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Cape Town’s community health workers saving lives during COVID-19 pandemic
Author: Bob Mash, Zameer Brey, Charlyn Goliath & Darrin Roman
Published: 07/07/2020

Cape Town's community health workers are helping to save lives during the COVID-19 pandemic by delivering medication to the houses of people in high-risk groups, writes Prof Bob Mash (Family Medicine and Primary Care) and his co-authors in an article for Health24 (6 July).

  • Read the article below or click here for the piece as published.

Bob Mash, Zameer Brey, Charlyn Goliath & Darrin Roman*

Public sector primary care facilities in Cape Town care for a large number of people with chronic conditions such as HIV/Aids, tuberculosis, diabetes, hypertension, asthma and chronic bronchitis and emphysema. Many of these patients are over the age of 55, which put them at an increased risk of more severe COVID-19 infection.

It is, therefore, laudable that community health workers (CHWs), in partnership with the Western Cape Metropolitan Health Services and non-profit organisations, delivered 184,000 parcels of medication to peoples' homes in Cape Town during May 2020. Something that had never been done before. People with the aforementioned chronic conditions had their medication hand delivered by their local community health worker to their home. Given that we could still see a rise in infections in the Western Cape, these life-saving actions of CHWs are very important.

During the COVID-19 epidemic, the home delivery of medication has meant that people who are more at risk of severe COVID-19 have not exposed themselves to infection on public transport or at health facilities in order to obtain their medication. This has undoubtedly saved lives and enabled facilities to reduce numbers and maintain social distancing. In addition, by delivering medication at home, facilities have had more capacity to prepare for the surge of patients with COVID-19.

Prior to the onset of COVID-19, the Metro Health Services had invested in teams of community health workers across the city as part of a move towards more community-orientated primary care. Teams are employed through local non-profit organisations, linked to primary care facilities and responsible for defined groups of households. Under normal circumstances community health workers would visit their households and identify people with health risks who need assistance. These include, for example, people with symptoms of TB, people on treatment for chronic diseases, people that are pregnant or need family planning or immunisations.

Having this system already in place enabled a rapid re-organisation of CHWs to deliver medication and also to assist with community screening and testing for COVID-19. Most of the components needed to deliver medication at home were already in place and just needed to be brought together. The Metro Health Services already had a system for pre-packaging medication and delivering to health facilities for those with stable chronic diseases. The one missing piece of the puzzle was how to get the medication parcels from the facility's pharmacy to the non-profit organisation. This was solved in a variety of innovative ways using Uber drivers, bicycles and scooters from local entrepreneurs, as well as drivers employed by the Western Cape Department of Health or non-profit organisations.

One of the major difficulties with the system was that people had not registered their correct address or telephone number with the department of health. It was very difficult to reach people to confirm their address. Out of the 184,000 parcels delivered, 16,600 were returned. In order to solve this problem the department has created a WhatsApp automated messaging system where people can send in their correct details. If you want to access this system then send the message “Hi" to 0872406325. You will need your appointment card details, address and contact number.

Other benefits of the home delivery system include the ability to screen households for symptoms of COVID-19 (recent onset of sore throat, cough, fever or shortness of breath) when making the delivery. By definition, these households contain individuals who are more at risk of severe disease. In those with mild COVID-19 symptoms, the department of health is currently only testing people who are over the age of 55 years or with co-morbidities such as these chronic conditions. The same system can be used to deliver non-pharmaceutical materials or nutritional supplements.

We hope that this service will also improve collaboration between facility-based and community-based services. In addition, the stature and acceptability of CHWs within communities should be enhanced by performing such a valuable task.

Patient responses have so far been very positive and this innovation is possibly something that will stay with us beyond the epidemic.

*Prof Bob Mash heads the Division of Family Medicine and Primary Care at Stellenbosch University. Dr Zameer Brey is an employee at the Bill and Melinda Gates Foundation and Charlyn Goliath and Darrin Roman work at the Western Cape Metropolitan Health Services. This is an abridged version of an article published in the African Journal of Primary Health Care & Family Medicine recently.