South Africa

with supply-side partners so that primary and secondary care facilities become better equipped to provide services for NCD treatment and disease management. Third, comprehensive preventive and treatment strategies were encouraged in order to target multiple conditions and risk factors and achieve the best health outcomes.

South Africa

In South Africa, existing estimates suggested fairly low rates of diagnosis: over 50% of patients with hypertension and 20% of patients with diabetes were undiagnosed. Furthermore, no population-wide screening programs appeared to exist for these conditions. Most individuals diagnosed with hypertension or diabetes were found to seek care, but less than one-third of patients receiving hypertension treatment and just over half of those receiving diabetes treatment were meeting treatment targets. The prevalence of cardiovascular disease, diabetes, and key risk factors was found to be high across all subpopulations defined by race, income, and urbanicity. However, there were differences in diagnosis rates, disease management, and care-seeking behavior between racial groups. There were also important differences between the risk and treatment profiles of males and females. Rural populations were found to lack consistent access to health facilities and differ from urban populations in terms of diagnosis for diabetes and cholesterol. Rates of NCD diagnosis, treatment, and disease control were worse among the population under age 50.

Among patients and other community members, knowledge of health behaviors and practices was high, but people had low awareness of their own health status and limited ability to monitor their condition and engage in health promotion activities. Few support groups were available, and providers lacked time to counsel patients on disease management. Health facilities were found to lack proper tests and equipment for diagnosis and ongoing monitoring of NCD patients; 20% of Provincial Health Clinics (ProvHCs) and CHCs lacked sufficient glucose testing materials, and 40% lacked cholesterol testing equipment. Additional challenges included large patient volumes and low staffing levels, leading to long wait times and high patient loads for individual providers. Community care givers (CCGs) were found to be an underutilized mechanism to potentially alleviate gaps in the continuum of care for NCDs; they were respected by community members but had limited capacity to diagnose and monitor NCD patients. In addition, care was not well integrated across providers and facilities, particularly between CCG services provided in the community and facilitybased services. Lack of trust between community members and facility-based personnel, and between CCGs and facility staff, was cited as a barrier to greater integration of NCD diagnosis and management.

Several recommendations were developed from these key findings to guide the design of HealthRise interventions in South Africa. First, CCGs should be trained and equipped to diagnose and monitor NCDs in order to overcome barriers related to patients’ need to access health facilities. Second, a population-wide screening program using frontline health workers should be implemented, in coordination with facility-based care, to combat widespread under-diagnosis. Third, interventions that encourage individuals to seek diagnosis and follow-up care at health facilities should also address staffing and infrastructure gaps to avoid exacerbating problems related to staff shortages and high patient loads and to ensure new patients get needed support. Finally, interventions should focus on increasing individuals’ ability to understand and monitor their own conditions, whether through support groups, expanded counseling from providers, increasing access to monitoring equipment, or improving patient awareness of disease status and treatment.