Re-organising primary health care to respond to the Coronavirus epidemic in Cape Town, South Africa

CITATION:Mash, Robert & Goliath, Charlyn & Perez, Gio. (2020). Re-organising primary health care to respond to the Coronavirus epidemic in Cape Town, South Africa. African Journal of Primary Health Care & Family Medicine. 12. 10.4102/phcfm.v12i1.2607The original publication is available at http://www.phcfm.orgCape Town is currently one of the hotspots for COVID-19 on the African continent. The Metropolitan Health Services have re-organised their primary health care (PHC) services to tackle the epidemic with a community-orientated primary care perspective. Two key goals have guided the re-organisation, the need to maintain social distancing and reduce risk to people using the services and the need to prepare for an influx of people with COVID-19. Facilities were re-organised to have 'screening and streaming' at the entrance and patients were separated into hot and cold streams. Both streams had 'see and treat' stations for the rapid treatment of minor ailments. Patients in separate streams were then managed further. If patients with chronic conditions were stable, they were provided with home delivery of medication by community health workers. Community health workers also engaged in community-based screening and testing. Initial evaluation of PHC preparedness was generally good. However, a number of key issues were identified. Additional infrastructure was required in some facilities to keep the streams separate with the onset of winter. Managers had to actively address the anxiety and fears of the primary care workforce. Attention also needed to be given to the prevention and treatment of non-COVID conditions as utilisation of these services decreased. The epidemic exposed intersectoral and intrasectoral fault lines, particularly access to social services at a time when they were most needed. Community screening and testing had to be refocused due to limited laboratory capacity and a lengthening turnaround time

The challenges of reshaping disease specific and care oriented community based services towards comprehensive goals: a situation appraisal in the Western Cape Province, South Africa

Similar to other countries in the region, South Africa is currently reorienting a loosely structured and highly diverse community care system that evolved around HIV and TB, into a formalized, comprehensive and integrated primary health care outreach programme, based on community health workers (CHWs). While the difficulties of establishing national CHW programmes are well described, the reshaping of disease specific and care oriented community services, based outside the formal health system, poses particular challenges. This paper is an in-depth case study of the challenges of implementing reforms to community based services (CBS) in one province of South Africa. A multi-method situation appraisal of CBS in the Western Cape Province was conducted over eight months in close collaboration with provincial stakeholders. The appraisal mapped the roles and service delivery, human resource, financing and governance arrangements of an extensive non-governmental organisation (NGO) contracted and CHW based service delivery infrastructure that emerged over 15–20 years in this province. It also gathered the perspectives of a wide range of actors – including communities, users, NGOs, PHC providers and managers - on the current state and future visions of CBS. While there was wide support for new approaches to CBS, there are a number of challenges to achieving this. Although largely government funded, the community based delivery platform remains marginal to the formal public primary health care (PHC) and district health systems. CHW roles evolved from a system of home based care and are limited in scope. There is a high turnover of cadres, and support systems (supervision, monitoring, financing, training), coordination between CHWs, NGOs and PHC facilities, and sub-district capacity for planning and management of CBS are all poorly developed. Reorienting community based services that have their origins in care responses to HIV and TB presents an inter-related set of resource mobilisation, system design and governance challenges. These include not only formalising community based teams themselves, but also the forging of new roles, relationships and mind-sets within the primary health care system, and creating greater capacity for contracting and engaging a plural set of actors - government, NGO and community - at district and sub-district level.Web of Scienc

Home delivery of medication during Coronavirus disease 2019, Cape Town, South Africa

Brey Z, Mash R, Goliath C,Roman D. Home delivery of medication during Coronavirus disease 2019,Cape Town, South Africa:Short report. Afr J Prm Health Care Fam Med. 2020;12(1),a2449. https://doi.org/ 10.4102/phcfm.v12i1.2449he public sector primary care facilities in Cape Town serve a large number of patients with chronic diseases such as human immunodeficiency virus, tuberculosis, diabetes, hypertension, asthma and chronic obstructive pulmonary disease. Prior to the Coronavirus disease 2019 (COVID-19) epidemic, stable patients with chronic conditions attended the facility or support groups to obtain their medication. During the COVID-19 epidemic, these patients would be put at risk if they had to travel and gather in groups to receive medication. The Metropolitan Health Services, therefore, decided to offer home delivery of medication. A system of home delivery was rapidly established by linking the existing chronic dispensing unit system with the emerging approach to community-orientated primary care in the Metro. Medication was delivered as usual to primary care pharmacies, but then a variety of means were used to disseminate the parcels to local non-profit organisations, where they could be delivered by a city-wide network of community health workers (CHWs). Innovations included various ways of delivering the parcels, including via Uber, bicycles and electric scooters, as well as Google forms to monitor the success of the initiative. It was estimated that up to 200 000 parcels per month could be delivered in this way via 2500 CHWs. The new system was established throughout the Metropole, and its strengths, weaknesses, opportunities and threats are further discussed. The initiative may prevent COVID-19 amongst people with comorbidities who would be at risk of more severe diseases. It may also have de-congested primary care facilities ahead of the expected surge in COVID-19 cases

