Modelling cost benefit of community-oriented primary care in rural South Africa.

Rod Bennett,Geoff Abbott,Jannie F Hugo,Tessa S Marcus

doi:10.4102/phcfm.v12i1.2225

Abstract

BackgroundGlobally, rural populations have poorer health and considerably lower levels of access to healthcare compared with urban populations. Although the drive to ensure universal coverage through community healthcare worker programmes has shown significant results elsewhere, their value has yet to be realised in South Africa.AimThe aim of this study was to determine the potential impact, cost-effectiveness and benefit-to-cost ratio (BCR) of information and communications technology (ICT)-enabled community-oriented primary care (COPC) for rural and remote populations.SettingThe Waterberg district of Limpopo province in South Africa is a rural mining area. The majority of 745 000 population are poor and in poor health.MethodsThe modelling considers condition-specific effectiveness, population age and characteristics, health-determined service demand, and costs of delivery and resources.ResultsModelling showed 122 teams can deliver a full ICT-enabled COPC service package to 630 565 eligible people. Annually, at scale, it could yield 35 877 unadjusted life years saved and 994 deaths avoided at an average per capita service cost of R170.37, and R2668 per life year saved. There could be net annual savings of R120 million (R63.4m for Waterberg district) from reduced clinic (110.7m) and hospital outpatient (23 646) attendance and admissions. The service would inject R51.6m into community health worker (CHW) households and approximately R492m into district poverty reduction and economic growth.ConclusionWith a BCR of 3.4, ICT-enabled COPC is an affordable systemic investment in universal, pro-poor, integrated healthcare and makes community-based healthcare delivery particularly compelling in rural and remote areas.

Highlights

In spite of substantially higher per capita government spending on health in South Africa, including extensive investment in primary care and the treatment of infectious diseases, there is no correspondingly significant improvement in public health when compared with that of global upper-income and middle-income countries.[1]
Note that numbers of community health worker (CHW) and home-based care (HBC) are the actual numbers employed according to the model
It was calculated that 122 teams (122 team leaders (TLs), 979 CHWs, 182 HBCs) would be needed to deliver a full package of community-based healthcare to 630 565 people eligible for such services in Waterberg

Summary

Introduction

In spite of substantially higher per capita government spending on health in South Africa, including extensive investment in primary care and the treatment of infectious diseases, there is no correspondingly significant improvement in public health when compared with that of global upper-income and middle-income countries.[1] With the current trajectory, the country is not on course to achieve the 2020 or 2030 SDG-3 targets.[2] Community-based healthcare, a prioritised government policy, remains a reactive and haphazard facility add-on, with less than optimal implementation fidelity,[3] especially in respect of service integration, project duration, community health worker (CHW) training and conditions of employment. The drive to ensure universal coverage through community healthcare worker programmes has shown significant results elsewhere, their value has yet to be realised in South Africa

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