Re-organization of primary health care in Cape Town during

COVID-19 epidemicProf Bob Mash

Family Medicine and Primary Care

Stellenbosch University

Principles

• 90% of all cases of COVID-19 will be self-managed and/or managed in primary care

• Systems perspective.• Community orientated primary care• We must reduce risk to people

without COVID-19 • De-congest primary care • Emergency care continues• Opportunity for innovation and

health system strengthening

Screen and stream

• Screen all patients for COVID-19 before entry

• Integrate other screening

• Stream into “hot” and “cold” streams

• Provide immediate “see and treat” stations

In the ‘hot’ stream

• Assess and triage (mild, moderate, severe, critical)

• Manage mild and collect samples in COVID-19 testing area - home

• Admit to facility those that are moderate or worse for treatment and referral

• No intubation or ventilation in primary care

• Possibility of end of life care

• Admit to facility those needing other primary care services

In the ‘cold’ stream

• Acute non-COVID cases admitted to the emergency room or centre

• Cold stream is not COVID safe

• De-escalating of chronic care (NCDs, HIV, TB, mental health) in facility and escalating in community

• Maternity care continues

• Family planning continues, emphasis on long term options

• Immunizations and growth monitoring continues

• Most support services significantly reduced (rehabilitation, eye health, oral health, nutrition, counselling, social).

Readiness of primary care facilities

Key issues on readiness checklist

• Infrastructure – maintaining separate streams and social distancing

• People management – staff anxiety, stress and infection

• Social services – integration of health and social services

• Surge contingency plans – how to plan

• Facility level management and decision-making

• Referral pathways and availability ambulances