A framework for implementation of community-orientated primary care in the Metro Health Services, Cape Town, South Africa

CITATION: Mash, R. et al. 2020. A framework for implementation of community-orientated primary care in the Metro Health Services, Cape Town, South Africa. African Journal of Primary Health Care & Family Medicine, 12(1):a2632, doi:10.4102/phcfm.v12i1.2632.The original publication is available at https://phcfm.orgIn South Africa, the national policy on re-engineering primary health care (PHC) supports the implementation of ward-based outreach teams with community health workers. In the Western Cape, a community-orientated primary care (COPC) approach has been adopted in provincial goals for 2030 and the key strategies for the improvement of district health services. This approach is expected to improve health and also save costs. A task team was established in the Metropolitan Health Services to develop an implementation framework for COPC. The framework was developed in an iterative process with four learning sites in the metropole over a period of 18 months. The framework consists of 10 inter-related elements: geographic delineation of PHC teams, composition of PHC teams, facility-based and community-based teamwork, partnership of government and non-government organisations, scope of practice, information system, community engagement, stakeholder engagement, training and development of PHC teams, system preparation and change management. This framework was implemented at the four learning sites and is now being taken to scale and further assessed in the metropole.Publisher's versio

Understanding the current discourse of rehabilitation: With reference to disability models and rehabilitation policies for evaluation research in the South African setting

Evaluation of rehabilitation programmes is essential in order to monitor its effectiveness and relevance. There is however a need to consider policies when conducting evaluation research in rehabilitation. The aim of this paper is to present the theoretical and legislative underpinnings of rehabilitation in South Africa. A narrative review of national and international disability legislation and empirical research in context of rehabilitation was conducted. The findings of this review reveals that as a fluid construct, the discourse of rehabilitation has been underpinned by the changing theoretical and socio-political understandings of disability. This in turn has influenced various international and national health and disability policies and legislations that oversee the implementation of rehabilitation practice. Despite this, there has been little evaluation of public health rehabilitation services in context of these policies and legislations in South Africa. The fluidity of rehabilitation need to be considered when conducting evaluation research in rehabilitation.Department of HE and Training approved lis

The acceptability of three vaccine injections given to infants during a single clinic visit in South Africa

BACKGROUND: The Expanded Programme on Immunisation (EPI) has increased the number of antigens and injections administered at one visit. There are concerns that more injections at a single immunisation visit could decrease vaccination coverage. We assessed the acceptability and acceptance of three vaccine injections at a single immunisation visit by caregivers and vaccinators in South Africa. METHODS: A mixed methods exploratory study of caregivers and vaccinators at clinics in two provinces of South Africa was conducted. Quantitative and qualitative data were collected using questionnaires as well as observations of the administration of three-injection vaccination sessions. RESULTS: The sample comprised 229 caregivers and 98 vaccinators. Caregivers were satisfied with the vaccinators’ care (97 %) and their infants receiving immunisation injections (93 %). However, many caregivers, (86 %) also felt that three or more injections were excessive at one visit. Caregivers had limited knowledge of actual vaccines provided, and reasons for three injections. Although vaccinators recognised the importance of informing caregivers about vaccination, they only did this sometimes. Overall, acceptance of three injections was high, with 97 % of caregivers expressing willingness to bring their infant for three injections again in future visits despite concerns about the pain and discomfort that the infant experienced. Many (55 %) vaccinators expressed concern about giving three injections in one immunisation visit. However, in 122 (95 %) observed three-injection vaccination sessions, the vaccinators administered all required vaccinations for that visit. The remaining seven vaccinations were not completed because of vaccine stock-outs. CONCLUSIONS: We found high acceptance by caregivers and vaccinators of three injections. Caregivers’ poor understanding of reasons for three injections resulted from limited information sharing by vaccinators for caregivers. Acceptability of three injections may be improved through enhanced vaccinator-caregiver communication, and improved management of infants’ pain. Vaccinator training should include evidence-informed ways of communicating with caregivers and reducing injection pain. Strategies to improve acceptance and acceptability of three injections should be rigorously evaluated as part of EPI’s expansion in resource-limited countries.IS

Pre- and post-test results of the cognitive functioning level of workers with intellectual impairment after the implementation of a structured activity programme in a protective workshop

