The Anglo American / COPC Research Unit collaboration during 2020

Introduction: The Impact Catalyst is an initiative founded by Anglo American, Exxaro Resources, CSIR, Zutari (formerly Aurecon), and World Vision South Africa, to create mechanisms that drive large-scale, socio-economic development initiatives through public-private partnerships. The initiatives are designed to leverage collaboration across all sectors and are selected for impact beyond the scale of individual participants. The focus is on improving the health, wellbeing and living conditions of mine host communities, and the community-oriented primary care approach was selected as the desired model for implementation in the health sector. COPC is a cooperative healthcare delivery approach that is guided by a set of principles that put people, individually and collectively at the epicentre of health and architects of healthcare.  The ability to sustain wellbeing and prevent, manage and control the disease is central to social development and the effectiveness of any healthcare service.

Brief History: Following an initial project Design Phase in November 2018, the Community-Oriented Primary Care (COPC) Research Unit of the University of Pretoria submitted a scoping analysis of what universal health coverage should look like in the Mogalakwena sub-district of the Waterberg district. An initial pilot phase was implemented in 3 clinics of one of Anglo American’s largest platinum mines, the Mogalakwena mine in October 2019.

As a direct result of the early positive results in the pilot sites, Anglo America immediately scaled COPC across all its mine host communities when Covid-19 entered South Africa during March 2020. Together with the University of Pretoria’s COPC Research Unit, Anglo developed a health response to support its labour force with home-based care while initiating COPC implementation across all of its host communities. This ensured the deployment of up to 77 clinical associates across 22 Anglo sites (including the 4 Business Units of Kumba Iron Ore, De Beers, Platinum and Coal).

These clinical associates, while providing screening/swabbing/contact tracing to Anglo employees and contractors, also supported in the public health sector, mainly through training public health professionals in the Covid-19 protocol, setting up screening stations and building relationships with health stakeholders. It was clear from the start that having a well-informed community health worker cadre in the Mogalakwena pilot site significantly influenced the extent of panic and chaotic responses. The fact that the small pilot begun in 3 clinics of this area instantly spread across all 11 sites, was largely attributed to the uniform training provided by the COPC Research Unit’s clinical associates. This in itself provided evidence that putting measures in place to prevent disease also contribute to a structured approach to any unexpected health events such as Covid-19.

Approach: By definition, COPC works within a defined geographic area with the best local information delivering a comprehensive integrated care model dealing with the most common and most important conditions. It then deals with it from prevention and promotion through curative, rehabilitative and palliative care starting with the neediest section of each community. This includes practising with science making use of the best available evidence and working with the multi-disciplinary and intersectoral teams to integrate care around individuals and families. This translates into caring for people and families from the home to the clinic and the hospital and back.

The main features comprise:

• Visiting and caring for patients at home: this service is enabled through well-trained and equipped community health workers that are linked to support from clinical associates, clinic staff, doctors via mobile devices;
• Making a local assessment of Local Institutional Support Assets or LISA (partnerships and networks);
• Mapping and modelling to ensure an appropriately staffed service in particular geography;
• Deployment of  digital technology for data capturing and telemedicine solutions;
• Two-year practical ongoing training for CHWs through a combination of intensive training blocks and weekly training/problem-solving sessions;
• Problem and priority analyses, and joint development of care pathways/options and decisions on specific interventions to implement;
• Organising multi-disciplinary teams of the appropriate local clinicians to coordinate care;
• Research to solve inefficiencies and optimize service delivery, as well as ongoing monitoring and evaluation.

The primary benefits of COPC interventions include:

• Extension of health and care services from and to people in the places where they live, work and play (community);
• Provision of universal, cost-effective, quality healthcare;
• Generation of a social return on investment through improved health for all;
• Generation of an economic return on investment through direct and indirect saving and incremental beneficiation.

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