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Nov 22
The Health Systems Trust hosts newly appointed Senior Advisor to the Office of the U.S. Global AIDS Coordinator at Inanda CHC

By: Lunga Memela (Communication Engagement Lead)

Inanda Community Health Centre Facility Team Lead, Matron Thembelihle Ndimande; HST's  SA SURE Project Programme Manager, Joslyn Walker, and OGAC Senior Advisor, Jirair Ratevosian during the visit.

The Health Systems Trust (HST) was privileged to host Jirair Ratevosian, the newly appointed Senior Advisor to the Office of the U.S. Global AIDS Coordinator and Health Diplomacy (OGAC), during his 16 November 2021 visit to eThekwini's Inanda Community Health Centre (CHC). HST has supported the facility since October 2020, successfully streamlining patient flow, improving the appointment system, and strengthening retention activities, particularly with a TB and HIV reduction focus.

A distinguished advocate for global health and human rights, Ratevosian was recently appointed by American President Joe Biden to serve in the senior advisory position where he is helping to oversee the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), HST's primary funder through the Centers for Disease Control and Prevention (CDC).

The visiting delegation, including the Director for CDC South Africa, Dr John Blandford, and CDC Quality Improvement Branch Chief, Jonathan Grund,  was welcomed by the CEO of Inanda CHC, Dr Sethembiso Mncwango together with HST's Director of Health Systems Strengthening (HSS), Ronel Visser, and HSS's South Africa Sustainable Response to HIV/AIDS (SA SURE) Project Programme Manager, Joslyn Walker. The SA SURE Project supports the Department of Health (DoH) to provide sustainable HIV and TB-related care and treatment service delivery through training, mentoring, coaching and direct service delivery. The four health districts supported by the SA SURE project in KwaZulu-Natal are eThekwini, uMgungundlovu, uThukela and Zululand. 

Inanda CHC CEO, Dr Sethembiso Mncwango, speaks about the challenges and success stories of the facility.

Challenges in service delivery

Painting a picture of the work that happens on the ground, Mncwango highlighted that Inanda CHC is the second busiest health facility in eThekwini after KwaMashu CHC. It has nearly 10 600 patients on antiretroviral therapy, and it offers an array of health services to the greater Inanda Township despite the number of challenges including: space is severely constrained, extreme poverty, unemployment and substance abuse in the area.

The outbreak of COVID-19 certainly interrupted HIV service delivery and the provincial riots of July 2021 had a major impact on DoH's HST-supported Central Chronic Medicines Dispensing and Distribution (CCMDD) programme, Mncwango said. The looting and vandalisation of chronic medication pick-up points had a ripple effect on adherence, medical appointments, and the monitoring and evaluation of preventative interventions through the Synchronised National Communication in Health (SyNCH) programme.

How HST has assisted

HST Data Filing Clerk, Jessica Khanyile, walks the visiting delegation through the new and more effective filing system.

"We've got a footprint across the country," said HST's HSS Programme Manager, Joslyn Walker, when giving an overview of the organisation to the visiting delegation. Not only does HST's PEPFAR programme support the DoH at all levels of the health system (provincial, district, facility and community), HST has also grown to be CDC South Africa's largest and highest-performing district support partner. 

One of the biggest highlights of HST's work at Inanda CHC has been the implementation of a highly effective case management approach, which has resulted in organised and functional filing rooms; effective appointment systems; and client-centred communication.

Whether tested in the community or at the facility, HIV testing personnel refer clients directly to clinicians for same-day initiation and immediate linkage to treatment. They trace patients who miss appointments within seven days – all efforts being a major win for HIV prevention, testing, treatment initiation, adherence, return to care and overall service delivery. "Case management starts with an effective appointment system. Improved filing systems really changed the patient flow," Walker explained.

Inanda CHC has also seen an impressive increase of the total number of clients remaining on ART (or TROA) from July 2020 to September 2021. With increased HIV testing, there has been an increase in case finding. ART optimisation improved consistently despite stock-outs, the July riots and the COVID-19 outbreak. The Men's Health Campaign (MINA) was successfully launched at Inanda CHC.

Also noteworthy, HST's case management approach has improved viral load management for clients, pinning a clear focus on the 95-95-95 goals with the objective to promote viral load suppression that results in HIV being undetectable and therefore untransmittable (U=U).

Walker reported that effective case management has resulted in the reduction of missed appointments, and that waiting times have been reduced by half at the facility. The same HIV case management approach has been adopted for managing TB. "TB-presumptive and TB-diagnosed clients are case-managed and followed up with closely for treatment initiation," Walker added.

The visiting delegation was taken on a walk-through of the facility, giving them a first-hand experience of service delivery at the facility. HST and Inanda CHC staff were present to answer questions and explain the day-to-day dealings of the facility.






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