Anova’s support in the Mopani district in Limpopo has evolved from service delivery to offering technical support to existing staff, improving infrastructure and imparting skills for a long-term effect. At present the Anova team in this region supports all 100 primary healthcare facilities and 7 hospitals in Mopani.
The Mopani district is a rural area where the population is scattered across numerous smaller villages and communities. The low population density means that any one healthcare facility will cater to very few people in its immediate area, or otherwise will serve a number of communities scattered across a large area.
In the first instance, clinic staff is under-utilised; in the second, the already limited resources of the community are further burdened by having to travel long distances to access healthcare.
Through its Khutšo Kurhula project, Anova engages in a series of health system strengthening and capacity building efforts to improve access to services as well as the overall quality of service in HIV prevention and care programmes. This is supported in the communities by the Family Free Project, another Anova initiative in the region, funded by Orange Babies, Netherlands.
Building healthcare capacity
Anova’s Khutšo Kurhula project, founded in 2004, initially focused on support group empowerment and ART service delivery. Since 2010, Anova has introduced technical support teams in the region to provide support in the comprehensive care, management and treatment of HIV (CCMT). This includes mentoring healthcare workers, in-service training, enabling more effective drug supply-chain management and improving accuracy in data collection through the District Health Information System (DHIS).
In addition, resources are provided to improve healthcare delivery and infrastructure improvements include the provision of air conditioners for improved drug storage and cabinets and shelving for efficient filing.
Anova also provides support for provincial and district strategic plans and the findings of research projects further feed into the process of strengthening health systems.
One of the team’s strongest investments in the region has been the strengthening of monitoring and evaluation. Anova has been digitising ART records dating back to 2004. All 109-health facilities in Limpopo initiating ART are using TIER.Net. Only 7 facilities are still in Phase 4 of the implementation phases (data cleaning and sign off). The focus now is on the quality of data in the system and being able to see treatment outcomes more clearly.
In Mopani, ART services have been introduced to all Anova-supported sites.
Anova also assists in upgrading the infrastructure in rural clinics to help in the management of HIV treatment. Where there is a clear need for facility improvements or renovations at Anova-supported sites, the team attempts to meet that need, working with provincial and local health departments to ensure the upgrades meet everyone’s requirements.
As the Department of Health scales up its ART programmes, pharmacies in public healthcare facilities are required to stock and manage HIV drug supplies. For small and under-resourced clinics in remote settings, proper storage of ARVs poses a number of challenges. In Mopani, Anova installed air-conditioning in selected clinics to ensure the high summer temperatures do not affect the drugs and paired this with training to show staff how to achieve optimal temperatures using temperature charts. They installed locks and tinted pharmacy windows to prevent UV damage. To help ease the impact of drug shortages, the Limpopo team also provides support on drug supply chain management to pharmacy staff.
Whilst there are many facilities that are in dire need of HIV-specific expertise, most do not require full-time specialists. This is especially the case where rural clinics cater to too few patients to justify a full-time doctor or specialist nurse. Working in partnership with the health department, Anova staff in the Mopani district has developed strategies to maximize the impact and reach of skilled staff.
Roving teams, usually comprised of a doctor, nurses, a data clerk and a pharmacist thus rotate from one site to the next. The teams are supervised by a technical manager based at Anova’s Limpopo-based office. Its success has made it a popular approach among other Anova teams including its Mpumalanga and Soweto-based projects. Other NGOs have also expressed interest in replicating the model.
Anova has become increasingly involved in the production of research and is making significant contributions to the existing body of knowledge around HIV. Anova’s Mopani team is developing a unit with specific expertise on clinical and operational research in rural settings.
Anova’s unique mix of clinical skills, research expertise and the relationship with the Department of Health provide fertile ground for research in rural South Africa. This is crucial because most available research and knowledge focuses on urban areas or high-resource settings rather than remote rural resource-poor settings. As already observed in the team’s paediatric and STI studies, findings and implications may be very different in rural settings. Currently, various research projects are conducted in collaboration with other Anova teams and national and international partners and academic institutions.
Dr Jean Railton