BroadReach Healthcare Down Referral Model
Country of Operation
SummaryBroadReach Healthcare's North West Province Down Referral Model in South Africa reduces the reliance on overburdened public health resources by leveraging the private sector in the treatment delivery for people living with HIV/AIDS (PLHA).
The goal of the program is to alleviate some of the burden on the public sector by leveraging existing capacity within the private sector.
Key program components
Patients are initiated at a public healthcare facility, the Wellness Centre, where they are stabilized for six months. The BroadReach Healthcare office is physically located in the Wellness Centre where stable patients are identified by a Wellness Centre doctor and immediately referred to the BroadReach Healthcare Down Referral programme. This identification and referral process takes place daily. Patients are then referred to a private general practitioner (GP) or clinic for continued government-funded treatment. Patients are referred to GPs based on geographic convenience for the patient and the BroadReach team makes the first appointment. This referral and registration process for new patients to become active in the programme only takes 1 day. Should a patient acquire an opportunistic infection or require treatment for another condition, they are referred back to the Wellness Centre, and then again to the private GP/clinic once stabilized.
Adherence interventions are tailored to the needs of each patient, and range from SMS reminders, workshops and support groups, to a series of home visits by an adherence counsellor.
GPs are provided with training, mentoring, monitoring system, free ARVs for their patients and payment for clinic visits
Program focus on family and buddies when conducting adherence support
Employing HIV positive peer educators and speakers. The trainer is positive, open about her status and taking ARVs, and patients start to show an interest in attending training
In May 2011, the programme began the down referral of stable hypertensive patients, with plans to phase in the down referral of stable patients diagnosed with epilepsy, diabetes, and asthma. Additionally, discussions are currently underway with NW Department of Health (DOH) to begin down referral of patients initiated at Tshepong Hospital feeder clinics into the programme. This will ensure continued capacity to enrol new patients at feeder clinics through the national Nurse Initiated Management of ART (NIMART) initiative.
Sustainability of the programme is ensured through BRHC’s unique partnership with the SA Department of Health. Through strategically crafted Memorandum of Understandings, the DOH is in alignment with GP and programme fees so that should BRHC be unable to manage and/or USAID funding cease, the DOH can absorb programme costs and continue operating the programme.
Quality of care is monitored by Aid for AIDS, the largest Disease Management Organization (DMO) in South Africa.
Additional Information Broadreach Monthly Report May 2008
2,561 patients have been down-referred since programme inception (Oct 05)