Assessing the level of readiness in Tshwane and Dr Kenneth Kaunda Districts for implementing a national patient based information system

Research Report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the Degree of Master of Public Health. March 2017.PURPOSE: The National Health Insurance programme has been identified as a priority to achieve Universal Health Coverage in South Africa. The development and implementation of a health information system (HIS) that is underpinned by a master population index (ability to uniquely identify a person), and operates on the electronic health records (EHR) model is critical for the implementation of the NHI. This study assesses the level of readiness in Tshwane and Dr Kenneth Kaunda districts for implementing a national patient based health information system. METHODS: This study design was a descriptive cross-sectional design. The study used a structured questionnaire to measure the level of readiness in two NHI districts, namely, Tshwane and Dr Kenneth Kaunda, for implementing a patient based National Health Information System in South Africa. RESULTS: The assessment has revealed that PHC facilities are at varying levels of readiness for implementing a national patient based information system. Tshwane scored better than Dr Kenneth Kaunda district on all four readiness criteria, with non-significant differences between them for core readiness, engagement readiness, and societal readiness and significantly higher levels in Tshwane for technological readiness. The readiness results varied across all four domains, ranging from 13% and 16% for core readiness to 59% and 68% for engagement readiness for Dr Kenneth Kaunda and Tshwane districts respectively. CONCLUSION: PHC facilities in Tshwane and Dr Kenneth Kaunda districts were capacitated with respect to ICT infrastructure. There were weaknesses with respect to business processes and IT support. The business process for the filing system needs to be defined, optimised and implemented in PHC facilities. The turnaround time for IT support was unacceptably high in both districts and needs to be improved prior to implementation of a patient based information system.LG201

Reducing initial loss to follow up among people with bacteriologically confirmed tuberculosis: LINKEDin, a quasi-experimental study in South Africa

Every person diagnosed with tuberculosis (TB) needs to initiate treatment. The WHO estimated 61% of people who developed TB in 2021 were included in a TB treatment registration system. Initial loss to follow up (ILTFU) is the loss of persons to care between diagnosis and treatment initiation/registration. LINKEDin, a quasi-experimental study, evaluated the effect of two interventions (hospital-recording and an alert-and-response patient management intervention) in six sub-districts across three high-TB burden provinces of South Africa. Using integrated electronic reports, we identified all persons diagnosed with TB (Xpert MTB/RIF positive) in hospital and at primary healthcare facilities. We prospectively determined linkage to care at 30 days after TB diagnosis. We calculated the risk of ILTFU during the baseline and intervention periods and the relative risk reduction in ILTFU between these periods. We found a relative reduction in ILTFU of 42.4% (95%CI:28.5,53.7) in KwaZulu Natal (KZN) and 22.3% (95%CI:13.3,30.4) in the Western Cape (WC) with no significant change in Gauteng. In KZN and the WC, the relative reduction in ILTFU appeared greater in sub-districts where the alert-and-response patient management intervention was implemented; KZN (49.3% (95%CI:32.4,62) vs 32.2% (95%CI:5.4,51.4)); and WC (34.2% (95%CI:20.9,45.3) vs 13.4% (95%CI:0.7,24.4)). We reported a notable reduction in ILTFU in two provinces using existing routine health service data and applying a simple intervention to trace and recall those not linked to care. TB programs need to consider ILTFU as a priority and develop interventions specific to their context to ensure improved linkage to care

COVID-19 : lessons and experiences from South Africa’s first surge

On 5 March 2020, South Africa recorded its first case of imported COVID-19. Since then, cases in South Africa have increased exponentially with significant community transmission. A multisectoral approach to containing and mitigating the spread of SARS-CoV-2 was instituted, led by the South African National Department of Health. A National COVID-19 Command Council was established to take government-wide decisions. An adapted World Health Organiszion (WHO) COVID-19 strategy for containing and mitigating the spread of the virus was implemented by the National Department of Health. The strategy included the creation of national and provincial incident management teams (IMTs), which comprised of a variety of work streams, namely, governance and leadership; medical supplies; port and environmental health; epidemiology and response; facility readiness and case management; emergency medical services; information systems; risk communication and community engagement; occupational health and safety and human resources. The following were the most salient lessons learnt between March and September 2020: strengthened command and control were achieved through both centralised and decentralised IMTs; swift evidenced-based decision-making from the highest political levels for instituting lockdowns to buy time to prepare the health system; the stringent lockdown enabled the health sector to increase its healthcare capacity. Despite these successes, the stringent lockdown measures resulted in economic hardship particularly for the most vulnerable sections of the population.http://gh.bmj.compm2021Paediatrics and Child Healt

Developing and implementing national health identifiers in resource limited countries: why, what, who, when and how?

Many resource-limited countries are scaling up health services and health-information systems (HISs). The HIV Cascade framework aims to link treatment services and programs to improve outcomes and impact. It has been adapted to HIV prevention services, other infectious and non-communicable diseases, and programs for specific populations. Where successful, it links the use of health services by individuals across different disease categories, time and space. This allows for the development of longitudinal health records for individuals and de-identified individual level information is used to monitor and evaluate the use, cost, outcome and impact of health services. Contemporary digital technology enables countries to develop and implement integrated HIS to support person centred services, a major aim of the Sustainable Development Goals. The key to link the diverse sources of information together is a national health identifier (NHID). In a country with robust civil protections, this should be given at birth, be unique to the individual, linked to vital registration services and recorded every time that an individual uses health services anywhere in the country: it is more than just a number as it is part of a wider system. Many countries would benefit from practical guidance on developing and implementing NHIDs. Organizations such as ASTM and ISO, describe the technical requirements for the NHID system, but few countries have received little practical guidance. A WHO/UNAIDS stake-holders workshop was held in Geneva, Switzerland in July 2016, to provide a ‘road map’ for countries and included policy-makers, information and healthcare professionals, and members of civil society. As part of any NHID system, countries need to strengthen and secure the protection of personal health information. While often the technology is available, the solution is not just technical. It requires political will and collaboration among all stakeholders to be successful