PROGRAMMATIC FUNDING FOR 2020-2022

HEALTH SYSTEM STRENGTHENNING

As the average lifespan in South Africa increases, so does the pressure on our health system to support the population. Thus we have an urgent need for partnerships that are efficient and effective in supporting South Africa to grow a strong and healthy economy.

Through ensuring timeous access to diagnostic tools and treatment, we can reduce the burden of disease. The projects we showcase below are just some of the incredible work being done in South Africa, by South Africans and for South Africans. They are geared to help strengthen our health systems, and to address health inequalities in poor resourced settings.

 

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PROGRAMMATIC FUNDING FOR 2020-2022

GREAT LEAP FORWARD (GLF)

Great Leap Forward (GLF) is a research and project-delivery think tank working within the context of academic entrepreneurialism. Its founding principle is that whilst most science emerges as a result of steady incremental progress, great leaps forward in scientific endeavour come from people with a system of beliefs and practices that enable long-term thinking and innovations.

GLF’s aim is to catalyse academic curiosity, independent thinking, intellectual flexibility, resilience and personal drive amongst high functioning and high potential professionals.

The unit is housed within the Wits Health Consortium (University of the Witwatersrand Health Sciences Faculty) and is part of the University’s commitment to advancing science by activating new and perhaps non-traditional approaches to old problems. Current projects include the 2019 – 2020 Entrepreneurial Academic Fellowship Programme, and post-graduate research projects into the field of academic entrepreneurialism. In 2018 a pilot Entrepreneurial Academic Fellowship programme delivered better than predicted results, indicated in chief by activation levels of around 40% of the cohort and by the foundation of four new research or related entities in less than 12 months.

 

ACADEMIC THINK TANK.

Resilience and personal drive

Independent thinking

Catalysing academic curiosity​

PROGRAMMATIC FUNDING FOR 2020-2022

CUTTING-EDGE, MOBILE PHONE-BASED EYE APP TO DETECT TREATABLE CAUSES OF EARLY CHILDHOOD BLINDNESS

Preventing blindness in children across South Africa through Machine Learning Technologies and a simple to operate mobile phone application.

Vision loss was the most prevalent developmental disability in children younger than 5 years in the Global Burden of Disease Study. In 2016, 25.2 million children were affected worldwide, corresponding to a prevalence of 3,991 per 100,000 children, 95% of whom live in low- and middle-income countries. South Africa has no national preschool or school eye screening service and screening is only performed sporadically by some local eye person- nel. The great majority of children never have an eye examination. There are very few data available on the prevalence of eye diseases in pre and primary school children in sub-Saharan Africa, however a screening study from South Africa found that 2.1% of over 8,000 children aged 4–7 years had visual impairment requiring diagnostic referral.

The commonest problems are refractive error and amblyopia (lazy eye) which are easily treated but if no action is taken by age 7, there is a risk of permanent visual loss. The most serious problem is retinoblastoma (cancer of the eye) which occurs in 1 in 20,000 children; if diagnosed early 100% of children survive but if diagnosis is delayed the mortality rate is 100%.

Children can be screened for these, and many other conditions with simple non-invasive tests called the red reflex test and the corneal light reflex test. A flash photograph is taken of the child’s eyes in a darkened room, normal images have symmetric red reflections (red-eye) through the pupil, and symmetric reflections of the flash on the cornea (front of the eye). Abnormal images have absent or asymmetric ‘red-eye’ reflections or asymmetric corneal light reflections. Screening is currently carried out by skilled technicians using expensive equipment and cost is therefore a major barrier to implementing screening more widely in South Africa. Machine learning technology has the potential to deliver low cost screening, performed by unskilled individuals using a standard smartphone. An image of the eyes will be taken using a specialised app and a deep learning convolutional neural network will interpret the image, giving a result as normal, abnormal or inadequate. Children with abnormal results will be referred to appropriate facilities for more detailed examinations and treatment.

We believe that the development of this app has the potential to bring low-cost optimcal screening to children across South Africa and reduce the burden of visual loss and death.

Changing the way we identify and diagnose treatable optical conditions within minutes.

