For the past 18 months, Medicins sans Frontieres (MSF) in partnership with the Nelson Mandela Foundation (NMF) have been gradually handing over the care of 2200 people on AIDS drugs and HIV services to nurses and doctors in the province.
The handover is part of the original partnership agreement between the organisations and the health department, that the EC would take full responsibility of the programme when it was sustainable, said the MSF.
After only three years the programme has achieved universal coverage of anti-retroviral treatment within the last two years in one of the poorest, rural areas in the country. According to MSF the community model proves that ARV programmes can be nurse-driven at clinic level with support by community mobilisation and treatment literacy
“We were happy to receive the support of MSF and NMF in 2003. We asked them to help us in one of the most difficult rural areas”, said Mrs Nomalanga Makwedini, Chief Director of Primary Health Care of the Eastern Cape health department. “This is a model that we are very keen to roll out to other rural areas and to share it with other provinces,” she added.
The programme is run from St Elizabeth Hospital and 12 clinics, serving approximately 150 000 people.
“Four years later this experience proves that decentralized HIV/AIDS care is the optimal model for rural areas. At the same time, the model has brought many benefits to primary health care services as whole, with improvements in clinic and laboratory services, infrastructure, drug supply, training, and staff motivation,” Makwedini said.
Health-e visited the programme last year where people on treatment showed high levels of adherence and literacy regarding their treatment despite low levels of school education.
MSF doctors have implemented a decentralized model in the face of a chronic shortage of health staff as an effective strategy for treatment in rural areas. The model entails a mobile team to support nurses at clinics; the recruitment of adherence counsellors; and strong community engagement to support the health system.
“Implementing comprehensive HIV services in Lusikisiki has needed many ‘out-of-the-box’ solutions to overcome the challenges we faced,” said Dr Hermann Reuter, MSF project co-ordinator. “The only way to make this programme sustainable and replicable is to ensure that those solutions are urgently translated into policy changes at National and Provincial levels.”
Mothomang Diaho spokesperson for NMF, is confident that the programme is well established under the leadership of the province .
‘From its inception the programme was designed to be integrated into the health care system. “In times of huge challenges, government needs the support of NGO partners with their experience, extra resources and flexibility to move quickly”, said Diaho.