The University of Pretoria’s (UP) Community Oriented Primary Care (COPC) Research Unit is leading the vaccination of undocumented communities against COVID-19 in Gauteng.
This is in collaboration with partners from the international community, local NGOs and religious community leaders, and the departments of health and local government.
Under the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ)/UP Project, vaccination has been open since October at clinics in Ekurhuleni, Johannesburg and Tshwane, while there are also pop-up vaccination sites in informal settlements and in inner-cities for homeless people in these municipalities. There are plans to roll out this programme to other provinces, in collaboration with several partners, to provide COVID-19 vaccinations to communities facing challenges with accessing such services.
The COPC Research Unit is based in the Department of Family Medicine at UP’s Faculty of Health Sciences.
According to Professor Debashis Basu, Head of the Department of Public Health Medicine, “Undocumented people include South Africans who have lost their documents, people from surrounding countries with expired documents or without documents. Many of the people are homeless, living on the streets or in informal settlements.”
There are also many people who are employed, living in formal housing, who do not have identity documents.
Vaccinations at the Zama Zama informal settlement.
UP’s COPC approach entails working with people in geographic areas where informal settlements have been mapped in detail and where access to fixed vaccination sites is limited, identifying their needs and working with partners to meet those needs. “We go to the communities where easy access can be provided, rather than asking them to come to formal facilities. As part of our comprehensive and ongoing care, we issue people with a patient-retained booklet called ‘Road to Linked Care’. The book acts as their identity in terms of their medical and vaccination records. We seize the opportunity to create awareness of other high-burden diseases such as tuberculosis and HIV, and to identify social needs that might be addressed at the primary healthcare level.”
However, the government’s COVID-19 vaccine rollout programme is designed to register people with their unique identification information. This is necessary to prevent duplication and to be able to track people. “Unfortunately, this excludes a large number of people without the necessary documents. And they are often at great risk and in need of vaccination and healthcare,” explained Prof Basu.
He said that undocumented people are reluctant to access health services, including vaccination. “There is a long culture of stigma and exclusion. They do not trust the system and are afraid that they will be reported to the police, then apprehended and deported.”
The National Department of Health has recognised this challenge and is partnering with UP in rolling out the vaccination programme. This is in line with the long history the UP COPC Research Unit and its partner departments have working with homeless people, substance users, commercial sex workers, undocumented migrants and people who live in informal settlements and in mining communities.
“We are well-placed to take up the responsibility to assist in this vaccination programme,” said Prof Basu.
The UP COPC Research Unit offers a health check with the vaccination as these communities are often neglected, resulting in undetected chronic conditions among individuals. “When we find such conditions, we record that on the ‘Road to Linked Care’ booklet and encourage them to seek help in a clinic of their choice.”
Vaccinations at NG Church, Daspoort, Pretoria.
Other partners include Doctors Without Borders, the International Committee of the Red Cross, the United Nations Refugee Agency, International Organization for Migration, Section 27, South African Red Cross Society, Tshwane Leadership Foundation, churches and NGOs, and mining companies.
So far, more than 4 000 people have been vaccinated in Gauteng through the programme. “We are initiating a structured course to address vaccine hesitancy and behaviour change through motivational interviewing, which entails guidance on lifestyle changes towards improved personal health,” said Prof Basu.
According to Professor Jannie Hugo, Director of the COPC Research Unit at UP, the training will be done through UP’s existing education networks where it regularly trains around 100 clinical associates working in 24 mining communities in six provinces. This training is then cascaded to staff – clinic staff and community health workers – in the local district health services.
“It is critical that people who are excluded or hard to reach are enabled to benefit from the vaccination programme to prevent islands within which the virus can hide and spread,” Prof Hugo said. “An important principle of COPC is equity; meaning those most in need should get priority and access. This is sound public health practice as well as social justice. It also fits in with the [United Nations] Sustainable Development Goals approach.”
He explained that if undocumented communities do not participate in the vaccine rollout, “the pandemic will continue to disrupt lives and livelihoods”.