Background

The Covid-19 Doctors on Call Helpline was established on 27th March 2020 in response to the outbreak of Covid-19, in South Africa for the reasons stated below.

• The uninsured population in South Africa are the most vulnerable – they don’t have access to a general practitioner telephonically and are forced to turn to a clinic system that is already overwhelmed. This group is unfortunately also more prone to rapid spread of infectious diseases, given the lack of social infrastructure.
• The National Institute of Communicable Diseases has also recommended that concerned members of the public contact their doctors first, rather than present at their surgeries, clinics or emergency rooms, in order to prevent further spread of the virus and potentially infect frontline healthcare workers, which will further disable the healthcare system.

The purpose of the national helpline is to enable the uninsured, vulnerable communities and those most in need of assistance with free telephonic medical advice from a group of South African doctors regarding any Coronavirus queries or concerns they may have.

The program was established by one of the largest doctor associations in South Africa, the KwaZulu Natal Doctors Healthcare Coalition (KZNDHC), in partnership with Usizo Advisory Solutions and Vula.

Program Overview: March 2020 – June 2020

The Covid-19 helpline is a national initiative, operating during the hours of 08h00 – 17h00 (Monday – Friday).

For this period, we have over 440 doctors (across the country) who have kindly volunteered their time, to ensure that all South Africans are able to access information, get their questions answered and understand how to handle health risks associated with this frightening disease.

Administered by a local call centre, all calls are received by a trained call centre agent, screened, and then rooted to a doctor-on-call, for advice related to Covid-19. Callers only pay for a normal phone call and do not have to pay for the discussion with the doctor. In many instances our doctors are returning calls as the callers do not have airtime.

The doctor network receives prior training and provide advice according to the NICD guidelines. All calls are documented and reported on. Referrals are made directly in the Vula App, which is linked to the National Institute of Communicable Diseases.

A strict roster is coordinated and monitored, in order to assess demand and capacity requirements.

Feedback on the Program

To date we have received about 10 000 calls. The average calls per day are 250.

Calls are received from throughout South Africa.

The calls are patched to the doctors on the roster. The calls received are reviewed by the doctor on call and what follows is:

• Screening of patients via a telephonic interview – Non-touch Process
• The patients are triaged and are:
  • Requested to stay in the homes, self-isolate, as they are not Covid-related symptoms. However, the hygiene protocols are enforced.
    A doctor on call will call these patients after a few days to review their health status and advise appropriately.
  • If the presenting symptoms suggest that this patient needs to be consulted. The patient is referred to his / her regular doctor or a Public Health Facility.
    Before attending for a consultation, the patient must make an appointment and only visit the medical doctor at the allocated time.
    Here again, the hygiene protocols of social distancing, masks, hand washing and refraining from entry into public spaces are impressed upon the patient.
  • Patients will then be subject to testing, treatment, contact tracing.
  • The doctor on call, if he is in receipt of the test results, will communicate the results to the patient’s doctor.
    Positive results are logged onto a platform that registers the patient with the National Institute of Communicable Diseases, to set into action the process of contact tracing and subsequent management.
  • Positive patients, depending on their circumstances can self-isolate with strict protocols.
    However, many of the low socio-economic patients live in crowded dwellings, in clustered communities, no running water, cannot afford or acquire sanitizer or even soap. These patients are removed to a Quarantine center provided for by the Government.

Marketing

The program has a targeted marketing campaign. The marketing is done in all the official languages of the country.

The Independent Newspaper Group with a national footprint also markets the program extensively.

The Management Committee of the program has engaged in Print and Social Media campaigns and we have attempted to inform the communities about the Pandemic, their own specific roles, the need to protect their families and communities.

This is an additional outreach to those who need to engage in Behavioural change and help contain the transmission of the virus.

Governance

The KZNDHC, Usizo Advisory and Vula ensures that the program abides by strict clinical and project protocols.

All decisions are made according to NICD Guidelines, Case Definitions, Patient Under Investigation Guidelines and National Department of Health Guidelines.

Success of this Program

The commitment of 440 volunteer doctors and commitment to a social responsibility program underpins this program.

There is strict governance to the National Guidelines, which are often changed by the authorities based on evolving science of Covid-19.

There is also a need to reassess the case definition based on the data and shape of the epidemiological curve.

The trajectory and guidelines are adapted to National Department of Health’s advisory panel of experts.

Conclusion

In a country like South Africa with a high number of socially unequal citizens, the high level of poverty and the impact on driving the poor to extreme poverty and overwhelmed Health facilities, this program has helped the poor and indigent people to seek expert medical advise and alleviate fear, anxiety and uncertainty.

Majority of the calls are from anxious people, who, if this service was not available, would have to visit Public facilities that were already overwhelmed or to sacrifice the need for basic essential necessities like food and pay for a consultation just to alleviate anxiety and counsel patients.

This initiative has been of tremendous value as the National Department of Health tries to manage the crisis caused by Covid-19 in a country where its health system was already being challenged.

A true success by some committed group of volunteer doctors.

 

Prof Morgan Chetty
MBcHB, PHD, FCFP, MPH, MFamMed, DTM+H, DOH, DHSM, IAQS