Staff at a Primary Health Clinic Go Beyond the Call of Duty to Provide Antiretroviral Treatment in South Africa
The rural Eastern Cape communities in South Africa face a common set of problems when caring for people living with HIV & AIDS – the huge distance to hospital facilities and the large patient load at these facilities. The newly increased capacity of smaller primary health care clinics to initiate clients on antiretroviral (ARV) therapy has been a major step in extending antiretroviral provision throughout South Africa.
The US Agency for International Development (USAID)-funded Integrated Primary Health Care (IPHC) project, led by Management Sciences for Health (MSH), is building on existing and functioning systems for ARV rollout by helping primary health care sites become prepared to increase access to ARVs closer to communities. To prepare Thornhill Health Centre to provide ARVs, IPHC trained staff, prepared clinical and pharmaceutical services, organized the file management system, and designed a better data management method for patient management.
Before Thornhill was able to provide ARVs, clients had to travel 132 km to the hospital to receive their medication. The costs and distance made this largely impractical. The commitment of the staff proved to be the key to sustained improvements at the health centre. Staff helped ensure that the centre met the training requirements, that the systems were established, and that the facility was assessed. The staff at Thornhill Health Centre has become well known for finding solutions to challenges and for their dedication to their clients. Thornhill Health Centre was accredited as an ARV site in September 2008.
In the two years since accreditation, the staff at Thornhill Health Centre has continued to go the extra mile for their clients. They started seeing clients at 7a.m., so patients can adhere to their medicine even when having to get to work or school early in the morning. The staff also provides tea for the patients (from their personal funds) and has created a vegetable garden to provide soup to patients in the winter.
"This clinic is an example of best practice, of staff doing things without being reliant on government, but knowing that there is a reward for doing something voluntarily," said Alude Dube, IPHC HIV & AIDS technical advisor for the province.
The Thornhill staff also takes great care in organizing their patient files, which makes it easier and quicker to retrieve information. They developed a laboratory summary form that makes it easy to see the health and treatment status of a client at a glance. Color coding and an electronic bar coding system helps ensure accuracy and improve information management.
IPHC is providing further assistance to the health centre by providing a data capturer who helps ensure that records are up to date, registers are completed, and information is fed to the Department level for further analysis. Improved data collection helps Thornhill measure its results and manage patients better.
Thornhill Health Centre is fortunate to have enough space in the dispensing area to allow clients to receive their medication in private. In addition, because ARV and general pharmacy clients are not segregated, stigma is reduced. The system allows confidentiality, and improves staff-client relationships.
The Thornhill Health Center has successfully improved patient flow, increased the number of clients tested following counseling, reduced waiting times, and decreased their defaulter rate.
Right after Thornhill was accredited, the health centre started two clients a week on ARV treatment - meeting the expected treatments of about eight per month. Now, because of the dedicated staff, they initiate about 45 patients per month on treatment and are able to cope well with the demand.
IPHC is a collaborative effort of the National Department of Health (NDoH), the provincial Departments of Health in the Eastern Cape, KwaZulu Natal, Limpopo, Mpumalanga, and North West provinces, and USAID. The IPHC Project supports 68 primary health care and community health centers, as well as 16 accredited antiretroviral sites.
The IPHC project supports the government to improve access to child heath, reproductive health, and HIV & AIDS services by strengthening management systems at the district level, using a supportive supervision system, and improving the use of data for decision-making. Linkages between health facilities and the communities they serve are also promoted.