BACKGROUND: Globally, rural populations have poorer health and considerably lower levels of
access to healthcare compared with urban populations. Although the drive to ensure universal
coverage through community healthcare worker programmes has shown significant results
elsewhere, their value has yet to be realised in South Africa.
AIM: The aim of this study was to determine the potential impact, cost-effectiveness and
benefit-to-cost ratio (BCR) of information and communications technology (ICT)-enabled
community-oriented primary care (COPC) for rural and remote populations.
SETTING: The Waterberg district of Limpopo province in South Africa is a rural mining area. The
majority of 745 000 population are poor and in poor health.
METHODS: The modelling considers condition-specific effectiveness, population age and
characteristics, health-determined service demand, and costs of delivery and resources.
RESULTS: Modelling showed 122 teams can deliver a full ICT-enabled COPC service package to
630 565 eligible people. Annually, at scale, it could yield 35 877 unadjusted life years saved and
994 deaths avoided at an average per capita service cost of R170.37, and R2668 per life year
saved. There could be net annual savings of R120 million (R63.4m for Waterberg district) from
reduced clinic (110.7m) and hospital outpatient (23 646) attendance and admissions. The
service would inject R51.6m into community health worker (CHW) households and
approximately R492m into district poverty reduction and economic growth.
CONCLUSION: With a BCR of 3.4, ICT-enabled COPC is an affordable systemic investment in
universal, pro-poor, integrated healthcare and makes community-based healthcare delivery
particularly compelling in rural and remote areas.