It is estimated that today 4.74 million people are HIV+ in South Africa and the South African Medical Research Council (MRC) projected that without appropriate treatment to prevent the development of AIDS, the number of AIDS deaths within the next decade would be more than double the number of deaths due to all other causes, resulting in 6 to 7 million cumulative AIDS deaths in South Africa in 2010 [1
]. The pandemic entails both a medical and a logistical challenge. Leaving the medical challenge to the medical profession to overcome, engineers can contribute to the logistical challenge, which is based on managing health care using technology. The main challenges for the efficient and effective management of HIV/AIDS in South Africa are the inadequate physical infrastructure and the lack of reliable statistics on the disease. The data available are either estimates or projections and therefore range between educated guesses and wild speculation. The South African Government believes that the provision and supply of antiretroviral drugs to HIV/AIDS patients might be ineffective given the scale of the pandemic and its intersection with poverty and other epidemics such as Tuberculosis and Malaria. The lack of health centres, infrastructure and amenities (e.g. electricity and water) as well as low levels of treatment literacy are additional concerns for the required medication adherence rate of 95% (Orrell 2002 – Personal Communication). Due to the limited resources of the country and in attempting to address the 'hot spots' first, there is a need to establish areas with the highest HIV/AIDS prevalence. Some of the data that is required to address the pandemic relates to:
Location of high HIV/AIDS prevalence
Level of infrastructure available to communities
Infection rates of HIV/AIDS
Status quo of medical care within communities.
Most of this data is available in a number of systems. Municipalities will have data relating to the levels of infrastructure and the status quo of medical care. Doctors in the hospitals know how many patients with HIV/AIDS enter the clinic on a daily base and when and how these patients were infected. The design of a system that combines this information needs to address the following two issues: firstly combining data that is being managed by various authorities in a number of systems and secondly combining data that is spatial and non-spatial in nature. The system should function as an information system containing accurate HIV/AIDS and infrastructure data and support decision-making and management. The easy integration of the system into existing GIS environments that are established within the governmental structures such as the Electricity Department, the Surveyor General's office, the Deeds Office and others is essential. The information obtained will then be turned into knowledge for use in efficient planning, evaluation and policy-making. The belief is that any system based on geographic or spatial information system technology will provide a tremendous opportunity in HIV/AIDS patients' health informatics in South Africa. Whilst Spatial Information System (SIS) cannot solve the HIV/AIDS pandemic, it should be seen as an information-gathering tool that can be employed in the mobilization and response to the disease. The project aimed to establish parameters and benchmarks relating to the use of SIS to administer and manage patient data.
The Gugulethu township
Gugulethu is situated about 20 km from Cape Town and is arguably one of the oldest and fastest developing black townships in South Africa. Gugulethu is home to approximately 325,000 people (Bekker 2003 – Personal Communication), generally poor as indicated by the averaged monthly income of R1126 [2
]. The current HIV prevalence rate in the Gugulethu community is 27% (Bekker 2003 – Personal Communication). This translates into ±88,000 HIV/AIDS people and predominantly claims the lives of adults aged 19 to 40 leaving behind children and aging parents. The scale of the pandemic in the township is continuing to expand and as a result, the number of patients visiting the clinic is increasing (Matoti 2003 – Personal Communication).
Challenges currently being faced at the Gugulethu community clinic
One of the main challenges in most of the township-based clinics is the paper-based management system of HIV/AIDS patients. Each patient visiting the clinic has a folder comprising of personal information including name, address, next of kin. Clinical information for example height, weight, blood group, type of disease are also recorded. At each visit, respective folders for the patients are retrieved and entries are made in the patients' file by either the administrative clerk or the nurse. Since the registration, consultation and dispensing processes are carried out manually, human errors such as misplacing or losing the folders are bound to occur.
In addition, it is common that patients, who feel they are not benefiting from the health care and service that is being provided, will opt to go to another health centre. Several cases of patients transferring to other health centres or even patients from elsewhere coming for treatment at the Gugulethu community clinic have been registered. The main drawback in such cases is that the patients' health history is unknown and this is particularly dangerous in the case of antiretroviral treatment, since the history of the patients plays a major role in deciding on the treatment.
Another concern expressed by the staff is that as Gugulethu is a township, it is regarded as being a neglected and underprivileged area. Health officials and managers rarely access the township and are therefore unaware of the situation on the ground. Matoti (2003 – Personal Communication) reasoned that for the Gugulethu community clinic to undergo any upgrading to the infrastructure, it must first and foremost be visible on the South Africa health centres map. He further stated that health officials and managers must be made aware that over 27% of the inhabitants in Gugulethu are HIV+, that the people are struggling with the pandemic in the context of extreme poverty and that the poor existing infrastructure at the clinic hinder the delivery of efficient health care and service.