{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T12:53:07Z","timestamp":1792414387187,"version":"4.4.0"},"reference-count":62,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2024,8,2]],"date-time":"2024-08-02T00:00:00Z","timestamp":1722556800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,10,15]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>The role of the emergency medical service (EMS) is changing globally as ambulance crews respond to a shifting burden of disease, as well as societal stressors such as violence and inequality. New ways of thinking about how to provide emergency care are required to shift EMS from a role primarily focused on clinical care and transporting patients to hospital. In this paper, we present the experience of the Philippi Project (PP), an innovative community-based model of care developed by front line ambulance crews in a low-income neighbourhood in Cape Town, South Africa. Our insights were developed through observational, interview and document review work, within an overall embedded research approach. Our analysis draws on the everyday health systems resilience (EHSR) framework, which sees resilience as an emergent process that may be stimulated through response to stress and shock. Responses take the form of absorptive, adaptive or transformative strategies and are underpinned by system capacities (cognitive, behavioural and contextual). We consider the PP as a potentially transformative resilience strategy, defined as a new way of working that offered the promise of long-term health system gains. We found that the PP\u2019s initial development was supported by a range of system capacity attributes (such as the intentional development of relationships, a sense of collective purpose and creating spaces for constructive sense-making). However, the PP was hard to sustain over time because emergent ways of working were undermined both by other capacity attributes rooted in pre-existing organizational routines and two contextual shocks (Coronavirus and a violent incident). The paper adds a new empirical contribution to the still-small EHSR literature. In addition, the PP experience offers globally relevant lessons for developing community-based models of EMS care. It demonstrates that front line staff can develop creative solutions to their stressful daily realities, but only if space is created and protected.<\/jats:p>","DOI":"10.1093\/heapol\/czae070","type":"journal-article","created":{"date-parts":[[2024,8,2]],"date-time":"2024-08-02T09:28:30Z","timestamp":1722590910000},"page":"956-969","source":"Crossref","is-referenced-by-count":6,"title":["A community-based ambulance model: lessons for emergency medical services and everyday health systems resilience from South Africa"],"prefix":"10.1093","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9571-2817","authenticated-orcid":false,"given":"Leanne","family":"Brady","sequence":"first","affiliation":[{"name":"Health Policy and Systems Division, School of Public Health, University of Cape Town , Cape Town 7700,","place":["South Africa"]},{"name":"Western Cape Department of Health and Wellness , Cape Town 8000,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2775-7703","authenticated-orcid":false,"given":"Lucy","family":"Gilson","sequence":"additional","affiliation":[{"name":"Health Policy and Systems Division, School of Public Health, University of Cape Town , Cape Town 7700,","place":["South Africa"]},{"name":"Department of Global Health and Development, London School of Hygiene and Tropical Medicine , London WC1E 7HT,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5968-1424","authenticated-orcid":false,"given":"Asha","family":"George","sequence":"additional","affiliation":[{"name":"School of Public Health, University of the Western Cape , Cape Town 7460,","place":["South Africa"]},{"name":"South African Medical Research Council , Cape Town 7505,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaheem De","family":"Vries","sequence":"additional","affiliation":[{"name":"Western Cape Department of Health and Wellness , Cape Town 8000,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shakira","family":"Hartley","sequence":"additional","affiliation":[{"name":"Western Cape Department of Health and Wellness , Cape Town 8000,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,8,2]]},"reference":[{"key":"2025040409564015500_R1","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1136\/jech-2021-217480","article-title":"Health trends, inequalities and opportunities in South Africa\u2019s provinces, 1990\u20132019: findings from the Global Burden of Disease 2019 Study","volume":"76","author":"Achoki","year":"2022","journal-title":"Journal of Epidemiology and Community Health"},{"key":"2025040409564015500_R2","article-title":"Soil and land in the Philippi horticultural area","volume-title":"New Frame","author":"Adams","year":"2020"},{"key":"2025040409564015500_R3","doi-asserted-by":"crossref","first-page":"i35","DOI":"10.1093\/heapol\/czs005","article-title":"Paying for and receiving benefits from health services in South Africa: is the health system equitable?","volume":"27","author":"Ataguba","year":"2012","journal-title":"Health Policy and Planning"},{"key":"2025040409564015500_R4","first-page":"896","article-title":"Setting the scene for the paramedics in primary care: a review of the literature","volume":"22","author":"Ball","year":"2005","journal-title":"Emergency Medicine"},{"key":"2025040409564015500_R5","doi-asserted-by":"crossref","DOI":"10.15171\/ijhpm.2018.06","article-title":"What is resilience and how can it be nurtured? 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