People living in uMkhanyakude, a large rural district in northern KwaZulu-Natal, need better health services to help manage high blood pressure and high blood sugar.

This is according to a new ‘health needs’ framework developed by Africa Health Research Institute (AHRI). The research behind the framework was led by Dr Emily Wong and Dr Urisha Singh, and has just been published in the Lancet Global Health.

The authors say they hope the framework will empower healthcare workers, policy makers and researchers with a simple method to identify where health interventions are needed in South Africa, especially where communities are dealing with multiple infections or non-communicable conditions at the same time.

AHRI research previously revealed high levels of undiagnosed, untreated disease in rural KwaZulu-Natal. But the problem, says Wong, is that infectious and non-communicable diseases co-occur and yet the health system considers the care required for each condition to be very different.

“When you think about non-communicable diseases as a whole, digestive diseases are different from heart conditions or diabetes. Cancer screening is very different from mental health screening,” says Wong.

“As a health system, we tend to deal with things disease by disease. But patients, families and communities are dealing with multiple different conditions at the same time.”

She says their health needs framework arose out of this frustration. “We wondered if there might be a really simple framework that could be applied to most diseases.”

The framework attempts to apply the lessons from South Africa’s success in diagnosing and treating HIV to any condition, and to multiple conditions that co-occur.

“For any ill patient to receive the best care, they first need to be diagnosed correctly. Once their illness is diagnosed, they need to be linked in to care for treatments, medicines, and regular follow-ups from healthcare workers. Finally, they need continued access to their chronic medications and monitoring.”

She says in areas where these basic health needs (diagnosis, treatment and follow-ups) are unmet, healthcare interventions are needed.

To test the framework, the authors looked at three chronic conditions in uMkhanyakude, namely diabetes (high blood sugar), HIV, and hypertension (high blood pressure).

They relied on data from AHRI’s Vukukazi research programme, which collected surveys, test results and location data of over 18 000 people living in the district between 2018 and 2020.

They found that 55% of the population were living with at least one of these conditions. Some were living with it unknowingly before the Vukukazi study, and most were not having their health needs met according to the ‘health needs’ framework.

“We found that 93% of people with diabetes, 58% of people with hypertension and 21% of people with HIV, have unmet health needs,” says Wong. “In other words, many patients are living with at least one of these conditions knowingly or unknowingly, and if they have been diagnosed, many are not receiving chronic treatment or visiting clinics for regular check-ups.”

The number of unmet needs for HIV were much less compared to diabetes and hypertension. This shows how health systems are currently geared to reach people living with HIV, but not towards treating non-communicable diseases.

“HIV care programmes work on a community level, addressing specific health needs that individuals or households may have. And healthcare workers often go out into their communities rather than wait for patients to come to them in the clinic,” says Wong. “So we have an opportunity to adapt existing HIV health services to manage different chronic illnesses concurrently.”

“This research shows a need for an integrated, decentralised health system that offers care for multiple illnesses concurrently to the most vulnerable people in South Africa,” added Dr Urisha Singh.

“There is already an international consensus that care for non-communicable diseases should be combined with care for infectious diseases. For example, the World Health Organisation recently published a technical brief to help authorities better integrate NCD health services into the HIV care they already provide. For uMkhanyakude, this could mean improving access to diagnostic services, clinics and community healthcare workers to better manage hypertension and diabetes,” said AHRI executive director and co-author on the paper, Prof Willem Hanekom.