In the Cape Winelands health district of the Western Cape, Anova works in partnership with the Western Cape Department of Health to support and expand access to HIV-services. Anova currently supports 73 primary healthcare facilities in the area. Anova works closely with the local health department’s district managers and staff supporting the development of district plans and identifying gaps within the healthcare system.
The project focuses on health systems strengthening (HSS) through the scale-up of services, training and mentoring of clinical and data staff, and the long-term care of patients on antiretroviral treatment (ART). Skills sharing and training are integral to creating sustainable and effective care.
The Cape Winelands team emphasises the provision of training for healthcare staff in all five of its sub-districts. This includes HIV, PMTCT, paediatric HIV, TB, basic HIV training for nurse clinicians (NIMART) and other training for all levels of staff.
One of the most successful training initiatives has been the basic HIV training, which explains what HIV is to ease nurses into this technically dense topic. Complementing NIMART, this training and mentoring makes sure nurses are capable to monitor and dispense HIV treatment to their clients.
The team is dedicated to strengthening existing services through continuous quality improvement initiatives which are context-specific and facility-based. The focus is on helping facilities work smarter, which includes streamlining client care pathways by identifying areas of systems support, and implementing fast-lanes, triage and appointment systems.
Accurate data and trained practitioners in the healthcare system provide an environment for a campaign the team calls “Know your epidemic, Know your response”. This campaign allows clinics to look at their individual data and use that to inform their response.
An integral part of better equipping the health system to deal with HIV infection is sharing knowledge and experience. The annual Cape Winelands-Anova Conference is hosted in partnership with the Cape Winelands District Department of Health, providing a key avenue for workshopping and training counsellors, healthcare workers, and managers on the clinical aspects of HIV treatment and care, while promoting general skills development. With Anova’s transition to HSS these annual conferences increasingly focus on promoting HSS as everyone’s business and refining the responsibilities of different role-players in health.
To promote co-operation and a sense of partnership between public health management and researchers, Anova hosts an annual meeting for researchers to come together at Sustainable Rural Health Research Day. Researchers from various disciplines are invited to present the health research they are doing in the rural areas of the Western Cape. District, sub-district managers and health professionals are given an opportunity to meet the researchers to better understand the value of the work that is being conducted within their districts. The team also supports existing events and meetings in the HIV, AIDS, STI, and TB (HAST) programme with the aim to enliven such events. These include; the quarterly Clinical HAST Seminars, World TB Day and World AIDS Day.
Cape Winelands successfully implemented a system called Alternative distribution sites, where the needs of stable clients are put first to make their collection of chronic medication quicker and easier. This also frees up the clinic. This innovation is supported by the Cape Winelands Department of Health and has since been implemented at facilities where such systems support is required and viable.
Other areas of support include supply chain management, cold chain management, the standardisation and maintenance of dispensing rooms, and the roll-out of accredited dispensing software. The focus is to streamline pharmacy and to achieve compliance with the national core standards.
With more than 6 million South Africans living with HIV, and over two million people receiving ART in public healthcare facilities, monitoring and evaluation (M&E) of the ART programme is critical to signpost programme progress and performance.
The Cape Winelands district was one of the first to roll-out Tier 2 of the nationally earmarked three-tiered framework for ART M&E. To date this electronic system, TIER.Net, has been successfully implemented in 50 facilities. Anova provides on-going technical assistance to maintain data quality and is committed to promoting a culture of quality data use in the district.
In 2014, the system’s functionality was expanded to include the capture of Pre-ART client information; a first in South Africa to implement this innovation. The increased functionality, paired with strong community support, can improve tracking of clients who are not yet eligible to start treatment, and may increase the likelihood of their timely start on ART.
Dr Nelis Grobelaar
Sometimes tenuous, often contested, but always with the potential for humanity and compassion.