Improving healthcare for South Africans during and beyond COVID-19

The spread of coronavirus has shown that people with diabetes, hypertension and other non-communicable diseases are at greater risk of severe infection and death.

The UK, through its global Better Health Programme, is helping South Africa to gain knowledge on the link between these diseases and COVID-19 that will save lives during the pandemic and improve health outcomes beyond it, writes programme lead Myles Ritchie.

In South Africa coronavirus has exposed the alarming extent of diabetes, hypertension, obesity and other non-communicable diseases, known collectively as NCDs, and the weaknesses of its health system to prevent and treat them.

Reducing South Africa’s high prevalence of these diseases is one of the aims of Better Health Programme South Africa (BHPSA), a three-year programme of technical assistance managed by Mott MacDonald.

This was launched by the UK government to help low and middle-income countries reduce NCDs via strategies for prevention and treatment, tailored clinical guidelines and training for primary care staff.

We were just a few weeks into our first year of implementation when COVID-19 arrived in South Africa in early March 2020. On 23 March, President Cyril Ramaphosa declared a national state of emergency, ordering a stringent lockdown to curb the spread of the virus.

In what was a rapidly developing situation, we responded by pivoting some of our year one activities towards strategies to help the national health system cope with the outbreak and prepare for the inevitable pressures of increased caseloads and hospitalisations.

A key focus of this support has been increasing understanding of the relationship between NCDs and more severe COVID-19 outcomes.

Collecting new data

In April 2020 we contracted academics from two of South Africa’s leading universities to conduct a review of the emerging international evidence and assess the implications for the country’s health infrastructure and services.

The review, which was finalised in July 2020, found that the risk of hospitalisation, severe illness and death for COVID-19 was much higher in patients who had diabetes and hypertension.

While this review was underway, data emerged from a substantial study in Western Cape, based on a database of 3.5 million people, that further underlined this link. The study indicated that 52% of deaths from COVID-19 were associated with diabetes and 19% with hypertension.

The COVID-19 risks for South Africans with diabetes were considerably higher than found in similar international studies. Part of the explanation for this is almost certainly the high level of late diagnosis of diabetes in South Africa, which has resulted in increased levels of heart disease – an additional risk factor for COVID-19.

The Western Cape study showed that the COVID-19/NCD crisis was rooted in entrenched socio-economic inequalities: inadequate access to quality health services is more pronounced for poor and vulnerable South Africans.

Sharing our research

With evidence on COVID-19 accumulating at a very rapid pace, we recognised the need to share our data quickly or risk the research becoming out of date. BHPSA co-hosted a webinar with the South African National Department of Health (NDoH) and the World Health Organization to present the findings and compare them with global research.

Interest in our research was high and the event attracted delegates from national and provincial departments of health, research institutions and non-governmental organisations.

NDoH is using the data to inform guidelines, care pathways and protocols for NCDs in the context of COVID-19, and the messaging of a new communications strategy designed to promote healthier lifestyles.

The data has also been disseminated to other countries running Better Health Programmes, in line with the objectives the UK government. It was established to share knowledge and build partnerships that will improve health outcomes, advance economic development and contribute to the UN Sustainable Development Goals.

Better healthcare for NCDs

South Africa has been severely impacted by the pandemic. It is the worst-affected country on the continent – with most cases and most deaths. This has placed immense pressures on a health system already under strain from communicable diseases such as HIV/AIDS and tuberculosis.

But valuable lessons have been learnt, which will help to strengthen programming and service delivery for NCDs beyond the pandemic.

For example, there must be a greater focus on reducing obesity, and on the prevention and management of diabetes, hypertension and other diseases among the older population in South Africa.

These and other NCD responses targeted at specific high-risk groups need to be planned and delivered to meet local needs, through community health workers working at district level and reaching out to individual households.

COVID-19 has thrown a spotlight on just how many South Africans live with NCDs. By building on the knowledge and experience developed during the emergency, I believe they will be provided with better access to effective care and medicines in the future.