, curricula risk producing graduates who are technically skilled but critically unreflective about community power dynamics.

I am not asking for perfection. But imagine if in Year 2, after learning the role, we learned one tool: community/asset mapping (Kretzmann & McKnight, 1993). Then in Year 3, participatory learning and action (Chambers, 2010). By Year 4, we would be ready.

Lessons Learnt (So Far)

Personally: I have learned to be an active learner. I now read community OT literature independently (Kronenberg et al., 2011; Watson, 2020). I cannot wait for the curriculum to fill every gap.

Professionally: I will enter community service knowing that theory matters. I will not just do groups. I will ask: Whose agenda? Whose participation? (Freire, 1970).

Call to Action / Way Forward

To curriculum designers: Please consider integrating one community practice theory or tool per year from Level 1–3. Dancza et al. (2017) recommend scaffolding community competencies across a programme rather than concentrating them in a final block.

To students: Do not confuse early exposure with complete preparation. Read, question, and reflect.

To myself: Carry the question forward: How do I move from doing OT in a community to doing OT with a community?(Galvaan & Peters, 2019).

Conclusion: A Thought-Provoking Question

We learned the heart of PHC early, the role and the values. But we learned the hands and head, the theories and methodslate. Is it any wonder that many of us graduate feeling like we know why community OT matters but not how to do it well (Ned et al., 2020)?

References

Chambers, R. (2010). Revolutionising development: Reflections on the work of Robert Chambers. Practical Action Publishing.

Dancza, K., Warren, A., Copley, J., Rodger, S., Moran, M., McKay, E., & Taylor, A. (2017). Learning experiences on role-emerging placements: An exploration from the students' perspective. Australian Occupational Therapy Journal, 64(3), 217–225. https://doi.org/10.1111/1440-1630.12337

Eliot, G. (1870). The legend of Jubal and other poems. Smith, Elder & Co.

Freire, P. (1970). Pedagogy of the oppressed. Continuum.

Galvaan, R., & Peters, L. (2019). Occupational therapy curricula and socially responsive practice in South Africa. In F. Kronenberg, N. Pollard, & D. Sakellariou (Eds.), Occupational therapies without borders (2nd ed., pp. 487–498). Elsevier.

Kretzmann, J. P., & McKnight, J. L. (1993). Building communities from the inside out: A path toward finding and mobilizing a community's assets*. ACTA Publications.

Kronenberg, F., Pollard, N., & Sakellariou, D. (2011). Occupational therapies without borders – Volume 2: Towards an ecology of occupation-based practices. Churchill Livingstone.

Morville, A., & Erlandsson, L. K. (2013). The experience of occupational therapists in community-based practice. Scandinavian Journal of Occupational Therapy, 20(6), 423–432. https://doi.org/10.3109/11038128.2013.830773

National Department of Health, South Africa. (2018). Primary Health Care re-engineering framework. Government Printing Works.

Ned, L., Tiwari, R., Botes, M., & van Rensburg, E. J. (2020). Community-based education in South African health sciences curricula: A review of the literature. African Journal of Health Professions Education,12(1), 34–39. https://doi.org/10.7196/AJHPE.2020.v12i1.1168

UKZN Discipline of Occupational Therapy. (2025). Undergraduate programmes. University of KwaZulu-Natal. https://ot.ukzn.ac.za/undergraduate-programmes/

UKZN School of Health Sciences. (2025). Bachelor of Occupational Therapy degree. University of KwaZulu-Natal. https://health-sciences.ukzn.ac.za/degrees/b-occupational-therapy/

Watson, R. (2020). Community-based occupational therapy: A South African practice guide. Juta.

World Health Organization. (1986). Ottawa Charter for Health Promotion. WHO.

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“Holding the Future in Our Hands: Reflections on Maternal and Child Health in the Community”

“How we care for our mothers and children today shapes the kind of society we will live in tomorrow” (World Health Organization [WHO], 2020).

Introduction

As an occupational therapy student entering community-based learning, I am beginning to realise that health is not merely the absence of illness, but the presence of opportunity, participation, and dignity. During my first week of engagement with readings on maternal and child health (MCH), I was challenged to rethink how early life experiences shape individual and societal outcomes. Maternal and child health extends beyond medical indicators and reflects broader social, economic, and political realities (Marmot et al., 2008). This blog explores why maternal and child health is crucial to society and analyses its implications for occupational therapy practice, particularly at a community level within the South African context.

The Importance of Maternal and Child Health to Society

Maternal and child health is widely recognised as a cornerstone of sustainable development and social wellbeing (United Nations Children’s Fund [UNICEF], 2019). The health of mothers directly influences pregnancy outcomes, infant survival, attachment, and early childhood development, while child health affects educational attainment, employment prospects, and long-term productivity (Black et al., 2017). These outcomes demonstrate that maternal and child health is not only a healthcare issue but a societal investment.

In South Africa, maternal and child health is closely linked to structural challenges such as poverty, food insecurity, gender inequality, and unequal access to healthcare services (Department of Health [DoH], 2021). Many women experience barriers such as long travel distances to clinics, limited antenatal care, and high psychosocial stress, all of which negatively affect occupational performance and wellbeing (Petersen et al., 2012). Reflecting on this has highlighted for me that health outcomes are often shaped more by context than choice, prompting a shift away from individual blame toward systemic understanding.