Blindness Prevention

Blindness Prevention in Children

Mobile Phone Technology

PROGRAMMATIC FUNDING FOR 2020-2022

SOWETO ONCOLOGY HUBB / THE WINNERS’ CLUB

Public Healthcare in South Africa is severely under resourced, with limited services available to chronically ill populations, a reduced number of training posts for medical doctors, and treatment a fair distance from patients homes. However, through public-private partnerships, this ailing system can be remedied to ensure that all South Africans can realise the right to healthcare. One mechanism through which  you can be involved in achieving this is through “The Winners Club” – A Flagship, open access Soweto-Bara Oncology Hubb that is a hybridised version of teaching, quality service provision and research at an optimally positioned South African teaching hospital.

Optimising existing resources and developing an integrated oncology unit, ensures that we can expedite waiting lists for thousands of impoverished South Africans, while growing an existing partnership with the Chris Hani Baragwanath Academic Hospital (Bara).

Through a carefully managed public-private partnership between the Universality of the Witwatersrand, the South African Department of Health, and the Non Communicable Disease Research (NCDR) Division, critical improvements have already been made to create a simplified patient care system, ensure health system strengthening, and community capacity development. The NCDR Division has seen 40% of South Africa’s cancer diagnosed patients over the past 15 years. They have an ethos of teaching through a synchronistic system of service provision and scientific data collection, ensuring that they are able – within available means, to provide strongly evidence-based interventions to the community.

The NCDR have already left their mark on the breast cancer unit where staff are now able to manage their case load with a 72 hour turnaround time from diagnosis to surgery.


Given the improvements made through this partnership, the NCDR Division seeks to develop a flagship Soweto Oncology Hubb. Geared to optimising existing resources and developing an integrated oncology unit, they will ensure the expedition of waiting lists at the hospital for South Africa’s most prevalent cancers (breast, pancreatic, lung, colorectal, and cervical), grow their partnership with the hospital through providing:

  1.     Health systems strengthening in the form of training platforms for student doctors, nurses, residents and            community members,
  2.     Undertake cutting edge scientific research which will have global ramifications, and
  3.     To ensure excellent patient care through optimised service provision.


Together, we will create a world-first, fully synchronistic oncological unit in Africa. Services to the community will be based on a first come first serve basis, bypassing the need for clinical referrals from primary healthcare clinics, and reducing the time to diagnosis and treatment. Treatment options will be extended to include chemotherapy, radiation therapy, and other rehabilitation services to ensure that treatment outcomes are optimised, and patient care is prioritised. Research will be used to both bring in ongoing funding for supplementary staff, and generate knowledge in a high prevalence setting which could have world-wide implications.

The Programme will offer the opportunity for specialisation by medical residents, thus growing the number of trained oncologists in the country. The model for this flagship Hubb can then be replicated in other high prevalence and poor resourced settings, such as KwaZulu Natal – which currently up until fairly recently had a collapsed medical oncology chemotherapy service that required emergency intervention from the National Department of Health to address the situation

25% of new cancer diagnoses are made in the Gauteng Province, South Africa. The lack of treatment access is a humanitarian crisis that we can resolve.

SOME IMPORTANT FACTS ON CANCER IN SOUTH AFRICA

  • In South Africa, upward of 75,000 people are diagnosed annually with cancer (National Cancer Registry, 2014), furthermore, almost all people diagnosed require acute treatment and chronic medication, annually. Most patients are diagnosed late in the public sector (~70% are diagnosed with locally advanced or metastaic cancers and die generally within 3 months-2 years of treatment) SA does not have robust mortality data –we are trying to plug this gap with our cohort studies on breast, lung, prostate and esophageal cancers and supportive palliative care but it is estimated that mortality from cancer is at around 45,000 deaths per annum i.e. 60 deaths per 100,000 people. Our SA cancer mortality rates are as high as those from high income countries that, due to robust population screening programmes, unaffordable in SA, currently have incident rates double those of SA. So clearly the vast majority of SA people diagnosed with cancer in SA are diagnosed at late stage where 2 year prognosis is extremely poor.