Thesis (MA)--Stellenbosch University, 2005.ENGLISH ABSTRACT: Acknowledgement of the right to equal work opportunities for people with disabilities is widely supported in South Africa. Several policy documents and laws have been published since July 1993 and provide clear guidelines regarding equal opportunities for people with disabilities. A state subsidy scheme for protective workshops was introduced for the first time on 1 April 1997 (Operational Manual for Protective Workshops, 2001: 1). The purpose of this subsidy scheme was to provide work opportunities for people who cannot enter the sheltered or open labour market due to the effect of their disabilities on their daily functioning. In March 2001, the Department of Social Development and Poverty Alleviation in the Western Cape introduced a draft document, Operational Manual for Protective Workshops. The aim of the manual focused on the development of the worker role and economic empowerment of people with disabilities who work in protective workshops. Due to ignorance, fear and stereotyping, persons with intellectual impairment are being unfairly discriminated against in society and at the workplace. With reasonable accommodation, persons with intellectual impairment are able to demonstrate their work ability and contribute equally in the workplace. Persons with intellectual impairment contribute to the economy and society by means of their service in protective workshops. The aim of the study was to investigate whether the structured activity programme implemented in a protective workshop in the Western Cape brought a change to the level of cognitive functioning of workers with intellectual impairment as assessed by the Allen Cognitive Level Screen (ACLS), with the purpose of making recommendations regarding the sustainability and extension of the structured activity programme. Pre- and post-tests of the workers' cognitive functioning were done to determine whether the implemented structured activity programme had an effect on the cognitive functioning level of the workers. The ACLS was used as measurement instrument and a hypothesis was stated: HO - There is no change in the level of cognitive functioning of the workers after participation in a structured activity programme. H1 - There is a change in the level of cognitive functioning of the workers after participation in a structured activity programme. The Functional Information Processing Model (FIPM) was used as a frame of reference in the development of the structured activity programme for the occupational group. The structured activity programme was implemented and after one year and six months a post-test was done on the workers in the occupational group. The null hypothesis was accepted as p=O.28.A 95% confidence interval was indicated. The post-test indicated that there was no significant change in the cognitive levels of the workers in the occupational group after implementation of a structured activity programme. This could have resulted from the study sample being too small. Although the change was not statistically significant. it indicated that learning did occur on an Allen Cognitive Level (ACL) 3. It is recommended that the study to be replicated at other protective workshops that may provide a bigger sample to confirm the amount of learning that takes place.AFRIKAANSE OPSOMMING: Erkenning van persone met gestremdhede se gelyke reg tot indiensneming word sterk in Suid-Afrika ondersteun. Verskeie beleidsdokumente en werkstukke is sedert Julie 1993 gepubliseer wat duidelike riglyne aangaande hierdie standpunt stel. 'n Staatsubsidieskema vir beskermde werkwinkels is vanaf 1 April 1997 vir die eerste keer beskikbaar gestel (Operational Manual for Protective Workshops, 2001: 1). Die doel van hierdie skema is om werksgeleenthede te verskaf aan persone wat as gevolg van hul graad van gestremdheid nie die beskutte arbeids- of ope arbeidsmark kan betree nie. In Maart 2001 het die Departement van Sosiale Dienste, Wes-Kaap, 'n voorlopige dokument, Operational Manual for Protective Workshops, bekendgestel, wat fokus op die ontwikkeling van werksvaardighede en die ekonomiese bemagtiging van persone met gestremdhede in beskermde werkwinkels. Weens onkunde, vrees en stereotipering word daar onregverdig gediskrimineer teen persone met intellektuele gestremdheid in die samelewing, asook in die werksplek. lndien persone met intellektuele gestremdheid billik geakkommodeer word, sal hulle hul werkvermoëns demonstreer en sal hulle 'n gelyke bydrae kan lewer in die werksplek. Persone met intellektuele gestremdheid lewer 'n bydrae tot die ekonomie en die samelewing deur hul diens in beskermde werkwinkels. Die doel van die studie was om ondersoek in te stelof die gestruktureerde aktiwiteitsprogram, soos aangebied in 'n beskermde werkswinkel in die Wes-Kaap, 'n verandering in die kognitiewe funksioneringsvlakke van werkers met intellektuele gestremdheid, soos bepaal deur die Allen Cognitive Level Screen (ACLS), teweeggebring het ten einde aanbevelings te maak oor die uitbreiding en volhoubaarheid van die program. Voor- en na-toetse van die werkers se kognitiewe funksioneringsvlakke is gedoen om te bepaal of die gestruktureerde aktiwiteitsprogram enige verskil in hul kognitiewe funksionering gemaak het. Die Allen Cognitive Level Screen- (ACLS-)toets is as 'n meetinstrument gebruik en 'n hipotese is gestel: HO - Daar is geen verandering in die werkers se kognitiewe funksioneringsvlak na deelname aan 'n gestruktureerde aktiwiteitsprogram nie. H1 - Daar is 'n verandering in die werkers se kognitiewe funksioneringsvlak na deelname aan 'n gestruktureerde aktiwiteitsprogram. Die Functional Information Processing Model (FIPM) is gebruik as 'n verwysingsraamwerk vir die ontwikkeling van die gestruktureerde aktiwiteitsprogram. Die gestruktureerde aktiwiteitsprogram is geïmplementeer en 'n na-toets is na 'n jaar en ses maande op die werkers in die gestruktureerde aktiwiteitsprogram gedoen. Die nulhipotese is aanvaar aangesien p=O.28. 'n Sekerheidsinterval van 95% is aangetoon. Die na-toets het getoon dat daar geen statisties beduidende verskil was in die verandering van die kognitiewe vlakke van die werkers in die aktiwiteitsgroep na implementering van 'n gestruktureerde aktiwiteitsprogram nie. Die resultaat kan die gevolg wees van 'n te klein steekproef. Alhoewel die verandering in kognitiewe vlak nie statisties beduidend was nie, het daar tog 'n mate van leer op 'n Allen Cognitive Level (ACL) 3 by die werkers plaasgevind. Dit word voorgestel dat hierdie studie herhaal word by ander beskermde werkswinkels wat 'n groter steekproef kan lewer om die mate van leer wat plaasvind, te bevestig

