In the middle of nowhere, between the Namibian desert and the occasional acacia tree, proudly stands one of the Bophelo! vans – also lovingly referred to as ‘Daisy’ by the people who work with her. Daisy is a 4×4 mobile health clinic, with two fully equipped examination rooms, toilet facilities and all of the equipment necessary to provide patient education and confidential counselling. Daisy is accompanied by her colleague Tate Petrus, the other mobile clinic, and further escorted by the drivers, wellness testers and counsellors from PharmAccess.
Bophelo! is a partnership between the PharmAccess Foundation, the Namibian Business Coalition on AIDS (NABCOA) and the Namibian Institute of Pathology (NIP).
The partners initially created the Bophelo! project, using funding from the Dutch Postcode Loterij and the Global Fund for AIDS, TB and Malaria (GFATM).
Since 2008, Daisy, Tate Petrus and PharmAccess staff have tested more than 8,000 employees of Namibian companies. Namibia is a vast country, and the wellness testing has taken place all over Namibia: from the desolate and arid South to the densely populated North, from fishermen at the coast in Walvis Bay, to farmers in the East. Unsurprisingly, the mobile clinics travelled over 40,000 kilometres just in the first 12 months.
|Bophelo! does not focus solely on HIV/AIDS, instead it includes screening for a wider range of diseases, including hypertension, eleveated glucose levels, elevated cholesterol, haemoglobin levels, hepatitis B, syphilis, TB (symptom screening questions), BMI and waist circumference. The rationale behind this approach is that the client does not identify him or herself as being at risk for HIV infection, as might be the case in attending a VCT clinic.
Needless to say, this is a costly operation. To get a better insight into actual costs of the mobile clinics and to compare them with their fixed site counterparts, PharmAccess and Boston University performed a study on the cost and efficiency of the Bophelo mobile clinics. The results show that the Bophelo! project is unique in several ways:
Firstly, the study has shown that the mobile testing programme was only slightly more expensive than the fixed site programme (4% on a per person tested basis), when only considering HIV testing. This difference is equal to the difference in price for VCT testing kits, which were available less expensively to the fixed site testing organisation.
Secondly, Bophelo! uses local private sector funding to pay for over one third of all costs, with the remainder largely being funded by the Global Fund. It has demonstrated that local Namibian companies are willing to pay for wellness screening for their employees. Because of the private contribution,the actual costs per test for the public sector during 2009 were 35% lower than the cost of fixed site testing in Namibia.
Thirdly, the incremental cost of providing wellness testing is only 18.7%, compared to just HIV testing. However, 50.6% of all people had at least one of these conditions – versus a 10.5% prevalence of HIV in the tested population.
Fourthly, Bophelo! has been successful in reaching men, which are generally considered a hard to reach target group. Of the total population tested in the Bophelo! clinics, 64.2% are male. Employment at the sites visited by Bophelo! is skewed towards males, but the results suggest that mobile multi-disease screening clinics may be an effective way to reach males reluctant to access fixed site centres or unwilling to believe they are at risk of HIV infection.
|Patients who test positive for any condition are urged to seek follow up consultation and care. Those with medical scheme coverage are encouraged to see a private provider. Clients that need further treatment are given a standard MOHSS referral letter. The referral letter indicates the condition(s) detected. In addition, the Bophelo! counselor gives the patient a form coded with the same number as the testing information but without identifying information, which is meant for the employer. This form does not identify the condition(s) detected, but allows the employee to request time off so that all employees with a referral letter can seek consultation. This latter form (without diagnosis, and only containing the case number) is to be signed by the provider and returned to the employer as evidence that the employee did seek medical consultation.
Furthermore, as part of the Bophelo! screening process, PharmAccess collects a number of data elements on socioeconomic and risk factors for each person screened. This information, along with all of the test results, is entered into a database maintained by PharmAccess. Individual identifiers are not included in the database, the data is fully anonymous and provides a wealth of information of over 8,000 people’s health status.
Overall, the results of the Bophelo! evaluation are exceedingly positive: the project has been able to unlock a substantial amount of private funding, was able to provide testing to a difficult to reach target group and has provided evidence for the benefits of including more than just HIV testing.