South Africa’s biggest private healthcare funder has awarded a R2.5 million donation to the Chronic Disease Initiative for Africa (CDIA) towards NCD-related research and advocacy work in South Africa.
University of Cape Town (UCT)
UCT is one of the oldest universities in South Africa and has been ranked 179th in the Times Higher Education QS World University Rankings in 2008, climbing 21 spots from 200th place in 2007. UCT is the only African University to have been listed in the top 200. The university strives to be the premier research institution on the continent of Africa and this is reflected in steadily increasing its research output and qualifying post graduate students. The faculty of Health Sciences has also been considered to be one of the leading centres in Africa for the training of health care professionals. The faculty campus extends from its main teaching hospitals- Groote Schuur and Red Cross Children's hospital in Cape Town- to a range of secondary hospitals and primary health care clinics throughout the Cape Peninsula and beyond. The faculty hosts a large number of research institutes and its academic staff members have been increasingly successful in securing highly competitive research grants from international agencies such as the Wellcome Trust and the National Institutes of Health. The scope of research conducted in the faculty embraces the full spectrum of research questions from 'the bench to the bedside to the population', to quote the Dean of the Faculty, Prof Marian Jacobs. The University and Faculty of Health Sciences maintain research facilities and support services to allow scholarly productivity of the highest standard.
The Department of Medicine is a large academic and clinical department, playing a leading role in undergraduate and postgraduate medical education, provision of clinical care and research which includes basic, clinical and epidemiological research. The department hosts a number of Medical Research Council's Research Units, Institutes and a WHO Collaborating Centre. Two groups in the Department of Medicine are involved in this proposal.
The Division of Endocrinology and Diabetes collaborating with the MRC/UCT Research Unit for Exercise Science and Sports Medicine and the Chronic Diseases of Lifestyle (CDL) Unit, MRC has studied the epidemiology of diabetes and it's risk factors, determinants of quality of care for patients with chronic diseases, developed and evaluated CD interventions including promoting physical activity, smoking cessation and nutrition interventions to reduce blood pressure.
The University of Cape Town Lung Institute
The Knowledge Translation Unit of the Lung Institute has adapted WHO's Practical Approach to Lung Health for South Africa, raising the profile of chronic respiratory disease.
Using evidence-based implementation strategies it has deployed an expanded package, PALSA PLUS, which has simultaneously improved the care of infectious and chronic diseases. This has recently been adopted as national policy.
University of Stellenbosch (US)
The Division of Family Medicine and Primary Care at US resides within the Department of Interdisciplinary Health Sciences, which also includes Public Health and Primary Care Nursing. The Division has extensive input throughout the undergraduate curriculum and has developed 4 training complexes in the Western Cape for registrars in Family Medicine to train as specialist Family Physicians. The Division runs a Diploma and Masters degree by web-based distance learning with currently close to 200 postgraduate students throughout sub-Saharan Africa and supervises doctoral students in Family Medicine. The Division includes the current editor of the SA Family Practice Journal, which is the only African journal for Family Medicine and led the process of developing and publishing the Handbook of Family Medicine (Oxford University Press 2000 and 2006) and the SA Manual of Family Practice (Van Schaik 2006). The Division is committed to education, research and service that support the development of the District Health Services in South Africa.
University of the Western Cape (UWC)
The main purpose of the School of Public Health (SOPH) at UWC is to strengthen education and research in public health and primary health care and to build capacity in the health services. Since its inception, the SOPH has established itself as a significant and pioneering initiative in public health with a national and, increasingly, continental influence. Some of its key achievements have been:
- establishing a multi-level postgraduate programme in the field of public health, culminating in a Masters in Public Health and doctoral studies in Public Health;
- providing continuing education opportunities for health and welfare practitioners through our summer and Winter Schools which includes a short course on the public health aspect of CD;
- establishing a substantial integrated research and service programme to which many of students have contributed
- developing training manuals and materials for service providers, arising from research and service work, this includes manuals for community health workers;
- being designated a WHO Collaborating Centre for Research and Training in Human Resources for Health Development in 2004
Medical Research Council (MRC)
Two intramural research institutes of the MRC will participate in the research activities of the CoE for CDCSSA included in this proposal. They are the Biostatistics Unit and the Burden of Disease (BOD) Unit. The former provides statistical consultancy and services for research projects of the MRC and many other academic institutions. This Unit has extensive experience in the design and analysis of pragmatic randomized controlled trials. The Director, will act as a consultant to this proposal, and is an internationally recognized biostatistician.
The BOD Unit undertakes research to monitor trends in health status and risk factors including the evaluation and development of appropriate health information systems and has recently published the South African Comparative Risk Assessment highlighting the need for interventions to improve the management of risk factors for chronic diseases. This Unit has contributed to the development of health information systems including improvements in vital registration and the development of population based surveys. The Director of this unit will also act as consultant to this proposal and is also an internationally recognized epidemiologist.
Community Health Centres and Central Chronic Disease Dispensing Units
The public sector community health centres (CHC) are central to the delivery of health care of the district health plan. These CHCs are situated in the residential areas of underserved communities, within walking distance of the majority of the residents. They provide care for patients free of charge and refer patients when necessary to the secondary hospitals for care not available at the primary level. Professional registered nurses and non-specialist medical practitioners provide the care at the CHCs and experience heavy clinical loads. Doctors are frequently expected to manage up to 60-80 patients per day. Medication is dispensed from the pharmacy situated in each CHC, working from an essential drug list of available medications. However, the province is currently introducing a Central Chronic Disease Dispensing Unit where each patient's CD medication is pre-packed at a central depot based on prescriptions written at the CHC. These pre-packed parcels are then delivered to the CHC and collected by patients deemed to be stable, thus shortening waiting times and bypassing the queues of patients awaiting clinical services. Simple special investigations can be requested by staff working at the CHCs and are processed by and are therefore linked to the biochemical and pathology services of the Provincial Administration of the Western Cape. All patient care funding is made available from the Health Budget of the Provincial Administration of the Western Cape.
Brigham and Women's Hospital, Harvard Medical School
The Hospital is world renowned and has been a centre for training in cardiovascular medicine and research virtually since its founding in 1913. The history of the Cardiovascular and Cardiac Surgery Divisions is laden with medical firsts: the first mitral valve surgery, the first direct current cardioversion for atrial fibrillation, the first cardiac care unit, the first use of anti-arrhythmic medical following myocardial infarction. Clinical trials at Brigham and Women's Hospital have demonstrated that thrombolytic therapy (clot-busting drugs) could significantly improve a patient's chance of survival following a heart attack, that aspirin could prevent a first heart attack, that ACE inhibitors could save lives and attenuate left ventricular enlargement following a heart attack and that cholesterol lowering medication could save lives in patients following a first heart attack.
Harvard School of Public Health
The Programme in Health Decision Science (PHDS) at the School of Public Health promotes informed and systematic decision making in the use of health-related technologies and public health practices through the theory and application of decision science. Members of PHDS have been collaborating with members of the DM UCT and the MRC of South Africa on the disease burden and cost-effectiveness of interventions for CVD management over the last 8 years. The PHDS Cardiovascular Disease Working Group and Harvard University researchers are currently conducting several analyses funded by the NIH that address two related topics: (1) evaluating the cost-effectiveness of various tools for predicting CVD risk in South Africa and (2) using regional epidemiologic and cost data to evaluate the cost-effectiveness of various policy interventions, behavioural changes, and/or medical regimens used to prevent or treat those with CVD in low and middle-income regions.