Figure 1.
Geographical location of health and laboratory facilities in South Africa.
Map to reveal geographic location of ∼4756 health facilities (as at 2011/2012); including primary care, community centers and hospital-based clinics (black dots) and 260 NHLS routine pathology service laboratories, across nine provinces and the related 52 districts. Insert reveals the proportions of different category of health facilities requesting CD4 testing (also see Table 1).
Figure 2.
Colour-graded map indicating CD4 test volumes and laboratory-to-result turn-around-time (LTR TAT) in South Africa.
Map to reveal the daily CD4 test service volumes (workload), across 52 districts in South Africa, colour-graded according to volumes of tests requested, averaged over three year from 2009–2012. Higher testing volumes (as red or orange) as well as ‘hard to reach areas’ with low testing needs (yellow, more likely to require POC testing) are revealed. Approximately 3.8 million CD4 samples were referred during 2012 to an annual average of ∼60 designated NHLS CD4 facilities (existing shown as green dots). Insert reveals proportions of reports issued within a TAT of 48-hours, across all districts, averaged over years 2009–2012. The legend here highlights districts (as red) with less than 34% of reports or 35–80% of reports (mustard orange) issued within a 48-hour TAT (see legend on figure).
Figure 3.
Current CD4 service coverage precincts.
Map to reveal current estimated service precincts based on an averaged 100 km Euclidian radius. Areas without drawn service precincts largely coincide with districts with poorer LTR-TAT (see insert Fig. 2). Note many health care facilities that fall outside of service precincts that would benefit from implementation of additional Tier-1, 2 and 3 services. Red circles highlight relatively over-subscribed areas with multiple ‘centralised’/metro laboratories in densely populated areas. In such metropolitan areas with high testing demands, amalgamation of services and the formation of a ‘super-laboratory’ could create critical mass, consolidate on technical skills and quality control provided that transport and IT logistics are absolutely optimized.
Figure 4.
Six-tiered CD4 service framework and ideal proposed service coverage.
4a Graphical representation of an integrated, hierarchical ‘parent’, six-tiered CD4 service approach to secure scalable, ‘full-coverage’ across a national programme. From top to base, each band represents an increasing service load from an increasing base of referring health clinics. The proposed hierarchical ‘parent’ spatial support relationship between, and within, service tiers illustrates how higher service tiers can support and interact with lower service tiers, not only in a direct hierarchical fashion, but also how geographical location of different tiers in any given region can enable ‘parent/support’ relationships. 4b Reveals existing and ideal proposed service coverage precincts of 5 tiers of service in South Africa, based on an averaged 50–100 km radius ‘coverage-precincts’. In both 4a and 4b, ‘A’ and ‘B’ reveal examples of the envisaged integrated support relationships between lower and upper tiers, specifically how a Tier-3 or Tier-4 level laboratory can supplement and support local Tier-1 and Tier-2 services respectively. Likewise, in addition to the proposed support infrastructure, ‘C’ also reveals how higher tiers can function together within a defined service precinct, to accommodate high service demands and provide infrastructure support in terms of service back-up and disaster recovery.
Table 1.
Relationship between CD4 tiers and NDOH Health Care Facilities.
Table 2.
Description of Proposed CD4 Testing Tiers.