Differentiated Service Delivery in South Africa
South Africa has been a leader in innovative differentiated service delivery (DSD), and has prioritized the scale up of diverse DSD models, including appointment spacing and fast-track appointments, facility-based clubs, community-based ART groups, community ART distribution, DSD for adolescents, and services for key and priority populations. Additional priorities include enhancing Monitoring and Evaluation (M&E) of DSD, optimizing the use of district clinical specialist teams, and updating standardized training materials and standard operating protocols.
DSD models for adolescents living with HIV include the Youth Care Club Model (YCC), which provides adolescents access to clinical management, contraceptives, ART refills, routine health screenings, and psychosocial support in one quick visit. Other models include the Central Chronic Medicine Dispensing and Distribution (CCMDD) program; community pick-up points including private pharmacies; and mobile outreach services.
South Africa’s National Department of Health also recognizes the importance of enhancing its community-based models to address the needs of patients at high risk of HIV disease progression and others. Adherence and treatment guidelines are available for patients at high risk, and select health facilities are piloting Advanced Care Clinic (ACC) models. The standardized package of care for patients at high risk includes daily and weekly home visits; spot pill counts; enhanced adherence counseling; clinical monitoring with viral load monitoring every two months; and decentralized pharmacovigilance.
In October 2017, South Africa hosted the CQUIN workshop on DSD for Adolescents.