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Linkage to Care
Community Based Services (CBS) are a critical tool in assuring the health of communities in resource poor settings. They have the tools to provide a comprehensive set of services which include nutrition, wound care, home based rehabilitation, adherence to therapy, palliative care and psychosocial support. They have been shown to reduce re-admission rates to hospital. There are 850 Community Health Workers and 62 registered nurses who provide CBS to the 1.1 million residents in the Klipfontein Mitchells Plain Substructure. The challenge is that these services are under-utilised due to administrative failures and inefficiencies in referring these patients. Less than 500 CBS referrals were completed in 2021. An informal audit revealed that contributory factors to low referrals included lack of staff awareness of available services, how to access these services, limited access to paper-based referral forms, limited administrative support to ensure paper forms were scanned/e-mailed and frequent scanner/computer failure. This meant that the limited referrals that were actually completed, often never reached the destination, to the detriment of the patient. It is for this reason that a Doctor at Mitchells Plain Hospital came up with a solution.
Date: 2025/08/19
Version: 0.1
Tags:
eHealth
Government In-house Solution
Community Health Workers
Community Based Services
MS Forms
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Digital Patient Journey (HMS2)
The project is transitioning the Eastern Cape Department of Health from a predominantly manual patient medical record system that integrates other systems within the digital health landscape in South Africa, that includes NHLS, SANBS, HPRS etc. The system that is deployed is called HMS2, which is a inhouse developed system that maintains a shared medical record, allowing for the electronic recording and sharing of patient journeys (encounters and episodes) within and between healthcare facilities. This significant advancement allows the EC DoH to access real-time patient information across implemented healthcare facilities.
Date: 2025/08/06
Version: 0.1
Tags:
eHealth
Government In-house Solution
Health Management System
Intergrated Health System