5 research outputs found
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
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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