City of Tshwane and University of Pretoria Ward based Outreach Team Project

The National Department of Health has instituted major health care reform to address the burgeoning health system crisis created by the four epidemics. In support of the reengineering of primary health and the need to create a learning platform that is relevant and appropriate to the needs of health care in the 21st century, the Department of Family Medicine (UP) has been involved in the conceptualisation, development and implementation of a community-oriented approach to primary health in Tshwane District (Gauteng Province) and the City of Tshwane. 

To this end the Department of Family Medicine (UP) has: 

1. Supported provincial (Gauteng DoH, Tshwane District) and local (City Of Tshwane) government in the organisation and operationalisation of primary health care service delivery through municipal ward-based outreach teams (WBOTs);
2. Created an ICT enabled platform with the key private sector and government partners to support high-quality service, learning and research across all sectors and layers of service from the individual home to the highest level of institutional care;
3. Developed an integrated educational platform to support workplace learning for both academic (University, FET) and non-academic purposes that extends from community health workers in WBOTs, through undergraduate clinical associate and medical students, to postgraduate masters and doctoral students;
4. Embedded research into the service and learning platform, both to monitor and evaluate performance in order to improve practice and to generate a better understanding of health, care and disease as it is played out in individual, family and community life in defined geographical areas.

In a project to support NHI (National Health Insurance) development, the City of Tshwane partnered with UP Family Medicine to implement Ward Based Outreach Teams in Tshwane. The City of Tshwane is funding the project and their Health Department is appointing and paying the staff and managing the project. The role of UP Family Medicine is to develop and manage the information technology and data, to develop and coordinate the education of WBOTs, support implementation and develop and coordinate research. A comprehensive business case for a long term programme for WBOT/COPC needs to be presented by the end of the project.

The development of the WBOTs is within the guidelines of the National DOH for the re-engineering of Primary Care of which WBOT is one of 4 initiatives. The others include District Clinical Specialist Teams, Integrated School Health Services and the deployment of private General Practitioners in the District Health Services. Other community-based projects in the city are incorporated into the project. This is especially relevant in the Inner City where a project on commercial sex workers by Wits Reproductive Health and HIV Institute and several projects by Tshwane Leadership Foundation and Sediba Hope Clinic in the inner city are coordinated to create a network of WBOTs in the inner city. 

Learning 

Ongoing capability development of health workers, students and families are integral to the project. The capability of all involved is developed through peer learning. This involves workers, students and families and is aimed and increasing the capability of all involved. Learning material in the form of illustrated text creating videos, written text and cell phone screens is developed in units and modules.

Integrating with other community-based programmes

There is a range of community-based programmes in the City of Tshwane that has been running for a long time. All these programmes are integrated into a district-wide WBOT implementation project. Existing programmes include the WBOTs developed by the Gauteng DOH Tshwane District and the MSAMU (Multi-Sectoral Aids Management Unit) Peer Education Project. These projects work with NGOs in the city. 
The success of this integration will enable the partners in the city to establish WBOTs throughout the whole city.

Integrating with rest of District Health Care

The strength of COPC is that it needs to be fully integrated into the rest of the health and social care system. The project constantly working to integrate WBOTs into the rest of the District Health System specifically 
Clinics, NGOs, Hospitals and General Practitioners. Patients are referred to and from these services to be cared for at home. 

Information and Communication Technology ICT

Information technology has played a central part in this project. It is ICT supported and has supported high touch primary care. An information system is developed where data in the homes is collected by means of cell phones. This information is then collected and analysed and used to inform the practice of the WBOT as well as do analysis and research about integrating COPC. The key concept is that the information should first of all be available to the WBOT to identify health issues in the home and in the neighbourhood. This information is used to identify and prioritise problems. Interventions are developed and implemented and then monitored. The information system is built around an initial Household Registration and screening process (HHR), an individual health assessment (HSA) and condition management programmes. 

This information system is then integrated through a Health Information Integrating Exchange, developed by the CSIR in which different information systems input information to create repositories, which include an Electronic Patient Record (EPR). This information is then available to selected health care workers in different health services and for big data analysis and data discovery. Wellnicity, an actuarial science group, is involved in this part of the work. 

Similar information systems are developed for care at the clinics, health centres and hospitals to create an integrated comprehensive health information system. The initial partners in the development of the ICT system include the CSIR, Mezzanine-ware and Synaxon. Mezzanine-ware is responsible for the mobile health systems, Synaxon for the clinic-based systems while the CSIR is developing the Information Integration Bus. 

Conclusion

The development of integrating WBOTs through COPC theory and practice is aimed at establishing a basis of health care that can change the practice of health care and health outcomes for the future. This vision is realised through ever innovations and ever-growing collaborations.