  • Those diagnosed late, e.g. 90% of lung cancer is diagnosed at stage 4 and 10% at stage 3. They will die within 3-12 months of diagnosis; patients with cancers that have a better prognoses, for example breast and prostate cancer: advanced cases such as stage 3 and 4 disease, generally die within 2 years, while those diagnosed early (30%), dependent on the subtype of disease have favourable 5-year prognostic outcomes following their initial treatments. NCDR extensive investigations into the factors that influence late stage at diagnosis reveal the following key drivers: ignorance of the significance of early stage symptoms in 50% of cases, fear of diagnosis, treatments and death in 50% of cases and misdiagnosis, unnecessary delays and inappropriate management in the 3 tier referral network. In addition there are none or at best woefully inadequate electronic systems in place to support efficient referral and multi-disciplinary team optimum management of patients

  • Soweto houses a population of ~ 2 million people within 64km2. And the Chris Hani Baragwanath Academic Hospital serves the Greater Soweto population of around 3 million people. Despite being the second largest hospital in the South Hemisphere, Chris Hani Baragwanath Academic Hospital remains inadequately equipped to provide comprehensive oncology services including chemotherapy and radiation therapy. Rather, such services are currently centralised at Charlotte Maxeke Johannesburg Academic Hospital causing significant delays (up to 2 years for radiation treatment) and logistical constraints for booking patients requiring lifesaving chemotherapy treatments. Currently, the Non Communicable Disease Research (NCDR) Division house an army of grant funded navigators managing this process for their breast cancer patients –and out of pocket transport costs for sick Sowetan patients needing to travel on public transport to Charlotte Maxeke Johannesburg Academic Hospital. These patients would be better served having treatments at a dedicated chemotherapy unit at the Chris Hani Baragwanath Academic Hospital –where if necessary overnight hospital stays could be arranged for those who react badly to their chemo and are unfit to travel.

  • The NCDR breast clinic, the largest in the country, diagnoses close to 400 patients annually, with new breast cancers. Half of these are early diagnoses. By comparison, 70% of breast cancer diagnoses made in South Africa are diagnosed at a late stage!

  • NCDR patients have multiple comorbid conditions: 22% are HIV infected, 60% hypertensive, 11% diabetic, >11% depressive disorders. Each condition requires the careful management of multiple treatment regiments to ensure treatments do not interact.

  • As the average lifespan increases in South Africa, and concomitantly the ongoing impact of the HIV epidemic is felt, the pressure on the health system, and the need for partnerships that are efficient and effective in supporting South Africa to grow a strong and healthy economy is increasing. Through ensuring timeous access to diagnostic tools and treatment, we can reduce the burden of disease to the South African fiscas, while ensuring we support the drive to achieving the Millennium Development Goals through ensuring improvements to equity in the delivery of health services in the public sector.

  • 40% of all new cancer diagnoses are made in Gauteng, 5% are diagnosed at Chris Hani Baragwanath Academic Hospital. The hospital itself sees numerous cancer patients annually, and for many there is a 12 month waiting period before any treatment can be accessed. While diagnostic and surgical facilities are available, patients requiring non-surgical treatments such as chemo or radiation therapy are bussed, on a daily basis, through to the Charlotte Maxeke Johannesburg Academic Hospital in Johannesburg, to receive their treatment. This 80-120 minute round trip is followed by long waiting times, and overcrowded facilities which has a roll-on impact to treatment success for every individual entering the system. A quarter of the patients treated at Charlotte Maxeke’s overcrowded oncology wards have travelled from Soweto. This highlights the need for a Soweto-Bara Oncology Hubb to reduce pressure on the Charlotte Maxeke Johannesburg Academic Hospital, while catering to the life threatening needs of oncology patients in Soweto.

  • The NCDR have set up various cohort studies collecting robust incidence and mortality data to inform the National Cancer Registry and have cutting-edge research programmes in place covering health system strengthening work, clinical determinants of response to treatments and survival and molecular genomic work spanning precision medicine for individualised treatments to avoid drug-drug interactions, biomarkers of early detection, response to treatments, prediction of treatment resistance and survival

  • They wish to significantly improve serviced delivery to detect cancer earlier, treat it better and improve survival rates of our patients whilst at the same time doing world class research that ultimately informs Africa’s service delivery practices.

EXPEDITING ACCESS TO LIFE-SAVING CANCER TREATMENTS