Validity of the Stellenbosch University on-road assessment

CITATION: Swanepoel, L., Classen, S. & Goliath, C. 2015. Validity of the Stellenbosch University on-road assessment. South African Journal of Occupational Therapy, 45(3):9-15, doi:10.17159/2310-3833/2015/v45n3/a3.The original publication is available at http://www.sajot.co.zaENGLISH SUMMARY : Background: Internationally, occupational therapists are the professional group called upon to assess fitness to drive. Fitness to drive is assessed through a comprehensive driving evaluation consisting of a clinical battery of tests and an on-road assessment. The on-road assessment is the criterion standard for assessing fitness to drive. Such an assessment has not yet been developed or validated in the South African context. Purpose: This study empirically quantified the face, content and construct validity of the Stellenbosch University on-road assessment. Methods: Firstly face validity was established using feedback from peer reviewers, secondly, content validity using the ratings of expert reviewers, and thirdly construct validity was established by assessing between group differences in young drivers who drove the road-course. Results: Peer review indicated acceptable face validity. Expert reviewers had an average rater agreement percentage of 94%, indicating favourable content validity. One (of two) on-road outcome measures, the Global Rating Score, discriminated between two groups of drivers, indicating construct validity. Conclusion: This study introduced the first empirical on-road assessment in the South African context. The findings provided foundational information for occupational therapists interested in assessing in-traffic fitness to drive abilities. Implications for practice, research and policy were discussed.http://www.sajot.co.za/index.php/sajot/article/view/327Publisher's versio

Experiences of patients and service providers with out-patient rehabilitation services in a rehabilitation centre in the Western Cape Province

CITATION: Kumurenzi, A., et al. 2015. Experiences of patients and service providers with out-patient rehabilitation services in a rehabilitation centre in the Western Cape Province. African Journal of Disability, 4(1):1-7, doi:10.4102/ajod.v4i1.164.The original publication is available at http://www.ajod.orgBackground: Rehabilitation is important for persons with disabilities as it contributes to their sense of autonomy, self-worth and social participation, and improves their quality of life. Improving the quality of rehabilitation services requires the dialogue of patients’ perceptions with those of service providers, in order to recommend informed reform. Objective: The objective was to explore the experiences of persons with physical disabilities and service providers, regarding the multi-disciplinary rehabilitation services provided at a community-based out-patient rehabilitation centre. Methods: A qualitative, exploratory study design was used to collect the data. A focus group was conducted with conveniently selected persons with physical disabilities. Three in-depth interviews were conducted with purposively selected key informants. All ethical considerations were adhered to during the implementation of the study. Results: Patients and service providers had different experiences regarding accessibility to rehabilitation services, and similar experiences with patient education and intensity of rehabilitation. Although the patients experienced that the service providers had sufficient knowledge and skills to manage them, services providers expressed that they lacked certain skills. Conclusions: The experiences expressed highlighted the need to improve rehabilitation services in terms of increasing the capacity of service providers and providing transport services for persons with disabilities.http://www.ajod.org/index.php/ajod/article/view/164Publisher's versionAuthors retain copyrigh

Additional file 1: of The challenges of reshaping disease specific and care oriented community based services towards comprehensive goals: a situation appraisal in the Western Cape Province, South Africa

Table S1. Overview of appraisal findings. (DOCX 98 kb