Abstract
BackgroundPrimary care services in South Africa have been challenged by increasing numbers of people with communicable and non-communicable chronic diseases. There was a need to develop alternative approaches for stable patients to access medication. With the onset of the coronavirus pandemic there was an urgent need to decongest facilities and protect people from infection. In this crisis the Metro Health Services rapidly implemented home delivery of medication by community health workers. This study aimed to evaluate the implementation of home delivery of medication by community health workers during the coronavirus pandemic in Cape Town, South Africa.MethodsA convergent mixed methods study evaluated six implementation outcomes: adoption, feasibility, fidelity, coverage, cost, and sustainability of the initiative. Data sources included routinely collected data, a telephonic survey of 138 patients, an analysis of set-up and recurrent costs as well as 17 descriptive exploratory qualitative semi-structured interviews with 68 key informants.ResultsOver a 6-month period 1,054,657 pre-packaged parcels were sent to primary care facilities, 819,649 (77.7%) were delivered and of those 97,297 (11.9%) returned. The additional costs were estimated as 1.3% of a total health budget of R2,2 billion. The initiative was rapidly adopted as it decongested facilities and protected vulnerable patients. Although it was feasible to implement at scale, numerous challenges were encountered, such as incorrect addresses and contact details, transporting parcels, communicating with patients, having a reliable audit trail, and handling out-of-area patients. All role players thought the service should continue and 42.3% of patients reported better adherence to their medication.ConclusionHome delivery of medication by community health workers is feasible at scale and affordable. It should continue, but as one of a menu of options for alternative delivery of medication. The following need to be improved: efficiency of the system, the audit trail, adequate support and resources for community health workers, transport of medication, communication with patients, empanelment of patients, governance of the system and training of the community health workers.
Highlights
Primary care services in South Africa have been challenged by increasing numbers of people with communicable and non-communicable chronic diseases
These facilities linked with a network of 2500 community health worker (CHW) employed by non-profit organisations (NPO)
Adoption Implementation of home delivery was well aligned with the immediate goals of de-congesting primary care facilities in order to free capacity to handle the surge of COVID-19 patients as well as to reduce the risk of infection amongst people with chronic conditions who would otherwise attend to collect medication: “We needed to rapidly decongest our primary healthcare facilities, and the number seemed to indicate that many of the people, I think it was something like 40% of the people, that usually attend our
Summary
Primary care services in South Africa have been challenged by increasing numbers of people with communicable and non-communicable chronic diseases. There was a need to develop alternative approaches for stable patients to access medication. With the onset of the coronavirus pandemic there was an urgent need to decongest facilities and protect people from infection. In this crisis the Metro Health Services rapidly implemented home delivery of medication by community health workers. This study aimed to evaluate the implementation of home delivery of medication by community health workers during the coronavirus pandemic in Cape Town, South Africa. The enormous number of people accessing chronic medication threatens to overwhelm primary care services and undermine care for others. More high-tech solutions were piloted such as e-lockers and ATM-like pharmacy dispensing units [6, 7]
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