Page 23 - ONLINE – Nursing Matters October 2020_Vol 11

current issues

Task-shifting and technology The Quadcare clinical team includes management, improving on waiting time
doctors, nurses and clinical associates. The and consult time. The system also allows
In 2008, South Africa developed an company makes use of clinical associates for clinical supervision, data collection
innovative mid-level medical worker to allow for increased, affordable access and management of ICD-10 codes, to
model that can contribute substantively to private primary healthcare. Clinical monitor patient conditions, assist with
to the development of quality district-level associates can perform tasks and stop control and pick up on abnormalities
healthcare. The clinical associate was procedures that have been delegated by rapidly. This allows for proper data and
[4]
[7]
conceptualised as a health professional doctors, allowing doctors to focus on tasks health statistics collection, monitoring and
that would provide a long-term solution for which they are uniquely qualified, supervision of care provided by the clinical
to human resource constraints in district e.g. diagnostic work and supporting the team, financial data collection and even
hospitals. Clinical associates qualify with development of primary care services. management of the patient experience.
a Bachelor of Clinical Medical Practice The doctors then become responsible for With the country working towards having
and are consequently registered with supervision and development of policies, the National Health Insurance and
Improving access to private the Health Professions Council of South protocols and procedures which need Universal Health Coverage, Quadcare
Africa. They have the necessary skills to be adhered to by the clinical teams. will be well placed to provide accurate
[5]
healthcare in South Africa: and knowledge to function effectively This allows the different professionals data and health trends that will help
mainly in primary healthcare settings to provide better quality care within build this.
such as clinics, community health centres their own scopes of practice, improving
The Quadcare model and (CHCs) and district hospitals. Their scope access for marginalised communities References
and reducing the need for referral. They
of practice includes:
community healthcare services • Conducting consultations (history are less costly to hire, and one doctor 1. Koch JM, McLachlan C, Victor CJ, Westcott J, Yager C. The
1STATS SA, Quarterly Labour Force Survey (QLFS), 1st Quarter
taking and physical examination)
can supervise more than one making
2020, 23 June 2020. http://www.statssa.gov.za/?page_
id=1854&PPN=P0211&SCH=7889
the cost of healthcare affordable for
•
interpreting
and
Ordering
health care in South Africa. Journal of Public Health Policy,
investigations (e.g. electrocardio- the patients. Quadcare emphasises 2. Harris B, Goudge J, Ataguba J, et al. Inequities in access to

[6]
2011;32(Suppl 1):S102–S123. http://dx.doi.org/10.1057/
grams, laboratory tests, X-rays) the culture of love, tolerance and non- jphp.2011.35.
Dr Mmamontsheng Dulcy Rakumakoe, MB BCh, Dip HIV Man, MMed (Sports Sci), MBA • Diagnosing and treating common discrimination in its hiring practices and 3. Duby Z, Nkosi B, Scheibe A, Brown B, Bekker LG. ‘Scared
of going to the clinic’: Contextualising healthcare access for
men who have sex with men, female sex workers and people
Chief Executive Officer and Founder, Quadcare Medical Centers, Gauteng Province, South Africa conditions in its educating of health professionals, who use drugs in two South African cities. S Afr J HIV Med.
2018;19(1):701.
http://dx.doi.org/10.4102/sajhivmed.
• Performing procedures (e.g. lumbar making the team a safe and accessible v19i1.701
puncture, intercostal drain) space for the patients who interact with us. 4. Doherty, J, Couper, I, Fonn, S. Will clinical associates be effective
for South Africa? S Afr Med J. 2012;102(11):833–835. http://
• Assisting in surgery (e.g. caesarean dx.doi.org/10.7196/SAMJ.5960
Statistics South Africa (Stats SA) discrimination, abuse and unprofessional access good quality healthcare. The section) Technology plays a critical role in the 5. National Department of Health, Regulations Defining Scope
of Practice of Clinical Associates. Government Gazette, 11
published its latest General Household behaviour of healthcare workers when aim was to design a model that would • Providing patient education and Quadcare delivery model. Patient November 2016.
Survey (GHS), revealing the number of accessing healthcare services in South provide inclusive care that has the counselling records are electronic. Practices make 6. Hamm J, van Bodegraven P, Bac M, Louw JM, Cost effectiveness
of clinical associates: A case study for the Mpumalanga
South Africans who are covered by a African public health facilities. [3] potential to improve health outcomes for • Making appropriate admissions, use of tools such as Google Suite and province in South Africa. African Journal of Primary Healthcare
and Medicine. 2016;8(1).
medical aid scheme. The group’s data all people, while reducing healthcare discharges and referrals Registers. This allows for greater time 7. Dulcy Rakumakoe, Interview, 3 August 2020
show that between 2002 and 2018, Many South Africans do not have costs for society. • Prescribing medicines for common
the percentage of individuals covered disposable cash. We have a public health and important conditions according
by a medical aid scheme increased system that is highly overburdened with The company is an innovative network of to the Essential Drugs List up to
marginally from 15.9% to 17.1% in 2016, generally demotivated and non-sensitised affordable, world-class medical centres Schedule 4
[3]
before declining to 16.4% in 2018. On staff. Many of the private health services in grassroots communities to ensure this • Issuing sick certificates for a period
22 June 2020, Stats SA confirmed that are concentrated in affluent suburbs and access. Quadcare leverages task-shifting, not exceeding 3 days and that should
in the first quarter of 2020, before the towns where people can afford to pay the technology and innovation to provide contain the name and contact details
country went into national lockdown, the private rates for healthcare. To be able patient-focused primary healthcare of the supervising registered medical
[1]
unemployment rate rose to 30.1%. to access decent levels of healthcare, services to these communities. Quadcare practitioner
people residing in townships and rural is a network that offers services at more • Working under the supervision of
In their article on Inequities in Access areas must take the little money they have competitive and affordable prices than a doctor – the supervising medical
to Healthcare in South Africa, Harris et out of their pockets and travel far. its competitors. On average, prices are practitioner must be identified by the
al., found that socio-economic status, more than 50% less than that of individual service in which the clinical associate
race, insurance status, and urban-rural Quadcare was established in 2019 as a practitioners. Furthermore, wider cover- is working and must always be
location were associated with lack of facility that serves the ‘missing middle’ by age allows Quadcare to establish a available to the clinical associate
access to care. Black Africans, the providing access to quality health services good reputation in communities as a safe • Performing any act delegated by
[2]
poor, uninsured and rural respondents, that are affordable, geographically space and reputable service providers. the supervising medical practitioner
experience the greatest barriers. The accessible (townships and rural areas), in accordance with the education,
barriers are even higher for marginalised and recognise and uphold patient love The clinics are in Gauteng in the following training, and experience of the
populations, including lesbian, gay, and dignity irrespective of race, gender, areas: Carletonville, Meadowlands, clinical associate.
bisexual and transgender people sexuality, income levels and age. The Turffontein, Fox Street in Johannesburg
(LGBTQIA is the standard acronym used) company wanted to challenge the idea CBD, Edenvale, Braamfontein, Alexandra
who face barriers because of stigma, that only people with high income can and the University of Johannesburg.
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