The coronavirus pandemic has negatively affected the delivering of primary healthcare services and health-seeking behaviour, according to experts.

South Africa needs a resilient primary healthcare system that can contain the covid-19 pandemic while still maintaining its core functional purposes of delivering essential health services such as maternal and child health services, screenings for cancer and chronic diseases, and the management of minor illnesses and immunisation. 

This, according to experts participating in a coronavirus-centred webinar series, will assist in reducing mortality and morbidity from treatable and preventable diseases. 

The webinar, held on Wednesday, September 23, was organised by the department of family medicine and primary care at Wits University. It was moderated by Stephen Pentz, academic coordinator for health systems science with senior lecturer Dr Juliet Nyasulu, and head of family medicine, adjunct Professor Richard Cooke, as panelists.  

Nyasulu said, “Covid-19 had called upon a lot of resources that went into the preparation of the emergency response to the covid-19 pandemic. It also negatively affected the health-seeking behaviour because people were looking at the clinics as high-risk areas and would rather avoid covid-19 by not getting vaccinated or not picking up their medication. 

Cooke referenced research done by PHCFM, which looked at 109 facilities within the City of Johannesburg in quarter two versus quarter three, saying, “There was a 24% reduction in the primary health care head count. There was a 6.4% reduction for those on current antiretroviral treatment between quarter two and quarter three and then 48% of facilities within the City of Johannesburg were closed in July for greater than one day. Certainly, covid-19 has significantly impacted the services. 

With immunisation campaigns halted at the start of the pandemic, coupled with changed health-seeking behaviour, Nyasulu, using the WHO building blocks of a health system framework, proposes building trust in the population through ensuring that coming to clinics is safe, by implementing an ongoing screening process of service providers and providing training.

Dr Juliet Nyasulu and Dr Himani Pandya applied a conceptual framework based on the World Health Organisation’s building blocks of a health system to the current covid-19 pandemic. Graphic: PHCFM

However, Nyasulu said that this might lead to overcrowding and an inability to physical distance and suggested looking at innovative ways to continue providing primary health care. “There is a need for social mobilisation and socialisation. Why can’t we think of taking the services to the community? For example, with mobile immunisation clinics so that people are receiving these essential services in the community?”  

When an audience member from Zambia expressed the same concern of HIV patients failing to adhere to treatment regimens and not picking up medication out of fear of contracting the virus, Nyasulu suggested building on existing systems and structures in place. This was in reference to the collection of medication at pharmacies and dispensing machines as opposed to clinics and suggested that these systems could be implemented across Sub-Saharan Africa where this has been an issue. 

“We’ve already been using this for HIV services and chronic conditions. So, this is an opportunity to maximise these innovations and be able to reach the people who are the targets for our essential servies,” Nyasulu said.

These dispensary machines are located across the country in both rural and urban areas.

FEATURED IMAGE: Covid-19 shifted the focus off of primary healthcare services as resources were pushed toward the emergency pandemic response. Photo: Zainab Patel