Clinic does a cracking job - at R70 an appointment
Donor-funded Joburg clinic also manages to train pharmacy assistants, and has dramatically cut long queues
Just past Montecasino on William Nicol Drive, one of Johannesburg’s busiest roads in the north of the city, is a nondescript clinic that is easy to miss, yet its impact is felt by 107,000 patients a year.
The privately run Witkoppen Health and Welfare Centre sees about 425 patients a day, and asks only R70 for an appointment and medication. The first appointment is free.
The clinic reaches patients from the Kya Sands, Diepsloot and Lion Park townships.
Many state patients are willing to pay for the service and medication they receive, including access to a mental health clinic, a psychologist, antenatal care, doctors, nurses, medication, and TB and HIV treatment.
But long queues and waits for drugs have been a problem, said executive director Dr Jean Basset, so the clinic unveiled an expanded pharmacy on Wednesday to speed up medicine dispensing and shorten patient waiting times.
The Discovery Foundation funded the expansion. “We are [now] able to ensure that patients are seen faster. More storage capacity means stock levels are maintained. We don’t really have stock-outs, but poor storage capacity can mean clinics run out of medicines,” said Basset after the launch. Basset, who started working at the clinic 20 years ago, added that long waiting times at clinics are a “national issue”.
The new pharmacy has more dispensing hatches and a fast-track line to offer a short queue for the elderly, the heavily pregnant and the very ill.
The expanded pharmacy is unique in that there is a separate section for dispensing drugs to children and their caregivers, to try to keep kids from waiting with sick adults where they could pick up infections. The biggest concern is spreading TB from adults to children.
With less developed immune systems, children are at risk of illness, explained Basset.
The site began in 1947 as a feeding scheme, and was one of the first clinics in SA to offer antiretroviral treatment in the early 2000s.
Medication is supplied by the national health department.
“We are 100% donor-funded,” said Basset, The clinic also trained pharmacy assistants for the state – 86 so far.
There is a national shortage of thousands of qualified pharmacists, said Basset, explaining that, if one pharmacist has three pharmacy assistants, three times as many patients can have medicine dispensed to them.
Assistants trained for 12 months to earn a stock-taking qualification, and for another year to 18 months to qualify to dispense medicine under a pharmacist’s supervision.
Basset said she didn’t think the state had enough pharmacists to train assistants.
The importance of training assistants for the state was that assistants learnt to advise patients on how take to their medicine and what side-effects to watch out for. “They get exposure to how the state operates as it is slightly different to how the private sector operates.”
It was especially important to encourage patients to stick to taking their ARVs and TB drugs, and to explain the importance of this to them.
US ambassador Deborah Birx told Times Select two weeks ago that too many people who start ARVs in SA don’t return to the clinic for treatment and are “lost to follow-up”. According to the President Emergency Plan for Aids Relief (PEPFAR), 76% of those patients who started on ARVS in 2018 for the first time returned for more.
This means up to 24% of new patients stopped treatment, Bassett said the centre was able to keep more than 90% of patients returning for ARV treatment, by SMSing patients about their appointments the week before and day before. If they didn’t turn up, counsellors would contact them the same day, and again if they hadn’t returned in a week.
“Someone is caring about them so it is easier to stay in the system. We are not complacent. We know who is coming.”
The patient follow-up system is simple and the clinic uses a department of health IT system to monitor patient attendance. It also buys SMS bundles to send appointment reminders.
Basset said keeping patients in the system was about management and “sticking to the system” they use. The counsellors were trained to work well with patients. “There is no point in shouting at them if they don’t return for treatment.”
The model to track defaulting patients was researched and designed by the health centre and was now used by the health department, while it used fingerprint technology to identify and record patients.
Research the clinic had conducted showed male patients wanted to be treated by men, so the man cave was born – a male section with a male doctor and male nurses.