Academic Reflections: Occupational Therapy, Occupation, and Development

From an academic point, maternal and child health aligns strongly with occupational therapy’s focus on meaningful occupation, participation, and function (Wilcock & Hocking, 2015). Motherhood itself can be understood as a complex occupation, encompassing caregiving, emotional labour, decision‑making, and role balancing. When mothers experience physical illness, mental health challenges, or reduced social support, their ability to engage in daily occupations may be compromised, affecting both mother and child (Whiteford & Townsend, 2011).

Similarly, childhood development is deeply occupation‑based. Play, social interaction, and exploration are essential occupations that support cognitive, motor, and socio‑emotional development (Case-Smith et al., 2014). In under-resourced communities, limited access to safe play spaces, educational toys, and early childhood programmes can restrict children’s occupational engagement, increasing the risk of developmental delays. This understanding has deepened my appreciation of occupational therapy’s preventative role within maternal and child health.

Implications for Occupational Therapy at a Community Level

This week’s learning has reshaped my understanding of occupational therapy practice beyond institutional settings. Community-based occupational therapy focuses not only on individuals, but on families, environments, and systems (Galvaan & Peters, 2018). Within maternal and child health, occupational therapists can support caregivers through health education, routine building, stress regulation, and promotion of responsive caregiving practices.

At a community level, occupational therapists are well positioned to:

Promote early childhood development through play-based and culturally relevant interventions

Support maternal mental health by facilitating coping strategies within daily routines

Advocate for accessible services and inclusive environments

Collaborate with community health workers, NGOs, and primary healthcare teams

This aligns with South Africa’s primary healthcare and re‑engineering framework, which emphasises prevention, health promotion, and community empowerment (DoH, 2018). Through this lens, occupational therapy becomes a tool for strengthening resilience and participation rather than merely addressing dysfunction.

Political and Personal Reflections: Developing a Critical Lens

Engaging with maternal and child health has revealed its deeply political nature. Women, particularly those in marginalised communities, often carry the burden of caregiving within systems that offer limited support or recognition (Kruk et al., 2018). This imbalance reflects broader power relations within healthcare, society, and policymaking.

As a student, I am beginning to find my voice within these realities. I now recognise that occupational therapy is inherently political because it engages with issues of access, equity, and occupational justice (Townsend & Wilcock, 2004). Remaining silent or neutral perpetuates inequality. This week marked a personal disruption: a shift from viewing occupational therapy as neutral clinical work to understanding it as socially responsive and ethically driven practice.

On a personal level, this learning has prompted me to reflect on my own values, assumptions, and positionally. I am learning to listen more attentively and to practice reflexivity, recognising how my background shapes how I interpret health, motherhood, and success.

Conclusion: Caring for the Present, Shaping the Future

Maternal and child health is not solely about reducing mortality statistics; it is about expanding possibilities for participation, growth, and wellbeing. For occupational therapists, supporting maternal and child health means advocating for environments that enable meaningful occupation from the earliest stages of life.

As I move forward in my community-based learning, I carry with me a renewed sense of responsibility and purpose. If occupational therapy is committed to enabling participation and promoting justice, then engaging with maternal and child health is not optional, it is fundamental. The question that remains for me is: How can occupational therapy continue to challenge systems that limit mothers’ and children’s opportunities to live meaningful lives?

References (APA 7th Edition)

Black, R. E., Taylor, L., Arole, S., Bang, A., Bhutta, Z. A., Chowdhury, A. M. R., … Victora, C. G. (2017). Comprehensive review of maternal, newborn, and child health interventions. The Lancet, 389(10064), 77–90. https://doi.org/10.1016/S0140-6736(16)31593-8

Case-Smith, J., O’Brien, J. C., & Duff, S. (2014). Occupational therapy for children and adolescents (7th ed.). Elsevier.

Department of Health. (2018). Re-engineering primary health care in South Africa. Pretoria: Government Printer.

Department of Health. (2021). Guidelines for maternal, neonatal, child and women’s health. Pretoria: Government of South Africa.

Galvaan, R., & Peters, L. (2018). The intersection of disability, participation, and community practice. South African Journal of Occupational Therapy, 48(1), 1–6.

Kruk, M. E., Gage, A. D., Arsenault, C., Jordan, K., Leslie, H. H., Roder-DeWan, S., … Pate, M. (2018). High-quality health systems in the Sustainable Development Goals era. The Lancet Global Health, 6(11), e1196–e1252.

Marmot, M., Friel, S., Bell, R., Houweling, T., & Taylor, S. (2008). Closing the gap in a generation: Health equity through action on the social determinants of health. The Lancet, 372(9650), 1661–1669.

Petersen, I., Lund, C., Stein, D. J., & Seedat, S. (2012). Mental health and poverty in South Africa. International Review of Psychiatry, 24(6), 513–528.

Townsend, E., & Wilcock, A. (2004). Occupational justice and client-centred practice. Canadian Journal of Occupational Therapy, 71(2), 75–87.

UNICEF. (2019). Maternal and child health: Programming guidance. New York: UNICEF.

Wilcock, A. A., & Hocking, C. (2015). An occupational perspective of health (3rd ed.). SLACK Incorporated.

World Health Organization. (2020). Maternal, newborn, child and adolescent health. https://www.who.int