Metro Health Services (MHS) recently commissioned Prof Bob Mash from Stellenbosch University (SU) to evaluate the home delivery of medication by community health workers during the Covid-19 pandemic and recommend future policy directions.
Mash, the head of the Division of Family Medicine at SU's Faculty of Medicine and Health Sciences (FMHS), says that the home delivery of medication by community health workers was adopted as a response to the pandemic for mainly two reasons. Not only do these services assist in decongesting primary care facilities, but it keeps patients with chronic conditions like HIV or diabetes out of facilities where they risk exposure to Covid-19.
“We know these groups do much worse if they get Covid-19 and are at higher risk of death," Mash explains. “We have such huge numbers of people on chronic medication and the largest HIV programme in the world. One in four South Africans over the age of 45-years has diabetes. We need to decongest health facilities so that clinicians can focus more time and attention on those that are unstable or sick."
Albeit necessary, the rollout of these home-delivery services happened rapidly, without the usual planning and consultation process. Consequently, there were some concerns with the financial and legal implications of delivering medication to patients' homes via community health workers. To evaluate these services, MHS granted Mash R150 000 for research.
Alongside his team consisting of Dr Darcelle Schouw, Dr Emmanuelle Daviaud, Dr Donela Besada and Mr Darrin Roman, Mash conducted a convergent mixed-methods study to evaluate the implementation outcomes. The study focused on the period of April to September 2020 when the Covid-19 pandemic began and home delivery was implemented.
Interviews were conducted with managers and health-care workers from all substructures, facilities, NPOs and the MHS and feedback from 138 patients was gathered through a telephonic survey. Additionally, routinely collected data on home delivery parcels and returns, as well as a cost analysis of data obtained from MHS, provided quantitative data for the study to rely on.
Overall, the evaluation found that the home delivery service was successful at decongesting facilities and undoubtedly saved lives amongst people who would otherwise have been exposed to Covid-19 infection. Almost all patients found the service helpful too and wanted it to continue. It not only reduced their risk of infection but also saved them time and money.
“My recommendation, which was echoed by patients, health workers and managers, is that this service should continue," Mash says. However, he adds that community health-care workers cannot spend all their time delivering medicines and a menu of alternative medication delivery systems is necessary. “I have suggested a mix of alternative pick-up-points including the possibility of smart lockers; collection as part of community-based adherence; and support groups as well as home delivery."