Newborn and infant hearing screening at primary healthcare clinics in South Africa designated as National Health Insurance pilot sites: An exploratory study

Abstract

Primary healthcare is the first level of care and entry for individuals into the healthcare system, which is accessible at PHC clinics and community health centres (CHCs). The services at these healthcare facilities include maternal and child care, immunisations, family planning and care for chronic illnesses, usually managed by nurses with advisory support and regular visits by medical practitioners and other relevant healthcare specialists (Bresick, Von Pressentin, & Mash, 2019;Cullinan, 2006). Such services can more broadly be categorised as preventative, promotional, curative and rehabilitative in nature (Cullinan, 2006;Schellack, Meyer, Gous, & Winters, 2011).An earlier review of the quality of services was conducted at 16 clinics in Johannesburg. Poor quality child health services for children who are ill was observed in relation to waiting periods, staff skills, triage and promotional, prevention and curative care. This was further accompanied by insufficient developmental assessment (Thandrayen & Saloojee, 2010). Of the 16 clinics, inconsistency was noticed in terms of immunisation and rehabilitation in 14 and 5 clinics, respectively. The Integrated Management of Childhood Illnesses (IMCI) approach was only utilised in 3 clinics, despite 12 having had an IMCI-trained professional. These findings by Thandrayen and Saloojee (2010), Background: Primary healthcare (PHC) is the first point of entry, providing basic services to individuals. South Africa is in the process of re-engineering its PHC as part of National Health Insurance (NHI) plans to ensure universal healthcare coverage.Aim: This study aimed to establish whether newborn and infant hearing screening (NIHS) could be integrated into the re-engineering process of the PHC as part of the NHI framework. Setting:The NHI pilot clinics in five provinces in South Africa.Methods: A non-experimental, descriptive, cross-sectional survey research design was adopted. Questionnaires were sent to nursing managers, unit managers or acting managers at PHC facilities. Nineteen of these self-administered questionnaires were completed. Data were analysed using descriptive statistics.Results: Immunisation services were the most common type of service offered at the clinics. Over a quarter of the respondents indicated that NIHS services were offered at their facility in the form of universal NIHS. Equipment was limited with a lack of valid and reliable screening measures. Only 2 (11%) respondents indicated budgetary resources. Follow-up and referral pathways were reported by 10 (53%) respondents, which did not include an audiologist. Conclusions:There is a need for careful and systematic planning in terms of early hearing detection programmes at PHC level. Planning needs to commence with considerations of who will perform NIHS, training of these personnel by audiologists and the role of the audiologist within the teams outlined in the NHI Bill.

Availability of resources for paediatric hearing care in a South African province

“…Hospitals depend on the availability of resources such as screening and diagnostic audiological equipment, human resources in the form of audiologists, finances and clinical protocols to provide EHDI services. 14 Thus, a lack of any of these resources can impede the provision of EHDI. Findings from this study showed an uneven distribution of the essential resources for providing EHDI within the state hospitals in the EC Province.…”

“…While EHDI has proven long-term savings globally, as the early rehabilitation of paediatric HL prevents the development of the negative impact of HL, previous research has reported the lack of resources to provide EHDI in various provinces in South Africa. 10 , 11 , 12 , 13 , 14 However, there is a paucity of the literature on the availability of resources to provide EHDI at state facilities in the Eastern Cape (EC) province. This lack of context-specific literature may negatively influence budget allocations for the provision of EHDI at state facilities, including employment of qualified clinical staff to provide quality healthcare, procurement of equipment for assessment and diagnosis of HL and procurement of assistive devices for HL rehabilitation.…”

Newborn screening in South Africa: the past, present, and plans for the future

“…While the current guidelines provide for biochemical NBS, the implementation thereof and adherence to previous guidelines have been limited, and to date, no progress reports have been issued [56][57][58][59][60][61] .…”