Demonstration project - South Africa
PALSA Plus (Practical Approach to Lung Health in high-HIV prevalence countries)
South Africa faces a chronic respiratory disease burden which includes a mix of infectious (with very high rates of tuberculosis and HIV co-infection) and non-infectious diseases. While the prevalence of asthma is similar to the global average, a recent population study suggested a very high prevalence of COPD in the country.
PALSA Plus has successfully been adapted in South Africa from the World Health Organization’s Practical approach to Lung Health (PAL) initiative. PALSA Plus is an integrated plan used primarily by primary care nurses for the management of priority respiratory diseases including TB and HIV co-infection. The approach was first used in a randomized control trial in the Free State Province and led to significant improvements in TB case detection, appropriate referral of TB severe cases, inhaled corticosteroid provision for asthma sufferers and voluntary HIV counseling and testing uptake among TB patients. PALSA became PALSA Plus when the guideline was expanded to include and integrate HIV & AIDS care. Through a collaborative process of workshops with expert clinicians, managers and policy-makers, the PALSA Plus guideline has been expanded and adapted to the local settings and current clinical protocols.
National, provincial and municipal health departments deliver through a network of 4500 primary health care clinics across the country. These clinics provide health care for 80% of the population. However, the critical shortage of physicians and nurses is a major obstacle to the quality of health care on offer. A policy of nurse-led primary care applies in most rural and even urban clinics. Free essential drugs for chronic respiratory diseases, including TB and antiretrovirals, are available at these clinics but access to care is limited by clinic capacity.
The potential role of GARD in South Africa and sub-Saharan Africa was explored at a 2-day symposium held in Cape Town, South Africa, in March 2007. Organized jointly by the South African Thoracic Society and the Pan-African Thoracic Society, the meeting was attended by physicians from more than 10 countries.