New community health platform brings primary care to millions
42 million South Africans rely on an under-resourced public health care sector. Inadequate access to health care perpetuate the inequalities that exist, and the nation faces four epidemics namely, infectious diseases – especially HIV/AIDs and TB, non-communicable diseases (such as diabetes and cardiovascular diseases), high levels of violence and injury, and mother and child illness and death – all linked to, and due to persistent social inequality.
Health care in South Africa is increasingly hospital-centred, disease focussed and specialised. This model has led to significant advances in medicine, has improved access to health care and proven profitable, but it excludes large segments of the population as it cannot provide universal access.
The Department of Family Medicine at the University of Pretoria has created a community-orientated primary care (COPC) model for today’s South Africa. “COPC is a geographically-based, collaborative approach to health that begins with individuals, and families in their homes,” explains research lead Professor Jannie Hugo.
COPC is primary care where health care professionals from different specialist fields and approaches work together with organisations and patients in defined communities. The result is a systematic identification and response to health and health-related needs to improve wellbeing. “COPC is an established concept, but our solution is novel in that it blends academic rigour, public health focus, clinical care and technological innovation and a transformative platform for improved society-wide health outcomes,” says Professor Hugo. The power of the model rests in its comprehensive care that integrates the home, clinics, GPs and hospitals to improve individuals’ ability to manage their health consistently. The full impact of the approach is set to revolutionise health care in South Africa.
AitaHealth is a smartphone application which supports the newest COPC model and is used by community healthcare workers in the field. Modules in the app collect patient information, guides responses and plans treatment and future visits. “The app guides community health workers through the process, and the information entered guides action, such as treatment or testing,” explains Professor Hugo.
The backend of the app has a sophisticated, web-enabled infrastructure so all information and interventions are available to managers to plan service and delivery, and support their team in real-time. AitaHealth is linked to a patient record system using Synaxon to provide continuity of information and care by connecting people in their homes to professionals in clinics and hospitals.
Education is also enabled through the application and is critical in healthcare, and COPC in particular. “To equip healthcare workers and professionals with the knowledge and skills required to carry out the complex tasks of COPC, is necessary for success and sustainable development,” remarks Professor Hugo. Continuous work integrated learning is built into the implementation plan and is supported by curricula, face-to-face training and specifically developed learning materials. Through workplace learning, health workers transition to higher qualifications and professional development to empower and upskill community members.
The collection of information also provides robust data on the real health situation and services in communities. This kind of information means teams can tailor health care to individuals in defined areas, and can be used in basic and applied research. And will be some of the most robust clinical and epidemiological data ever recorded.
As a result of this work, the National Research Fund is funding 14 masters and 12 doctorate students who are working on various aspects of learning in community health to improve the model, quality of care and the general level of capability in health, including health research.
Looking to the future
The project is already supporting the health of communities around Tshwane and is replicable and scalable, which means that it can be extended throughout South Africa. Because this is such a sustainable and affordable community-based health care system, millions more can benefit from this new approach both in terms of wellbeing and upskilling, to create more employable citizens who can also contribute to their community’s health.