Clinical Associates and COPC in the mining communities in South Africa 

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Delivery of the needed PPE

Clinical Associate (ClinA) is a cadre that represents a profession that was established in the  last two decades in South Africa. After completing a 3-year Bachelor of Clinical Medical Practice (BCMP) degree at one of three universities in South Africa that offer the degree, ClinAs register with the Health Professional Council of South Africa (HPCSA) to work as health professionals. 

The profession was established to promote quality equitable health access (1). Most of the ClinAs are recruited from the rural areas which has promoted high retention of personnel in those areas that they are allocated (2). As a ClinA follows the medical education fraternity; they are able to consult and manage patients in collaboration with registered medical officers/physicians for promotion of universal health coverage (3).

The University of Pretoria's Community-Oriented Primary Care (COPC) Research Unit collaborated with the provincial department of health, Anglo American, Council for Scientific and Industrial Research (CSIR), and World Vision to implement COPC at a household level within mining communities. The implementation team is led by clinAs, in collaboration with community health workers. The clinAs build networks and partnerships with various stakeholders, to enable collaboration and to provide holistic bio-psycho-social care to the households and individuals at the household level.
COPC is not a facility-based approach, but working within communities, meeting the people where they are. The clinAs, together with the CHWs, do home visits, up refer patients, follow up down-referred patients, and liaise with clinics and hospitals. The clinA also plays an important role in the coordination of care process of the patient. The clinA works under the guidance of a family physician or a mine clinician. 

ClinAs make use of ICT platforms that enable data collection and mapping of stakeholders and areas of work. They also have ongoing training programmes with the CHWs to facilitate learning and community education. 

During the COVID-19 pandemic, clinAs screened, tested, tracked, and traced COVID-19 positive patients. The clinAs did home visits to households with a COVID-19 positive patient, and provided food parcels to households that are food insecure. The clinAs also participate in the rollout of the COVID-19 vaccination programmes, both within the mining facilities and the mine host communities. 

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In the context of COVID-19, Clinical Associates provide the following services to the mining company’s employees and contractors: 

  • Timely response to all case management requests for home-based visits; 

  • Conduct a COVID-19 specific clinical assessment; 

  • Conduct a COVID-19 screening test (per protocol and fully clothed according to WHO/ national institute of communicable diseases (NICD) guidelines – personal protective equipment (PPE); 

  • Conduct contact tracing (at home) and assess social circumstances; 

  • Facilitate the delivery of parcels with home essentials; and 

  • If necessary, liaise with the regional communicable disease coordinators
     

Success stories

  1. The Anglo American mining sector has benefited the services of the ClinA hence the extension of contract period of the ClinA work (Fig. 1)

  2. Stake holder involvement has been beefed up by providing of necessary equipment and knowledge (Fig. 3)

  3. Training of the CHWs, area managers, hospital and clinic staff has been successfully done (Fig. 2)

  4. Continuous professional development (CME) is also being carried out 

  5. More job opportunities for new graduates in 2020/21 (Fig. 1)
     

Challenges:

  1. Access to patients/family due to poor road network and conditions

  2. Lack of data signal in rural areas to use mobile ICT

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Some of the ClinAs for the different mining health centres.

Back row: Anelisa Mahlulwana, Nonhlanhla Mamba, Nhlanhla mahlangu, Mary Mabogwane, Kabelo Mpai
Tumisang Tsheko, Esther Mashabela

Front row: Maureen Tapala, Asanda Hlatshwayo, Nomoya Magazi

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clinAs from Voerspoed in COPC training

References:

Lumbani Tshotetsi DCM, BSc HSE, PGD PH, MSc Epi, University of Pretoria, Faculty of Health Sciences, Hatfield, South Africa

Wayne Renkin BTh, MDiv, Researcher, COPC Research University, Department of Family Medicine, Faculty of Health Sciences, Pretoria, South Africa


Ngcobo, Sanele. (2019). Clinical associates in South Africa. SAMJ: South African Medical Journal, 109(10), 706. https://dx.doi.org/10.7196/samj.2019.v109i10.14092


Moodley SV, Wolvaardt JE, Louw JM, Hugo J. Trends in practice intentions and preferences of clinical associate students: Implications for training and health services in South Africa. S Afr Fam Pract (2004). 2020 Feb 6;62(1):e1-e7. doi: 10.4102/safp.v62i1.5033. PMID: 32148053. 


Doherty, J., Couper, I., & Fonn, S. (2012). Will clinical associates be effective for South Africa?. South African Medical Journal, 102(11), 833-835. doi:10.7196/SAMJ.5960